The treating surgeon reversed course - the court wasn't convinced
A Minnesota worker who lost his long-term disability benefits after shoulder surgery could not persuade a federal appeals court to restore them.
On August 28, 2026, the US Court of Appeals for the Eighth Circuit affirmed a lower-court ruling that a former sheet metal fabricator was not entitled to continued benefits from Unum Life Insurance Company of America. The case turned on a plan feature many benefits teams administer: a disability definition that tightens after two years.
The worker hurt his left shoulder in October 2019 and had surgery the next month. His surgeon initially reported he could not work, and Unum approved short-term and then long-term disability benefits from April 2020.
His plan first defined "disabled" as being "limited from performing the material and substantial duties of your regular occupation." After 24 months, that standard changed to being "unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience."
From June 2020, the treating surgeon repeatedly reported the worker could handle sedentary work, at one point telling him he "may have to think about switching careers." A Unum vocational consultant identified three jobs - production clerk, rental dispatcher, and routing clerk - that fit those restrictions. When the tighter definition took effect on April 13, 2022, Unum ended the benefits.
The surgeon later changed his opinion, saying the worker could not work, and an occupational therapist agreed. But the courts declined to credit what the district court called an "attempt to walk back" the earlier restrictions, finding nothing in the medical records explained the reversal. The district court also noted the surgeon "backtracked" when he spoke with Unum's reviewing doctor.
For benefits professionals, the procedural detail is worth noting. Because Unum's plan did not give the administrator discretionary authority, the district court reviewed the denial de novo - acting as factfinder rather than deferring to the insurer. The question was whether the worker had shown, by a preponderance of the evidence, that he was disabled under the "any gainful occupation" standard. The court found he could perform sedentary work.
The worker also argued Unum failed to give adequate notice or a fair review under its claims policy, a Regulatory Settlement Agreement, and ERISA's claims-procedure rules. The appeals court said that even a procedural failure of that kind would entitle a claimant only to de novo review in federal court - which is what he received.
The panel affirmed the judgment for Unum.
