Judge Richard Berman
Mercado stopped working in 2008 due to knee joint degenerative disease, and osteoarthritis. Despite initially providing long term disability (LTD) benefits First Unum (Unum) required proof of continuing disability. Surveillance undertaken in July 2010to obtain a better idea of Mercado’s daily activities with her minor childrenshowed Mercado able to perform a wide range of activities. Holding Mercado did not prove denial of LTD benefits "arbitrary and capricious" district court dismissed her complaint alleging Unum violated ERISA by improperly denying her LTD benefits while unable to work. In addition to substantial medical evidence, the surveillance corroborated Unum’s determination that Mercado had sedentary work capacity. In those videos Mercado was observedamong other things, walking without a limp or unsteady gait, walking ascending stairs and standing without outward signs of distress or discomfort, and even dancing. Noting the substantial evidence supporting Unum’s decision to deny LTD benefits, Unum’s alleged conflict of interestbased on its dual role as administrator and payer of benefitswas not a "tie-breaker" tipping the balance toward a finding that its decision was arbitrary and capricious.
