Short-Term Disability Approval Does Not Establish Long-Term Disability; Claimant Must Prove Total Disability Throughout the Elimination Period with Evidence of Functional Limitation

Introduction

In Alexander v. Unum Life Ins. Co. of Am. (2d Cir. Mar. 17, 2026) (summary order), the Second Circuit affirmed a judgment for Unum after an ERISA bench trial “on the papers” (i.e., on the administrative record). The plaintiff, Katherine Alexander, a nurse practitioner, sought long-term disability (LTD) benefits based on lingering symptoms she attributed to COVID-19 (“Long COVID”), including fatigue and “brain fog.” Unum had previously paid short-term disability (STD) benefits for the plan’s maximum thirteen-week period but denied LTD benefits.

The central question was whether Alexander proved she was “totally disabled”—as the plan defined that term—continuously throughout the plan’s “elimination period” (here, December 28, 2021 through April 4, 2022). The case also presented a recurring ERISA dispute: how courts evaluate self-reported symptoms (fatigue, cognitive fog) when objective medical testing may be limited, and whether the earlier STD award effectively compels LTD eligibility.

Important caveat: the decision is a non-precedential “summary order”. While it does not create binding circuit law, it provides a clear illustration of how the Second Circuit applies existing standards in ERISA disability disputes—particularly in Long COVID contexts.

Summary of the Opinion

The Second Circuit affirmed the district court’s determination that Alexander failed to carry her burden to prove she was “totally disabled” throughout the elimination period. The court emphasized:

  • Alexander’s occupation involved light physical exertion but significant mental demands.
  • The district court found Alexander’s psychiatric provider agreed she was not cognitively prevented from working.
  • For physical limitations, the record contained limited objective evidence showing inability to perform job duties; the district court permissibly gave minimal weight to self-reported symptoms alone.
  • Unum’s payment of STD benefits did not bind the LTD determination; the LTD question remained whether she proved total disability for the elimination period.

Analysis

Precedents Cited

The summary order’s reasoning is anchored in appellate review standards and ERISA factfinding norms, as reflected in the cited authorities:

1) Standards of Review: de novo vs. clear error

  • Connors v. Conn. Gen. Life Ins. Co., 272 F.3d 127 (2d Cir. 2001): Cited for the proposition that, after an ERISA bench trial, the Second Circuit reviews findings of fact for clear error and conclusions of law/mixed questions de novo. Connors is also invoked to stress that factual findings based on a paper record receive the same deference as those based on live testimony.
    Influence here: This framed Alexander’s appeal as an uphill battle: she needed to show not merely that a different factfinder might have ruled for her, but that the district court’s factfinding was clearly mistaken.
  • Siemens Energy, Inc. v. Petróleos de Venezuela, S.A., 82 F.4th 144 (2d Cir. 2023): Quoted for the “definite and firm conviction” articulation of clear error and for the rule that a finding must be upheld if it is “plausible in light of the record viewed in its entirety.”
    Influence here: This supported affirmance even where Alexander pointed to contrary evidence—so long as the district court’s view was plausible.
  • Badar v. Swissport USA, Inc., 53 F.4th 739 (2d Cir. 2022): Cited for the principle that when “two permissible views of the evidence” exist, the factfinder’s choice between them cannot be clearly erroneous.
    Influence here: The panel used Badar to explain why conflicting inferences about disability did not justify reversal.

2) STD vs. LTD: no required “merger” of determinations

  • Artz v. Hartford Life & Accident Ins. Co., 100 F.4th 921 (7th Cir. 2024): Used to reject the argument that awarding STD benefits makes it erroneous to deny LTD benefits. The Second Circuit cited Artz’s skepticism toward “effectively require[ing] a merger of short-and long-term benefits determinations.”
    Influence here: Artz provided persuasive authority for treating STD approval as non-dispositive. The panel grounded this in the plan’s own language: LTD eligibility turned on continuous total disability through the elimination period, not on the prior STD award.

3) Weight of evidence; subjective symptoms; objective functional measurement

  • Freedom Holdings, Inc. v. Cuomo, 624 F.3d 38 (2d Cir. 2010): Cited for the appellate principle that reviewing courts give “great deference” to a district court’s decision about what weight to assign to evidence.
    Influence here: This insulated the district court’s decision to discount self-reports absent stronger corroboration.
  • Williams v. Aetna Life Ins. Co., 509 F.3d 317 (7th Cir. 2007): Quoted for the key idea that even if symptoms like fatigue are not easily measured, “functional limitations due to [a claimant’s] fatigue could be objectively measured.”
    Influence here: Williams served as the conceptual bridge for the court’s treatment of Long COVID: the panel accepted that symptoms may be subjective while still endorsing the expectation of objective evidence of functional impact (e.g., ability to sit/stand, sustain concentration, tolerate activity).
  • Tranbarger v. Lincoln Life & Annuity Co. of N.Y., 68 F.4th 311 (6th Cir. 2023): Cited for the proposition that “general diagnoses” do not answer the more “granular question” about ability to work during the relevant period.
    Influence here: Tranbarger reinforced the court’s insistence on time-specific, job-specific proof—especially important given the plan’s elimination-period requirement.

Legal Reasoning

  1. Plan terms controlled the dispute. The plan required Alexander to be “totally disabled” throughout the elimination period, defining total disability as being unable, due to sickness/injury, to perform with “reasonable continuity” the “substantial and material acts” of her “usual occupation” in the “usual and customary way.”
    The court treated this as a continuous, time-bounded evidentiary requirement: Alexander had to prove disability spanning the entire elimination period (December 28, 2021–April 4, 2022).
  2. Occupational demands mattered: significant mental demands; light physical exertion. A vocational consultant’s characterization of the job as light but mentally demanding was not disputed. That framing narrowed what Alexander needed to prove: she had to show either cognitive inability to meet the mental demands, physical inability to meet the light exertion requirements, or both.
  3. The district court permissibly found the cognitive-disability proof lacking. The district court relied on records indicating she was “alert” and emphasized that her psychiatric provider agreed she was not cognitively prevented from working. On appeal, the panel held that—even if some evidence cut the other way—this conclusion was plausible and therefore not clearly erroneous under Siemens Energy, Inc..
  4. For physical limitations, the court endorsed a focus on functional proof, not just symptom reporting. While recognizing the nature of Long COVID complaints, the panel accepted the district court’s view that Alexander’s evidence was sparse: physical therapy notes showed difficulties but also suggested she “continue[d] to progress,” and the record lacked examinations/tests/objective findings demonstrating inability to perform the job’s physical requirements. The court’s reliance on Williams v. Aetna Life Ins. Co. and Tranbarger v. Lincoln Life & Annuity Co. of N.Y. underscores the distinction between:
    • a diagnosis/symptom description, and
    • evidence of work-preclusive functional limitations during the relevant timeframe.
  5. STD approval did not compel LTD approval. The court rejected Alexander’s argument that Unum’s STD payment made it error to deny LTD. It found no plan language creating such preclusion and cited Artz v. Hartford Life & Accident Ins. Co. to reject a required “merger” of determinations. In practical terms, the panel treated STD as potentially informative background, but not a legal concession of LTD eligibility.

Impact

Although non-precedential, the decision is likely to be cited (as permitted for summary orders) for several practical propositions in ERISA disability litigation:

  • Long COVID claims still turn on functional capacity evidence. Even where symptoms are inherently subjective (fatigue, brain fog), courts may look for objective or semi-objective indicators of functional impairment (testing, clinical observations, documented restrictions, structured functional assessments).
  • Elimination periods are a decisive proof window. Claimants must present evidence that tracks the elimination period specifically, not merely a general history of illness. The “granular” work-ability inquiry emphasized through Tranbarger v. Lincoln Life & Annuity Co. of N.Y. aligns with this.
  • STD does not equal LTD. The explicit refusal to “merge” STD and LTD determinations (via Artz v. Hartford Life & Accident Ins. Co.) supports insurers’ and courts’ tendency to treat STD as a separate coverage decision, often governed by different durations, definitions, and evidentiary expectations.
  • Appellate posture matters: clear-error review is deferential. Once a district court—reviewing de novo—makes factual findings on the administrative record, a claimant faces a steep burden on appeal under Connors v. Conn. Gen. Life Ins. Co. and Siemens Energy, Inc. v. Petróleos de Venezuela, S.A..

Complex Concepts Simplified

ERISA
A federal statute governing many employer-sponsored benefit plans. In disability cases, it commonly limits claims to the administrative record and frames how courts review benefit denials.
Total disability (plan-defined)
Not a universal medical concept. Here it meant inability, due to sickness/injury, to perform the substantial and material acts of the claimant’s usual occupation with reasonable continuity, in the usual and customary way.
Elimination period
A waiting period during which the claimant must remain continuously disabled before LTD benefits become payable. If the claimant cannot prove continuous disability throughout this window, LTD benefits are not owed.
De novo review (in the district court)
The court decides the benefit-entitlement question anew, without deferring to the insurer’s decision.
Clear error review (in the court of appeals)
A highly deferential standard applied to factual findings. Even if appellate judges might have weighed evidence differently, they affirm unless the district court made a definite mistake.
Objective evidence vs. subjective symptoms
“Subjective symptoms” are what a patient reports feeling (fatigue, pain, brain fog). “Objective evidence” includes measurable findings or documented functional limitations. The opinion’s key move is that even if symptoms themselves are hard to measure, their functional consequences (e.g., tolerance for activity, sustained concentration, ability to stand/walk) may be demonstrated through more concrete proof.

Conclusion

Alexander v. Unum Life Ins. Co. of Am. affirms a rigorous, plan-centered approach to ERISA LTD claims in a Long COVID setting: the claimant bears the burden to prove continuous total disability throughout the elimination period, and courts may require evidence of work-preclusive functional limitations rather than rely primarily on self-reported symptoms or general diagnoses. The decision also underscores that an insurer’s payment of short-term benefits does not, without supporting plan language, establish entitlement to long-term benefits.