Complex regional pain syndrome left a man disabled. His insurance company, Reliance Standard, terminated his benefits after two years. The claimant ultimately sued Reliance Standard for his disability benefits. A court in Vermont recently ruled in favor of the claimant, David Galuszka, finding he was disabled.
After accidentally shooting himself in the foot while hunting deer, Mr. Galsuzka suffered severe pain. His doctor’s diagnosed him with complex regional pain syndrome. This condition results in constant pain.
For two years, Reliance recognized Mr. Galsuzka’s disability from complex regional pain syndrome based on its finding that he could no longer perform in his own job. After two years of payments, Reliance terminated Mr. Galsuzka’s benefits for a number of reasons. The court found in favor of Mr. Galsuzka for the following reasons:
- Reliance was wrong in requiring objective medical evidence. Reliance’s policy did not require objective medical evidence. Additionally, courts have found that complaints of pain supported by the medical record is enough for a finding of disability.
- Reliance was wrong in asking that the Social Security Administration’s (“SSA”) ruling that Mr. Galsuzka is disabled be ignored. The court disagreed and held that an SSA ruling is a factor in determining whether he is disabled. Further, Reliance failed to explain the differences between its standards and the social security administration’s standards for finding disability. Reliance failed to explain why it reached a different outcome than the SSA.
- Reliance was wrong in finding that Mr. Galsuzka was exaggerating his pain. Reliance asserted that because Mr. Galsuzka was able to go deer hunting twice, he was inflating his constant pain. The court did not agree with this assessment. In fact, it stated that he was just trying to live a normal life, which is different than being able to keep a full time job. The court also noted that none of his doctors had questioned his complaints of pain. They found that Mr. Galsuzka’s unsuccessful attempt to return to work supported his complaints of pain.
- Reliance was wrong in arguing that the opinion of Mr. Galsuzka’s treating physician should be ignored. The court gave great weight to Mr. Galsuzka’s physician. It found that his opinion was based on a lengthy treatment period. The court also found that his opinion was supported by, and consistent with, the rest of the medical record.
- Reliance was wrong in cherry picking through the medical records. The court found that all of Mr. Galsuzka’s doctors consistently supported his disability.
- Reliance was wrong in relying on a paper based medical review. The court found that the doctor who reviewed the medical records did not determine whether he could return to work in occupations identified by Reliance. The court also questioned Reliance’s failure to physically examine him. The court held that this failure cast doubt on Reliance’s claims evaluation. In the end, the court found that the reviewing physician’s opinion was inconsistent with the medical record.
Based on the above reasons, the court concluded that as a result of his condition, Mr. Galsuzka was disabled.
