Arbitrary capricious is the standard used in many ERISA cases. It is when the Court must determine whether the insurance company acted reasonably in reviewing a claim. If the Court finds that an insurance company acted unreasonably it may reverse the decision of the insurance company.
In a recent Court case from Michigan, the Court reversed the Hartford Insurance Company’s denial of a claim. The denial of disability benefits was arbitrary and capricious.
Mary Beth Tobin filed for disability benefits with the Hartford for fibromyalgia and hypertension. She also suffered from depression. Her fibromyalgia caused pain that made it difficult to work.
The Hartford denied her claim based on the finding of their own doctors. Their doctors reviewed the file without examining Ms. Tobin. Their doctors’ reports failed to consider important evidence in the file. Basically, they only considered the information that would lead to a denial.
The court found it unreasonable that the Hartford did not consider what effect fibromyalgia had on her ability to function. Meaning they did not consider how her pain made it difficult to work. They also failed to consider other evidence in the file or explain why that evidence did not support her claim of disability. All of these decisions by the Hartford were arbitrary and capricious.
This case highlights the issues many people have with insurance companies. Insurance companies will cherry pick the file for information to support their position. They also fail to give proper explanations of why a piece of evidence was or was not considered.
An experienced ERISA attorney can help avoid issues likes those in this case. Filing for disability benefits or appealing a denial can be an overwhelming process. The experienced ERISA attorneys at Dabdoub Law Firm know how to handle cases against all major insurance companies, nationwide. Contact our office for a free evaluation and see how we can help.
