American United Life Insurance loses case in Ohio for discrediting valid evidence of back pain. The Court held that an insurer cannot give greater weight to a paper review when there is no basis to discredit the claimant's medical evidence.
Mr. Bruton worked in an IT managerial job. American United determined his job was sedentary but highly skilled. Mr. Bruton suffered from chronic back pain due to a number of conditions including lower lumbar spondylosis and central canal stenosis. He sought treatment with the appropriate doctors and underwent treatment options including:
- Opioid medications
- Physical therapy
- Epidural Injections
- Spinal ablation
- Transcutaneous electrical nerve stimulation
His doctors opined that he could not perform his occupation due to back pain. One doctor opined that the heavy opioid use caused cognitive impairments. Naturally, his doctors fully supported his inability to work.
American United denied his claim for long term disability benefits, in part, because it alleged he was not disalbed from his regular occupation. Of note, the insurer claimed his documented limitations were subjective exaggerations. But the Court did not agree.
The Court held that based on his treatment history, it would be hard to determine he was faking or exaggerating. He went to great lengths to obtain relief through injections, medications, and physical therapy. The Court found that he would have had to have fooled all his doctors for American United's position stand. That is not likely.
An insurer cannot just ignore the opinions of treating providers and supporting medical evidence. It cannot just accept at face value the opinion of its reviewers, especially when they only conduct a paper review. The court noted that American United did not have a doctor personally examine Mr. Bruton.
Our firm has handled many back pain cases. And we often see this argument. We do not just accept what the insurer’s reviewer concludes. We push back.
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