Background
Mr. Mulhern worked as an operating room registered nurse for about seven years. In early 2009, chronic pain stemming from herniated disks in the lumbar spine forced Mr. Mulhern to cease working.
Unable to meet the demands of his occupation, Mr. Mulhern submitted a claim for short-term disability benefits. Cigna approved his claim and made short-term disability payments for three months. Cigna then approved Mr. Mulhern’s subsequent claim for long-term disability (“LTD”) benefits. The Social Security Administration also approved Mr. Mulhern’s claim for social security disability (“SSDI”) benefits.
Cigna paid LTD benefits for more than six years before terminating Mr. Mulhern’s benefits effective November 22, 2015, suggesting he could return to work. Mr. Mulhern appealed Cigna’s termination of benefits. When Cigna denied his appeal, Mr. Mulhern filed a lawsuit against Cigna for his disability benefits.
The Court’s Review of Mr. Mulhern’s Claim
The court reviewed the facts of the case to determine whether the medical evidence proved Mr. Mulhern remained disabled beyond November 22, 2015. The court found that Mr. Mulhern was disabled when Cigna chose to terminate his benefits. The court stated that the medical records and evaluation do not reflect an improvement in Mr. Mulhern’s condition to allow for a return to work.
The court was unpersuaded by Cigna’s alleged reasons supporting disability. Notably, Cigna tried to argue that the social security administration's decision in 2012 to approve Mr. Mulhern’s social security disability benefits was not relevant here. Specifically, Cigna argued that the restrictions and limitations set forth by treating providers in 2012, were different from those set forth by treating physicians in 2015. The court correctly recognized that any discrepancies were due to Cigna’s use of different forms. The simple fact was that the medical records confirmed ongoing chronic pain causing significant physical restrictions. Because of this the court found that the restrictions and limitations relied upon by the Social Security Administration to approve SSDI benefits continued to be supported. In other words, Mr. Mulhern’s conditions had not improved.
The court was also not persuaded by Cigna’s suggestion that Mr. Mulhern’s ability to drive and exercise proved he was capable of full-time work. The court noted that the records made clear that any physical activity led to an increase in his pain. Further, medications taken for this pain negatively impacted Mr. Mulhern’s cognition and made traveling to and from work dangerous.
Ultimately, the court found Mr. Mulhern met his burden by a preponderance of the evidence that he was disabled at the time of the termination of his LTD benefits. Thus, Mr. Mulhern was entitled to long-term disability benefits.
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