LINA wrongly denied Mr. Stull, a regional manager, LTD benefits in Charlotte, North Carolina. LINA terminated benefits after a year and a half of payments and no change in his condition.
Mr. Stull was diagnosed with cervical dystonia, which causes his neck to involuntarily contract, causing his head to become locked in a tilted position. Mr. Stull’s symptoms also included a tremor in his head and hands, as well as chronic back pain.
Mr. Stull’s job as a regional manager required he drive 60-100% of the time. He was forced to leave work due to his pain and tremors.
LINA paid short-term disability benefits to Mr. Stull, but then denied his application for long-term disability (“LTD”) benefits. Mr. Stull appealed the initial denial, and LINA approved Mr. Stull’s LTD claim. LINA paid LTD benefits to Mr. Stull for about a year and half. Then it terminated his claim despite no change in his condition.
LINA argued that its termination of benefits was based on:
- A change in Mr. Stull’s treatment, from fast-acting opioids to Botox injections
- A lack of explicit work restrictions/limitations from his two main doctors
- LINA review by two doctors of Mr. Stull’s medical records
In this case, the court applied the abuse of discretion standard and still found LINA acted unreasonably. The Court noted the following in finding LINA unreasonably denied benefits:
- Mr. Stull had shown continued proof of his disability under the policy language. His condition had not changed, and he remained disabled.
Notably, his doctors noted the use of fast acting opioids imposes a restriction on his ability to drive. Mr. Stull’s decision to switch medications, from one fast acting opioid to another, did not change the fact that Mr. Stull’s abilities remained restricted. While Mr. Stull received Botox injections as part of his treatment, he continued to take fast-acting opioids, albeit a different drug from before.
- LINA’s doctors made baseless conclusions about Mr. Stull’s limitations and the lack of severity of Mr. Stull’s tremors.
As is typical in ERISA case, LINA relied heavily on its two reviewing doctors’ paper reviews of Mr. Stull’s medical records. However, the court stated that in case like this, the reviewing physicians cannot realistically determine the impact of the severe tremors and shaking hands on Mr. Stull’s ability to drive and do other tasks related to his work.
The court found that LINA failed to employ a reasoned and principled decision-making process and wrongly denied Mr. Stull benefits. LINA was ordered to pay past due benefits and put Mr. Stull on claim.
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