A California federal trial court found that Life Insurance Company of North America’s (“LINA”) denial of long-term disability (“LTD”) benefits to a Senior Executive with back pain was wrong.
Ms. Maureen Stratton’s Disability and Claim
Ms. Stratton’s lower back pain began in 2011. She tried various treatments including chiropractic care, physical therapy, improved diet, and various exercises but it kept worsening. She treated with numerous medical professionals including a physical therapist, orthopedist, physiatrist, primary care, and a physical medicine and rehabilitation specialist. Nothing helped. By 2017, she was struggling to manage a full day of work because of the pain as well as the extra time needed to manage her care and treatment.
She eventually stopped working in April 2017 and submitted her claim for disability benefits. LINA initially denied LTD benefits, and Ms. Stratton appealed. LINA approved the appeal and paid benefits, determining that she was disabled from her “own occupation.”
After 24 months of payments, the definition of disability changed to “any occupation.” LINA terminated benefits at this point, determining that Ms. Stratton was no longer disabled as defined in the policy.
Ms. Stratton appealed LINA’s denial. Included with her appeal were medical records from her multiple providers that documented abnormal clinical examination findings, worsening pain, and extensive treatment including physical therapy and injections. She also submitted objective MRI testing that documented abnormal physical changes in her spine and hip that likely were the cause of her pain, a functional capacity evaluation (“FCE”), and a letter of support from her treating provider.
Despite the extensive evidence of disability, LINA nonetheless denied the appeal. Ms. Stratton then filed a lawsuit in federal court.
The Court’s Ruling
In reviewing the file, the court gave significant weight to Ms. Stratton’s treating provider over LINA’s reviewing physicians. In doing so, the court considered the extent of Ms. Stratton’s treatment history with the doctor, the doctor’s specialization, and how much detail the doctor provides supporting their conclusions. All factors weighed in favor of the treating doctor’s opinions being reliable and credible.
In contrast, the court gave less weight to LINA’s reviewing physicians—none of whom ever examined Ms. Stratton—because they consistently misstated or selectively chose bits and pieces of medical records to support their opinions. They also did not discuss or consider Ms. Stratton’s consistent reports of pain, something they should have done. Ultimately, the court ruled in favor of Ms. Stratton.
Help from a Lawyer with Expertise in Disability Insurance
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