In this 2023 ERISA case, the Plaintiff, a doctor, commenced this action against the Defendant insurer to recover unpaid benefits after an adverse benefits determination on her employer-sponsored long-term disability claim. In a previous Order, this Court remanded the claim to ensure a “full and fair review” of the Plaintiff’s appeal of the adverse decision. After remand, the defendants denied the Plaintiff’s claim a second time and both parties moved for summary judgment.
The Plaintiff is a radiologist. Part of her job is to read and examine radiographic images. The Plaintiff gave birth to twins and soon began having difficulty seeing out of her left eye. She was eventually diagnosed with nerve damage in that eye. The Defendants initially paid for the Plaintiff’s long-term disability and the Plaintiff continued to work part-time as a supervisor but not in diagnosis. Eventually, the Defendants had an IME conducted on the Plaintiff and that physician’s opinion was that the Plaintiff’s vision problems were correctable. Therefore, the Defendants terminated the Plaintiff’s benefits. Plaintiff had another physician submit a report saying that the Plaintiff’s vision problem was uncorrectable. The Defendants had another IME physician review all the records, who concluded that the Plaintiff was able to work because the condition had largely corrected itself and that her job did not require her to have two healthy eyes and depth perception. Therefore, the Defendants continued to deny benefits.
The Court notes on the summary judgment that the Defendants’ physician went through the Plaintiff’s physician’s reports point by point and rebutted each point, but the Plaintiff’s physician did not do that to the Defendants’ physician’s report. The Court concluded that the Defendant was then allowed to rely upon their physician’s report and that such reliance was not arbitrary and capricious and did not violate the standard. Therefore, the Court granted the Defendant’s Motion for Summary Judgment and denied the Plaintiff’s claim.
If you need assistance navigating your claim for short term or long term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com. We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee. We offer a free consultation and would love to speak with you.