Marantz v. Permanente Med. Group, Inc. Long Term Disability Plan

In this 2012 ERISA case, the claimant, who was a doctor, underwent surgery for a herniated disc and degenerative disc disease, but she stopped working full time and obtained part-time work because the surgery did not eliminate her pain. As part of its investigation to determine whether the claimant satisfied the policy’s requirements, the administrator conducted an investigation, which included several days of surveillance video showing the claimant engaging in activities such as group exercise classes and lifting heavy items into her car after working at her part-time job; the administrator also conducted a functional capacity evaluation and obtained a medical professional review of the case. On appeal, the court agreed with the district court that the claimant did not show that she was entitled to benefits under the policy. In particular, the court found that the surveillance video was properly considered because it demonstrated an inconsistency between the claimant’s allegations and her actual or demonstrated abilities. The functional capacity evaluation, medical evidence, and medical professional review also supported the benefits determination and demonstrated that there was no violation of ERISA.

Judgment affirmed.

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