On July 24, 2020, McKennon Law Group PC’s client, Julie Hodgson, filed a 52-page Complaint against the administrator of her disability benefits, Lincoln Life Assurance Company of Boston (“Lincoln”), on the basis that Ms. Hodgson could no longer perform her job duties or those of any occupation because she suffered from chronic pain syndrome, connective tissue disease and fibromyalgia. Initially Lincoln had approved Ms. Hodgson’s short-term disability benefits, but after a transition and claim for LTD benefits, Lincoln improperly denied her long-term disability benefits, based on Lincoln’s reasoning that Ms. Hodgson no longer met the definition of disability.
The Complaint in detail attacked Lincoln’s examination and analysis of Ms. Hodgson’s claim and appeal for LTD benefits. First, the Complaint alleged that Lincoln contracted biased medical consultants who although agreed that Ms. Hodgson suffered from her impairing diagnoses, simply concluded that Ms. Hodgson was able to perform her job duties. The Complaint alleged that Lincoln’s reliance on these medical consultants was unreasonable since all of their reports were cursory, without adequate analysis and the paper reviewers did not clearly state the basis for disagreeing with Ms. Hodgson’s multiple examining doctors. Carrier v. Aetna Life, 116 F.Supp.3d 1067 (C.D. Cal. 2015).
Second, the Complaint alleged that Lincoln’s medical consultants did not examine Ms. Hodgson, though its Policy permitted it. This raised questions about the credibility of their opinions and the appropriateness of Lincoln’s benefits denial. Shaw v. AT&T, 795 F.3d 538 (6th Cir. 2015). This is to be contrasted with her treating providers who have regularly treated her for years and consequently gained great insight into her work limits. Therefore, their opinions were based purely on a “cold file review” of Ms. Hodgson’s medical records and therefore carried far less weight and did not have the benefit of the insight gained through personal observation. Sullivan v. Prudential, 2014 WL 3529974 (E.D. Cal. Jul. 15, 2014). A in person examination is especially important in cases involving subjective diagnoses, such as pain and fibromyalgia.
Third, Ms. Hodgson alleged that Lincoln and its consultants ignored Ms. Hodgson’s medical records that frequently referred to her numerous tender points in multiple exams, which courts have consistently recognized that such findings are significant in cases involving fibromyalgia. In Wulf v. Astrue, 773 F. Supp. 2d 984 (D. Kan. 2011), the court noted “as the Eighth Circuit said in [Brosnahan v. Barnhart, 336 F.3d 671 (8th Cir.2003)], the ‘objective medical evidence of fibromyalgia’ was the ‘consistent trigger-point findings’ and the plaintiff’s ‘consistent complaint during her relatively frequent physicians’ visits of variable and unpredictable pain, stiffness, fatigue, and ability to function. 336 F.3d at 678. This alone demonstrated that Lincoln’s medical consultant’s review of Ms. Hodgson’s medical records was incomplete and thus, any conclusions made from their review were flawed.
The Complaint concluded by attacking Lincoln’s vocational consultant’s report as incomplete, flawed and conclusory. Lincoln improperly relied on this vocational report which simply concluded that Ms. Hodgson could work in sedentary and light occupations, while failing to list the job duties of those listed occupations and the skills required to perform them. This detail is required by law. Turner v. Life Insurance Co. of North America, 2017 WL 6000099 (W.D. Wash. Dec. 4, 2017). Lincoln’s vocational analysis also failed to consider Ms. Hodgson’s non-exertional limitations, such as cognitive and psychological limitations, including those related to the side effects of her prescription medications and pain, and her limited ability to remain seated for an extended period of time. Such non-exertional limitations are important aspects of vocational capacity and should be considered. Rabuck v. Hartford Life and Accident Ins. Co., 522 F.Supp.2d 844 (W.D.Mich.2007). Finally, we alleged that the vocational consultant never looked at actual job postings or whether those businesses were looking to hire someone now (let alone whether Ms. Hodgson was a realistic candidate in the real-world employment market). Numerous courts have found that a group disability insurer’s failure to confirm that actual jobs are available in an occupation the claimant has the physical ability to perform violates the group policy. For example, in Kennard v. Means Industries, Inc., 555 Fed. Appx. 555, 557–58 (6th Cir. 2014), it was undisputed that, due to his medical condition, the clamant was only capable of working in an “absolute clean-air environment.” For all the reasons discussed above, the Complaint alleged that Lincoln’s reliance on its consultant’s vocational report was improper.
In less than two months after filing the lawsuit, Lincoln voluntarily reversed its denial of Ms. Hodgson’s claim for LTD benefits and agreed to pay her all disability benefits provided by the policy, plus prejudgment interest and our attorneys’ fees and costs. It was a total victory for Ms. Hodgson.
Unfortunately, many insurance companies participate in similar tactics to deny legitimate claims for benefits. Instead of accepting the opinions of treating physicians, insurance companies will often deny claims based on “a failure to meet the definition of disability” or lack of “objective evidence” or perform a “paper review” of medical files by “independent” medical consultants who are hired by the insurance company. If your disability insurer denied your claim for short-term disability or long-term disability benefits, please contact our firm for a free consultation. We have extensive experience with handling these types of disability claim denials