In a decision this month from the United States Court of Appeals, Fifth Circuit, the Hartford was ordered to pay a disabled lawyer (“Brian”) his benefits and attorney fees. In this dispute over long-term disability benefits, the Fifth Circuit, which rules on long-term disability cases decided in Texas, Louisiana and Mississippi, held that the Hartford abused its discretion in denying physical disability benefits to Brian and ordered the Hartford to also pay his attorney’s fees.
Brian has been suffering from degenerative back disease and mental disorders for over ten years. These problems interfere with his ability to function as an attorney and, in 2003, he applied for disability benefits through his firm’s long-term disability plan. His initial claim was granted with respect to his mental disability, but denied with respect to his physical disability.
In its final administrative review, the Hartford relied on the opinions of three independent experts, each of whom concluded that Brian had not supported his physical limitations and accounts of pain with objective medical evidence, as required under the policy. On the basis of these opinions, the Hartford rejected Brian’s treating physicians’ conclusions that Brian was disabled as well as the results of a Functional Capacity Evaluation that concluded Brian was not fit for sedentary work. In making its determination, the Hartford also noted that Brian remained listed as an attorney on his firm website, indicating that he was capable of performing the duties of an attorney.
After reviewing the administrative record, the court, in an extensive and thoughtful opinion, concluded that the Hartford abused its discretion in denying Brian physical disability benefits. In so concluding, the court noted that Brian’s alleged functional limitations and subjective accounts of pain had been repeatedly corroborated by objective medical evidence. The court found this evidence “overwhelming,” and reasoned that both the Hartford and its independent physicians concluded otherwise only by crediting arbitrary or inconclusive evidence. The court also observed that the Hartford was operating under a conflict of interest that could have had some effect on its decision, and that Brian had qualified for disability benefits from the Social Security Administration, a point that the Hartford had failed to address. Because the Hartford “deliberately ignored overwhelming objective medical evidence” supporting Brian’s claims, the court also saw fit to award Brian attorney’s fees.
There is no treating physician preference in the context of long-term disability claims, but neither may an administrator arbitrarily refuse to credit reliable evidence. “It surely should not effectively ignore it. Nor may an administrator rely on an expert opinion without considering its basis or whether, as was the case here, it is in plain conflict with the medical records”, the court reasoned. In conclusion, the court properly held that the Hartford “deliberately ignored” Brian’s medical evidence in order to support its “preferential and predetermined conclusions .”
Alan Olson writes this web-log to provide helpful information regarding long-term disability cases. He practices long-term disability law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here or for advice on specific disability benefit claims.