In Giovanna Reichard v. United of Omaha Life Insurance Company, the Plaintiff received both short term and long term disability benefits from her employer primarily due to her Crohn’s disease and related gastrointestinal issues and rheumatoid arthritis. During the first 24 months of her disability, she only had to prove that she could not perform the duties of her own occupation as a registered nurse for Coordinated Health.
When the definition of disability changed to requiring her to be unable to perform the duties of any occupation, United ordered a review of her medical records by its own registered nurse, nurse Grancer. Grancer found Plaintiff’s Crohn’s disease stable.
Plaintiff was then referred by Omaha to a vocational rehabilitation consultant, Douglas Palmer, who conducted a Transferable of Skills Assessment (TSA). He concluded she could do light and sedentary work and made some recommendations for other occupations which would be suitable for her and in which she should be able to find employment.
Plaintiff’s medical records were subjected to peer review by Omaha’s own physicians who all determined she was not disabled from working in professions that had been recommended by Palmer. Based on this evidence, United of Omaha denied her claim for long term disability benefits under the new definition, and found that there were occupations in which she could work that would meet the required income standard of her disability insurance policy.
She appealed and, after exhausting her administrative remedies, Plaintiff filed this ERISA action in the United States District Court for the Eastern District of Pennsylvania. She raised a number of issues, all of which were decided in favor of Omaha.
Court Denies Plaintiff’s Claim that Omaha Failed to Consider the Side Effects of Her Medication in Denying Her Claim
Plaintiff alleged that Omaha failed to consider the side effects of her medication when it decided she could work in other occupations. The Court cited a number of cases that supported the legal contention made by Plaintiff. The problem was that there was nothing in her medical record that indicated she was disabled due to side effects of any medication. The Court concluded that when the sole evidence of disabling side effects is the “Plaintiff’s assertion,” the plan administrator’s failure to consider the “Plaintiff’s self-diagnosis” is not an abuse of discretion as the Plaintiff claimed.
Substantial Evidence Supported Reports of Peer Reviewers, TSA and IME
Plaintiff argued that there was no substantial evidence for support of any of the peer review reports, of the results of the TSA, and the opinion of the medical professional who conducted the IME. The Court went through each report challenged by the Plaintiff and found substantial evidence supported each and every one of them. Some reports may have had some flaws, but the Court found that overall, substantial evidence existed to support the opinions that Plaintiff was not disabled from working in other occupations and Omaha did not act arbitrarily and capriciously in denying her claim.
This case was not handled by our office, but we feel it can be instructive to those who are struggling with providing required evidence to their disability insurance carrier. If you have questions about this or any other aspect of your disability claim, contact one of our disability attorneys at Dell & Schaefer for a free consultation.