Mass Court Finds Johnson&Johnson Abused Its Discretion In Long Term Disability Claim
The claimant, Ms. Petrone, worked for a subsidiary of Johnson & Johnson as a Finish Operator for 7 years. She stopped working after she was diagnosed with a L5-S1 disc herniation and underwent back surgery, a lumbar laminectory, which failed and left her with continued post-surgical pain and radiculopathy. Ms. Petrone was approved for short-term disability benefits and then received long-term disability benefits for nearly 2 years before the Johnson & Johnson plan administrator determined she no longer met the Plan’s definition of totally disabled. Despite an approval of Social Security Disability Benefits, Johnson and Johnson continued to refuse to pay long term disability benefits.
The Massachusetts Court reviewed the administrative record and found that Johnson & Johnson abused its discretion in denying Ms. Petrone’s claim because it failed to address substantial medical evidence in the file which supported that Ms. Petrone was, in fact, totally disabled. Additionally, Johnson & Johnson also abused its discretion by construing the evidence to determine that Ms. Petrone failed to cooperate pursuant to the terms of the Plan.
Ms. Petrone’s three treating physicians, expert occupational therapist, and independent vocational consultant, as well as the physical therapist retained by Johnson & Johnson to perform a FCE, concluded that Ms. Petrone’s disability prevented her from performing even “sedentary” work. An Administrative Law Judge for the Social Security Administration submitted a report finding Ms. Petrone disabled. Additionally, Ms. Petrone, her sister and her partner, all submitted sworn statements regarding Ms. Petrone’s disabling condition and her limitations in her ability to function.
Johnson and Johnson Ignores Medical Evidence Submitted by Former Employee
In its final denial letter, Johnson & Johnson failed to address any of this contrary evidence. Although a plan administrator is not required to rely on the opinions of the claimant’s treating physicians, they cannot completely ignore or dismiss contrary evidence without explanation. Johnson & Johnson addressed the sworn statements and indicated that they would be given less weight than the observations of trained professionals, and they addressed the vocational consultant’s assessment. However, Ms. Petrone’s medical records included multiple reports and Attending Physician Statements from her treating physicians which indicated that Ms. Petrone was severely limited in her functional capacity and was unable to perform any work. The final denial letter mentions some of the treating physicians, but completely ignores and fails to consider the contrary opinions found in the treating physicians’ reports. Further, Johnson & Johnson did not even mention that their own physical therapist performed an FCE and determined that Ms. Petrone was not capable of sedentary work.
The “Rubber Stamp” Method of Disability Claim Review
Instead, Johnson & Johnson relied heavily on the opinion of their hired allegedly independent medical examiner who determined that Ms. Petrone was recovered from her surgery and could return to work with no restrictions or limitations whatsoever. The court determined that there was no explanation for why this one independent medical examiner’s opinion was in such contrast to the opinions of the other multiple physicians who also examined Ms. Petrone and whose opinions ranged from her not being able to work at all, to her being limited to only “light” work. As such, Johnson & Johnson abused its discretion to credit a report with such a bias in favor of rejecting her claim. J&J employed what we often refer to as the “rubber stamp” method of claim handling. The rubber stamp method means and insurance company ignores everything the claimant sends to be reviewed, but what will accept without question whatever the opinion is of their own hired gun doctor.
J&J Ignores the SSDI Approval for Long Term Disability Benefits
Even though a favorable Social Security Administration decision granting disability benefits is not binding on a group long-term disability plan administrator’s decision to grant or deny benefits, it still must be addressed. The Court found that Johnson & Johnson abused its discretion by not addressing the SSA’s decision, especially because the SSA relied on certain medical evidence which Johnson & Johnson also possessed, but also failed to mention in their final denial letter. Additionally, the SSA applied a virtually identical definition of disability as was contained in the Johnson & Johnson plan when making their determination.
Johnson & Johnson also based their denial of disability benefits on a claim that Ms. Petrone failed to cooperate with the evaluation of her claim, which is required under the terms of the Plan. They stated that she failed to put forth her best effort while undergoing the FCE and Independent Medical Examination, which were performed at the request of Johnson & Johnson. While some reports of malingering, self-limiting behavior and exaggeration of symptoms were noted, both physicians also indicated that Ms. Petrone was “cooperative throughout the testing” and that there was no “generalized overreaction.” Additionally, Ms. Petrone provided an expert report rebutting the purported diagnosis of malingering, which the Court found Johnson & Johnson failed to fully consider.
While the Court found that Johnson & Johnson abused its discretion by picking the evidence from the administrative record which favored a denial of benefits and ignoring any evidence to the contrary, the Court also determined that there was also evidence in the administrative record to support that Ms. Petrone did not meet the Plan’s definition of total disability. Therefore, both parties’ motions for summary judgment were denied and the matter was remanded back to Johnson & Johnson to perform a full and fair review of Ms. Petrone’s claim for disability benefits. The fact this claim was remanded is only a partial victory as Johnson and Johnson will now have a second opportunity to review the claim and possibly deny disability benefits again.
If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, feel free to call Disability Attorneys Dell & Schaefer for a free consultation. We handle disability claim nationwide. Our law firm did not represent Ms. Petrone in her disability claim, appeal or lawsuit.
Resources to Help You Win Disability Benefits
Disability Benefit Denial Options
Submit a Strong Appeal Package
We work with you, your doctors, and other experts to submit a very strong appeal.
Sue Your Disability Insurance Company
We have filed thousands of disability denial lawsuits in federal Courts nationwide.
Protect Your Benefits
Get Your Disability Application Approved
We help claimants throughout the entire application process.
Prevent a Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.
Negotiate a Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Disability Company Reviews
(656)
Showing 8 of 656 Reviews
Sedgwick
Don't trust them, they like to play games
They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
Disappointed with NY Life Disability Excuses
I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
MetLife
They FULL OF ****
MetLife is what everyone on this review are saying. They don't contact you to let you know what's going on with your claim or to let know you need additional info. I had a... read more >
Sedgwick
Worst Company Ever
If something happens to you at work you better hope you die, my son is going through HELL because this company is handling his work comp. NO RETURN PHONE CALLS, TEXTS, EMA... read more >
MetLife
MetLife for disability? Avoid the surgery unless it's life-threatening
The worst company I ever dealt with, never received a call from my claim manager.
Reliance Standard
Short Term Disability Claim/Inconsistent to NO Communication
When I did call & reach a live person they were kind & helpful. The person assigned to my claim left one phone message & I have not spoken to her since. Information she re... read more >
Answered Questions by Our Lawyers
(0)
Helpful Videos
(908)
Showing 12 of 908 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips
Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?
When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >
Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak
If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >
Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company
When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >
Disability Benefit Denial Reason #3 - Video & Social Media Surveillance
One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >
How Do You Fight a Long-Term Disability Denial?
Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >
Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >
Disability Denial Reason #1 – Paper Review & IME
At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >
How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial
At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few things in the process. When you’re experiencing an injury or illness that makes it difficult (or impossible) to work, it can be tempting to file a claim as quickly as possible – but unless a claimant has all their ducks in a row, this could actually delay the ultimate r... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases
Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >
Sun Life Wrongfully Denies Disability After Paying For 23 Months
We represent a 57 year-old claimant who’s occupation was selling commercial vehicles for many years. Her job was very physical as it required her to climb in and out of semi-trucks multiple times a day as well as operate them which was very strenuous. She went out of work in due to ongoing and severe debilitating right hip, low back, and bilateral knee pain... Read More >
Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed
Our client, a registered nurse for Dignity Health, found herself in a difficult situation after being diagnosed with lumbar spondylosis and left knee arthritis. She continued to work, however, struggled while attempting to work through chronic lower back pain and left lower extremity radicular symptoms on a daily basis. Sadly, her condition failed to improve and... Read More >
Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision
The claimant is an 64 year old former Corporate Attorney and at a prominent Florida business law firm who was forced to cease working in his highly successful and rewarding profession, job, and career on January 27, 2021, and to seek disability compensation under his policies with Lincoln due to severe symptomatology stemming from or following a viral COVID-19 i... Read More >
Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal
Unum unjustly terminated our client’s disability insurance claim after it had approved and accepted liability for six months. Unum unreasonably concluded, without any evidence of improvement, that the claimant had resumed the sustained work capacity to perform the material and substantial duties of her high level occupation as a Transportation Division Manage... Read More >
Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease
The claimant is a 58-year-old former MRI Technologist for Fairview Health Services who has long suffered from the debilitating effects of her chronic medical conditions. She has a history of neck pain as well as right arm pain and numbness dating back to 2005 with a reoccurrence of severe symptomatology in 2013. MRI of her cervical spine performed in August of ... Read More >
Engineer With Depression Wins Prudential LTD Appeal
The claimant is a former Senior Technology Services Engineer for Accolade, Inc. who was forced to cease working on May 25, 2021 and to apply for disability insurance benefits under his policy with Prudential because of severe symptomatology related to depression and anxiety. Prudential initially approved his claim for LTD benefits as his symptoms were demonstrat... Read More >
New York Life Approves Disability Benefits for School Teacher With Multiple Sclerosis
Our client, a former elementary school teacher suffering from Multiple Sclerosis, contacted our office after New York Life terminated her claim for short term disability benefits and spoke with Attorney Stephen Jessup. New York Life had initially approved her claim for short term disability benefits, but in doing so awarded benefits only on account of a mental health condition, even though our client had filed... Read More >
Disability Lawsuit Stories
(765)
Reviews from Our Clients
