Dentist sues disability insurance carrier, third party administrator and allegedly independent medical examiner as a result of their conspiracy and bad faith actions to wrongfully deny disability benefits

In 2003, Dr. Morrow, a Dentist stopped working and sold his practice as result of suffering from anxiety, depression, and post-traumatic stress disorder. In order to determine if Dr. Morrow was eligible for disability benefits, Boston Mutual, his disability carrier, hired Disability Reinsurance Management Service, Inc.(hereinafter known as “DRMS”) to administer and handle the claim. This means that DRMS was given the authority to investigate the claim and make a final decision as to whether Dr. Morrow should be paid disability benefits. It is a common practice for disability insurance companies to hire another company such as DRMS to handle a disability claim.

In July of 2003, DRMS determined that Dr. Morrow could not perform his duties as a dentist and approved his claim for long-term disability benefits. In February 2006, DRMS wanted to hire an allegedly independent Doctor to review Dr. Morrow’s file and speak with Dr. Morrow’s treating physicians. DRMS hired a company known as BMI, which in turn hired Dr. Kilburn to complete a review of Dr. Morrow’s file. Dr. Kilburn completed her review and determined that Dr. Morrow was capable of returning to dentistry and that he did not have any functional limitations or restrictions. Despite, Dr. Kilburn’s report, the Boston Mutual continued to pay Dr. Morrow his disability benefits.

Even though Dr. Morrow continued to receive his disability benefits, he filed a lawsuit on the basis that Boston Mutual and its claim administrator (DRMS) engage in a “claim termination scheme,” in which they hire biased medical professionals to recommend the denial or termination of disability claims payments. Dr. Morrow further alleged that had he not uncovered the scheme of Boston Mutual and DRMS, then his claim would have been denied in June 2006. Dr. Morrow also alleged in his Complaint that the negative review of his file injured him because he “must now live in a constant state of uncertainty ass to whether Boston Mutual may decide to arbitrarily cancel his benefits at some point in the future,” and that this has “further exarcerbated his already frail mental health.”

In 2007, Dr. Morrow filed his lawsuit against Boston Mutual, DRMS, BMI, and Dr. Kilburn. The case is currently pending in the United States District Court for the District of Arizona. The Complaint listed six causes of action which included: breach of contract, bad faith, aiding and abetting bad faith, civil conspiracy, tortious interference with prospective advantage, and intentional infliction of emotional distress. The court has recently dismissed Dr. Morrow’s allegations for intentional infliction of emotional distress and tortious interference with prospective advantage. The court has acknowledged the Defendant’s bad faith conduct and has allowed all of the other counts to remain.

Practical Note: This is a great case in support of claimants. This case will hopefully make disability carriers think long and hard about participating in unethical schemes to deny disability claims.