Companion Life tried to play games and deny long term disability benefits, but thankfully a New Mexico Federal Judge made them pay disability benefits and attorney fees. The Plaintiff, Mr. Paul Chandhok, was recently awarded disability benefits in a decision by The United States District Court for the District of New Mexico, in a case decided on August 13, 2021. What makes this decision important for plaintiff’s contesting their claim for long term disability benefits is that the Court also demanded that Companion Life Insurance Company pay the claimant’s attorney fees. The Court reversed the benefit denial and determined that Companion’s long term disability decision was arbitrary and capricious and not supported by the available evidence. The full written decision by the Court is included below:
As a brief summary of the disability claim, Chandhok worked as an Assistant Sales Manager for a car dealership and became insured under the group long term disability policy effective June 1, 2015. He injured himself on January 9, 2016, while stepping in a pothole, causing pain to both his knee and foot. The medical information also supported associated psychological symptoms. After the injury, he struggled to perform the duties of his occupation, which required, amongst other duties, frequent standing and walking and interacting frequently with customers. All of these duties were hampered by his physical and psychological limitations. Ultimately, Mr. Chandhook could no longer perform his occupation and filed for a long term disability claim effective March 5, 2016.
The Companion Insurance Company took a number of unfair and ridiculous steps, to deny Mr. Chandhok’s claim. One, Companion decided that because he continued to work after the injury of January 9, 2016 that his injury and psychological symptoms did not support disability benefits after he stopped working as of March 5, 2016. This argument by Companion Insurance was made despite Chandhok’s supervisor suggesting a disability claim was a necessary measure given the supervisor’s observations of Mr. Chandhok’s difficulties working on a daily basis.
Why Did Court Reverse Companion’s Disability Denial?
The Court found that the decision of Companion Life to deny disability benefits was unreasonable (arbitrary and capricious) for the following reasons:
One: Companion Life argued that Mr. Chandhok was not diablsed before his diagnosis. Whether diagnosed with a condition or not, the issue at hand is whether he was Disabled from performing or sustaining full-time work as of March 5, 2016.
Two: Companion Life argued that Mr. Chandhok did not remain insured after his last day of work on March 4th, 2016. This conclusion is simply not supported by the policy or the available evidence because he was disabled and therefore still insured.
Three: Companion also argued that Mr. Chandhok was indeed Disabled, but only through July 5, 2016, which does not support the argument that he was also not insured, as noted above.
Four: Companion Life argued that Mr. Chandhok did not have a mental illness impacting his ability to work despite numerous medical records and statements from his doctors confirming mental health problems.
As a result of the numerous problems with the decision to deny Chandhok’s claim, the Court remanded the claim back to Companion Life to perform a refreshed and unbiased review. However, Companion Life failed to follow through on any meaningful basis. As noted by the Court, Companion Life merely “repackaged a flawed argument and applied it to a new disability date to avoid reconsideration of its original denial. Once the claim came back to the court the Judge did. It give Companion another opportunity to review the claim and awarded past due benefits and attorney fees. Companion argued against the award of attorney fees but the court ruled the the claimant had achieved some success of the merits and fees shall be paid.
This is a great victory for the claimant. Our law firm did not represent the plaintiff in this claim but we track and report on every important long term disability decision so that we can help claimants nationwide to collect long term disability benefits. Contact any of our disability attorneys for a free consultation and review of your long term disability claim.