Court Remands Finding That Reliance Arbitrarily Denied Disability Benefits

    Kelly Dean Brende v. Reliance Standard Life Insurance Company stems from a September 11, 2012, incident where Brende, a partner in a law firm, woke up one morning to discover her toes were numb. By the following day, the numbness had spread to much of her left side and she felt dizzy.

    She was evaluated in an emergency room, and over the next weeks and months, sought help from numerous medical practitioners. Despite numerous tests, no cause for her symptoms could be found. She never returned to work.

    Lack of Objective Tests Supporting the Disability Claim

    Brende’s symptoms were evaluated subjectively and the doctors generally believed she was suffering. None of them thought she was malingering or not sincerely in pain and discomfort. All objective tests, such as x-rays, MRIs, etc., came back normal. One physician concluded that she suffered from “depression and anxiety related to her illness…”

    Her initial application for long term disability benefits was granted since she was unable to perform the duties of her own occupation. Periodically, Reliance would call on specialists to review Brende’s medical records and/or conduct an independent medical exam.

    On December 10, 2014, Reliance discontinued her disability benefits on the grounds that she was “not physically impaired or psychiatrically impaired, and as she received LTD benefits under the Mental or Nervous Disorder provision, it appears [Reliance] has overpaid Ms. Brende LTD benefits.”

    Brende exhausted her administrative remedies and then filed this ERISA lawsuit, arguing that Reliance improperly denied her long term disability benefits. The Court agreed and remanded the case with instructions to Reliance to reevaluate its decision.

    Physical Disability Preventing Brende from Working in her Regular Occupation

    In deciding Brende was not disabled, the Court found Reliance had the “discretion to require objective evidence that Brende lacked the ability to engage in work as an attorney.” But, Reliance erred in finding her work was sedentary without considering any other job requirements.

    The policy definition of regular occupation was “the occupation the Insured is routinely performing when Total Disability begins.” Brende’s job as an attorney may have been sedentary, but the Court noted that the “substantial and material duties of an attorney include non-physical tasks, demands, and attitudes, including research, client contact, and frequent near acuity.”

    Reliance failed to consider that Brende claimed disability because of “cognitive impairment, fatigue, and malaise” that prevented her from practicing law. Even though no objective evidence was available, even one of Reliance’s own medical professionals, who reviewed Brende’s medical records and interviewed and questioned her, agreed that Reliance should follow the advice of her neurologist concerning her work limitations.

    Based on these findings, the Court held that Reliance’s denial of benefits was arbitrary and capricious. Since the Court’s decision was based on Reliance’s failure to make adequate factual findings on whether Brende could perform the substantial duties of her occupation, the Court remanded to Reliance to make a “full and fair review” and to give Brende a chance to “submit additional evidence supporting her claim for physical disability benefits. The Court deferred a ruling on whether Reliance’s application of the mental disability limitation was reasonable until Reliance reconsidered her application for long term disability benefits.

    If you have a medical condition for which no objective test exists to prove your disability, or you have any questions about your disability claim, contact one of our attorneys at Dell & Schaefer for a free case evaluation.

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