Dentist wins right to apply stricter standard of review in her case against Hartford for a claim for long-term disability benefits
(Group / ERISA Disability Policy) Carol Post, a dentist working at a hospital in New Jersey, was involved in a car accident in November 1993. Despite her whiplash injuries, she returned to work as a dentist, but was forced to stop working as a dentist because of her severe pain. She attempted in December 1993 to return to work as a pharmacist, since she also held a pharmacy degree. Ms. Post worked for nine months as a pharmacist and then was forced to stop working in September 1994 due to continued pain. During the period when she worked as a pharmacist, she averaged nearly a day per week that she was unable to work because of the pain. Ms. Post tried numerous physical therapy treatments that did not significantly improve her condition before attempting to return to work again in January 1995. Unfortunately she was forced to stop working once again in May 1995, because of her continued pain.
Evidence of Ms. Post’s treatment included records from 14 doctors over 10 years, beginning in 1993 following her accident. The treatments for her pain included:
- prescription drugs;
- trigger-point injections;
- physical therapy;
- acupuncture; and,
None of these treatments provided significant relief to her pain. Her neurologist, a professor at Columbia University, opined that her numerous medical conditions, such as severe myofascial pain, chronic debilitating headaches, sensitivity to light, nausea, vomiting, and irritable bowel syndrome, and insomnia were caused by her car accident and rendered Ms. Post totally disabled. Hartford paid total disability benefits from 1995 until 2002, and Ms. Post was approved for Social Security Disability Insurance (SSDI) benefits on August 7, 1998.
After paying Ms. Post disability benefits for seven years, Hartford abruptly terminated her benefits in January 2002, following a review of her file by Hartford’s medical director, in which Hartford’s doctor concluded that Ms. Post was not totally disabled. After exhausting her administrative remedies by filing two appelas, Ms. Post then filed suit for her disability benefits, but the trial court entered judgment against her, agreeing with Hartford’s argument.
Hartford argued that the medical records revealed Ms. Post had only a whiplash injury, relying mostly on the medical records review performed by its own physician and an independent medical examination. Hartford also based their denial on feedback from doctors who treated Ms. Post in 1994 and 1996, on forms prepared by Hartford that did not allow these treating physicians to indicate that Ms. Post was totally unable to work.
On appeal, the Third Circuit Court of Appeals, in Philadelphia disagreed with the trial court, noting that the District Court for the Eastern District of Pennsylvania had not properly considered that:
- Hartford’s denial was largely based on the review of Ms. Post’s medical records by its own physician;
- That Ms. Post had received a fully favorable decision on her SSDI claim; and,
- That Hartford aggressively used disability surveillance in an attempt to show that Ms. Post was not disabled.
Individually, each of these items was not enough to show that Hartford might have acted improperly in cutting of Ms. Post’s disability benefits. However, the Appellate Court ruled that based on the totality of all the carrier’s actions, the lower court could have found in favor of Ms. Post.
As a practical note, the lower court will have to reconsider their previous decision and re-evaluate Ms. Post’s case. There is no guarantee that Ms. Post will receive benefits even as the trial court looks at the evidence a second time, but at least Ms. Post will be given a second chance.
See Post v. Hartford Ins. Co., 501 F. 3d 154 (3d Cir. 2007).