Disability Denial Remanded to Anthem for Analysis of Claimant’s Job Duties

Although this Virginia Federal ERISA long term disability case was not handled by our disability insurance lawyers, it is an example of how Anthem denies disability benefits by asserting claimants are not disabled from performing their job duties without ever determining or analyzing what those job duties are.

Case History

In the case of Wyant v. Anthem Life Insurance Company, Anthem denied long term disability benefits to Wyant deciding that she could perform her job duties without ever evaluating what those job duties entailed. After working for 17 years at Gala Industries as a documentation assistant, plaintiff applied for short term disability benefits and stopped working. She suffered from diabetes, depression, myalgia, neuropathy, macular edema and other medical problems. Her application for short term disability benefits was granted, but when she applied for long term disability benefits, her application was denied.

In analyzing whether or not the plaintiff was disabled from performing the material and substantial duties of her job as a documentation assistant, Anthem commissioned three specialists to review her extensive medical file: A neurologist, ophthalmologist and clinical psychologist. All opined she was not disabled and that there were “no significant restrictions or limitations that would preclude Wyant from working as a document assistant at Gala Industries.”

The problem was that not one of the reviewing doctors ever mentioned the job duties they had determined she could perform. Even so, based on this review of medical records, Anthem denied her administrative appeal and she filed this ERISA lawsuit.

Federal District Court’s Remand Order

Although Anthem argued to the court that it had taken a reasoned approach to the analysis of plaintiffs claim for long term disability benefits, the district court disagreed. Instead, the court agreed with the plaintiff that she had presented evidence of “multiple medical conditions, eleven years of documentation, and a long list of potent prescription medications supporting her disability claim…”.

The court found Anthem abused its discretion when it denied her benefits, finding she was not disabled from performing her duties as a documentation assistant. The court noted that none of the reviewing physicians made any attempt to connect her medical conditions with her employment.

In fact, her job description was totally missing from any analysis and from any of the reports of those who concluded that she could perform the duties without ever analyzing what those duties were. The court held, “This omission leaves the court unable to perform an informed and meaningful review, renders Anthem’s decision fundamentally flawed, and constitutes an abuse of discretion.” The court remanded to Anthem to conduct an analysis consistent with the court’s opinion.

If you are having problems with your claim for disability benefits or have any questions about the process, feel free to call our Disability Attorneys Dell & Schaefer for a consultation.

Read about more Anthem disability claim cases on this page.

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We represent Anthem clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Anthem disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Anthem. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Anthem.

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Our lawyers help individuals that have either purchased a Anthem long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Anthem:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

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Skipp (California)

I am writing to highly recommend Greg Dell & The Law Offices of Dell & Schaefer as disability attorneys. Greg has handled my permanent disability case for over ten years. Along the way, disputes with the insurance Co. were quickly handled by Greg where, in each instance, we always prevailed. Regardless of the pressure to discontinue benefits, Greg assured my uninterrupted flow of benefit checks.

Years ago I had met an attorney from The Law Offices of Dell & Schaefer at a dental meeting and the message (& Biz card) I took away that day became extremely valuable when, much later, I suffered a career-ending injury and had to file for permanent disability benefits.

Even before filing a disability claim, the insured person needs the protection, advice, and power of a good disability attorney. There are potential hidden traps throughout & especially early the claim process. Disability insurance Co.’s look to circumvent their duty to pay. They don’t just write the checks! Dealing with my claim, I often felt my Insurance Co. was taking advantage of me.

To successfully claim & receive continuing benefits, it was clear early on that I needed legal representation. I called Dell & Schaefer, spoke with Greg Dell, and immediately understood that this attorney knew exactly what I was going through & that he had the experience and power to represent me, to stand up to the insurance Co., & to assure my uninterrupted benefits. As soon as Greg took over my case, all correspondence from the insurance Co. went straight to him for his handling. No longer were those insurance Co. letters being delivered to where I live, where they would result in distraction & uncertainties in my home.

It’s been a great relief to my family & me to have Greg Dell and the staff at the Law Offices of Dell & Schaefer, on the job, responding, on my behalf, to the insurance Co.’s relentless pressure to reduce or discontinue my benefits. Greg Dell deserves and receives my highest possible recommendation as a disability attorney.

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