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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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.

How do you help Anthem claimants?

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
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

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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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Jimmy H.

I contacted Jay Symonds with Attorneys Dell & Schaefer, he was the lead attorney on my case. I was very happy with every aspect of how my case was handled. Jay kept me informed every step of the way. Vanessa who worked with Jay on my case was also very professional and helpful. I had many, many questions and they both answered every one of them. I was prepared for a long drawn out wait, but was surprised that less than 2 weeks after Jay submitted my appeal documents Liberty Mutual reversed their denial and deposited a check for all back pay into my account! If you have been denied disability benefits I urge you to call Attorneys Dell & Schaefer, trust me YOU WILL BE GLAD YOU DID!

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