Credibility Judgments Without IME Lead to Remand Back to Libery Life for Full and Fair Review in Kentucky ERISA Disability Lawsuit

Background and History of the Claim

The Plaintiff in this case, Ms. L, applied for Waiver of Premium benefits with her Plan’s administrator, Liberty Life Assurance Company of Boston, also known as Liberty Mutual. She claimed disability due to her medical conditions of insulin-dependent diabetes mellitus type II, chronic pain, degenerative joint disease, degenerative disc disease, myofascial pain syndrome, morbid obesity, obstructive sleep apnea, peripheral polyneuropathy, physical deconditioning, right knee osteoarthritis and hyperparathyroidism.

Liberty Life denied Ms. L’s initial claim for disability benefits and said denial decision was based on a report prepared by Liberty Life’s consulting physician, Dr. Schwartz. Dr. Schwartz reviewed the paper records only and opined that none of Ms. L’s physical conditions, either by themselves or in combination, precluded her from performing sedentary, light or medium work duties on a full-time basis.

Ms. L appealed the benefit denial and submitted in support of her appeal, her own video statement, a vocational opinion report and a sworn deposition statement from her treating physician, wherein he disputed the findings of Dr. Schwartz and maintained that Ms. L was unable to perform any type of sedentary work due to her physical and cognitive limitations. He notes that it is the severity of each of her physical conditions and their particular cumulative effect which prevented her from being able to work.

Liberty Life upheld the denial of Ms. L’s claim for WOP benefits and the second denial decision was based on the peer review report of its consultant, Dr. Marella. Dr. Marella noted that Ms. L’s diagnoses were supported by objective medical evidence contained in her file. He did not speak with either Ms. L or her treating physician, but he did review the treating physician’s deposition statement. Dr. Marella concluded that Ms. L had no physical condition that precluded her from performing a sedentary, light or medium duty occupation. A vocational analysis was also conducted which was based on Dr. Marella’s description of Ms. L’s physical capabilities and found that Ms. L could perform a number of entry level positions.

Liberty Life Improperly Made Credibility Determinations When Evaluating The Severity Of Her Subjective Conditions

Ms. L’s primary objection stated in her ERISA lawsuit, was that Liberty Life improperly relied on the opinions of the physician consultants, who only performed paper reviews of the medical records, with regard to Ms. L’s subjective pain complaints. Ms. L argued that Liberty Life should have performed a physical examination instead of the file review and the Plan specifically reserved the right to conduct a physical exam.

The Court noted that some of Ms. L’s disabling conditions, and their severity, were fundamentally subjective and Ms. L claimed that she was unable to work mainly due to severe and persistent pain.

In his report, Dr. Marella did note that Ms. L’s pain was related to her conditions which included peripheral polyneuropathy, myofascial pain, cervical spine spondylosis, cervical spine degenerative joint disease and osteoarthritis of the knee. However, without ever examining Ms. L, he made a credibility determination regarding the severity of her pain. He stated that “[m]illions of patients have pain and continue to work in a modified aspect of their job or find a new one.” The Court recognized that without having physically examined Ms. L, “such a dismissive statement cannot be a basis for negating the severity of her pain.”

Dr. Marella also implied in his report that Ms. L may have been faking or being deceitful about her condition or its severity. He stated, “even without being a malingerer, she may have other reasons she feels she cannot return to work and these may not be factual or accurate.” The medical records provided various tests and office notes which confirmed her pain complaints, even though the extent of her pain cannot be quantified. Dr. Marella acknowledges the references in the records regarding Ms. L’s pain, fatigue, and neuropathy, and also states that he could not decipher some of the treating physician’s notes.

Where this dispute existed regarding the severity of Ms. L’s pain and whether it impaired her ability to work, Liberty Life could have performed a physical examination of Ms. L to obtain a more accurate assessment. However, the Court noted that it chose not to and instead made its own determination regarding the severity of her symptoms based “on a review of medical records that Dr. Marella found difficult to read. That necessarily involved a credibility determination.”

Ms. L’s credibility was also questioned regarding the severity of her diabetes and how, if at all, it affected her ability to work. Her treating physician maintained that Ms. L’s insulin-dependent diabetes aggravated her other medication conditions and that it was “the sum total of all her medical problems that can be related as severe.” However, Dr. Marella opined, based on his review of the paper records, that Ms. L’s diabetes was not disabling and that “[m]illions of patients have diabetes and very few require any degree of work restrictions.” Again, without having physically examined Ms. L, Dr. Marella made a credibility determination regarding the effect of her insulin-dependent diabetes.

The Court orders a remand back to Liberty Life

The Court noted that it conducted a thorough review of the administrative record and could not single out any objective medical evidence that Liberty Life relied on in its denial of benefits that did not involve some “material element of a credibility determination.” As such, Liberty Life did not perform a full and fair review of Ms. L’s claim and its decision to deny benefits was arbitrary and capricious. However, because the administrative record was unclear as to whether Ms. L was, in fact, “totally disabled”, the Court determined the proper remedy was to remand the case back to Liberty Life for a full and fair review of Ms. L’s claim for benefits.

Attorneys Dell & Schaefer did not represent Ms. L in her disability claim, appeal or lawsuit. If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, feel free to call Disability Attorneys Dell & Schaefer for a free consultation.


Did you find this helpful?
Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options
Submit a Strong Liberty Mutual Appeal Package

We work with you, your doctors, and other experts to submit a very strong Liberty Mutual appeal.

Learn more

Sue Liberty Mutual

We have filed thousands of disability denial lawsuits in federal Courts nationwide against Liberty Mutual.

Learn more

Protect Your Benefits
Get Your Liberty Mutual Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Liberty Mutual Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Liberty Mutual Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Liberty Mutual Reviews
(0)
Answered Questions by Our Lawyers
(0)
Helpful Videos
(861)
Showing 12 of 861 Videos
Disability Benefit Tips
(329)
Showing 8 of 329 Benefit Tips

Gregory Dell and Stephen Jessup discuss their experience in handling Liberty Mutual claims at all stages

Every week we speak to individuals nationwide seeking assistance with Liberty Life Insurance ... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability benefits under a long term disability policy, your medical rec... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many long term disability claimants don't know about (or expect) from the claims re... Read More >

How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults... Read More >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves th... Read More >

Disability Denial Reason #1 – Paper Review & IME

At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny lon... Read More >

How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial

At Dell & Schaefer we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few thi... Read More >

Applying for Standard Disability Benefits? Top 5 Claim Denial Reasons

At Dell & Schaefer, we've helped hundreds of clients recover long term disability benefit... Read More >
Dell Disability Cases
(369)
Showing 8 of 369 Dell Disability Cases

Liberty Mutual Approves Disability Benefits to Senior Vice President

Our client, a former Senior Vice President for a large national corporation, filed for disability after having suffered a massive stroke durin... Read More >

Liberty Mutual Overturns Denial of Disability Benefits Following Submission of an ERISA Appeal

Liberty Mutual Initially Approves Disability Claim After Finding Total Disability From Own OccupationOur client, John, was working as a Ch... Read More >

Liberty Reinstates Long Term Disability Benefits for the Second Time

Our client, a former Liberty Mutual employee, has had a less than ideal experience with Liberty - both as an employee and as a recipient of di... Read More >

Dell Disability Lawyers Successfully Appeals Denial of Benefits to Former Inventory Control Specialist

Pre-disability and initial disability claimOur client contacted us for assistance with her claim against Liberty Mutual after receiving a ... Read More >

Liberty Mutual Twice Denies and Approves Long-term Disability Benefits to IT Systems Analyst with Rheumatoid Arthritis

Our client, Ms. V, had been employed as an IT Systems Analyst with Highmark Blue Shield, one of the ten largest health insurers in the U.S. an... Read More >

After Initially Being Denied Long Term Disability Benefits, Dell Disability Lawyers Gets Former Wal-Mart Employee on Claim with Liberty Mutual

A former employee of Wal-Mart contacted our firm on March 11, 2015. She informed us that she had recently been diagnosed with Multiple Scleros... Read More >
Disability Lawsuit Stories
(764)
Showing 8 of 764 Lawsuit Stories

Court Orders Liberty to Pay LTD Benefits to Plaintiff Who Proved She was Disabled

The case of Spears v. Liberty Life Assurance Company of Boston (Liberty) began when Plaintiff was employed by United Techn... Read More >

8th Circuit Court of Appeal Overturns Award of LTD Benefits for Disabled Walmart Employee

It is important to point out that this case was not handled by Dell & Schaefer. However, we wanted to write about this case as there is mu... Read More >

LTD Claimant's Failure to Submit Timely Appeal Was Fatal to His Disability Insurance Claim

In a recent Florida case not handled by our law firm a claimant’s untimely submission of his ERISA appeal proves fatal to his claim. The cas... Read More >

District Court Affords Greater Weight To SSDI Award Than Surveillance Footage

In Rouleau v. Liberty Life Assurance Company of Boston, plaintiff Michelle Rouleau, a Registered Nurse (RN) for a Hospital, had a history... Read More >

Michigan Court Finds Plaintiff Eligible for Long Term Disability Benefits

In Chamness v. Liberty Life Assurance Company of Boston, plaintiff James Chamness, a board-certified pediatrician who is also a pediatric slee... Read More >

Liberty Mutual Ignores SSDI Approval and Denies LTD Benefits Wrongfully

Thousands of long term disability claimants receive both social security disability benefits ... Read More >

One Year Period to File Lawsuit Following Liberty Life Insurance Denial is Valid

In Webb v. Liberty Life Assurance Company of Boston, Ronald Webb, an employee of Adobe Systems Incorporated, took out several life insurance p... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our lawyers for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability lawyers have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance lawyers that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our lawyers have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We welcome you to contact any of our attorneys for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 700 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our lawyers help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

Do you work in my state?

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.

What are your fees?

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.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, GoToMeeting sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.