Liberty Mutual’s denial of LTD benefits to woman with back disorder is reversed by Minnesota Court and affirmed by Appellate Court
Willcox v Liberty Life Assurance Company of Boston is an interesting long term disability insurance case. Theresa Willcox originally brought her disability lawsuit in the U.S. District Court in Minnesota. When Liberty Life determined that she did not qualify to have her short-term disability benefits extended into long-term disability benefits, she made the usual appeals to the decision. Liberty Life made its final decision in May 2006, which led to her disability attorney filing a law suit pursuant to ERISA § 502, 29 U.S.C. § 1132.
Her long-term disability attorney presented the Court with fifteen exhibits, all drawn from publicly available resources. This presented a problem for the Court as ERISA generally does not allow the Court to consider evidence outside the administrative record. At the same time, the exhibits contained material designed to help the Court evaluate whether Willcox had been given a fair hearing – anatomical charts, medical dictionary definitions, journal articles. One exhibit was provided to demonstrate the possibility that a conflict of interest existed. It addressed the qualifications of the neurologist Liberty Life hired to evaluate Willcox’s medical files.
The exhibits presented by her disability attorney did not include any medical data or diagnostic test results that weren’t already present in Willcox’s administrative record. He asked the Court to consider this information. Liberty Life argued that the District Court should allow Liberty Life to offer rebuttal exhibits and remand the case back to the disability plan for administrative review if the Court felt that the exhibits should be accepted into evidence.
So what were these medical exhibits about? They included generic anatomical charts, medical dictionary entries, journal articles, and similar material that would help a claims handler or judge understand what the test results in the medical record revealed.
What were the test results that needed to be understood? There were a series of medical exams designed to evaluate the presence of a condition known as L5 radiculopathy. There were also MRIs and CT scans. This condition causes weakness in the leg, impaired sensation, foot drop and pain. It is caused by compression of the nerve that comes from the L5-S1 segment of the spine.
Why would L5 radiculopathy cause Willcox’s disability? Because of the debilitating pain in her lower left leg that did not respond to surgical options, she could no longer work full-time. Her job was sedentary, but the long hours of sitting caused excruciating pain. Because of the involvement of her spine, walking to relieve her pain was not an option. She was no longer able to fulfill her duties as a claims adjuster for Blue Cross Blue Shield.
What precipitated her disability? She was injured in a car accident in March 2003. She tried the chiropractic route first but had to undergo a spinal diskectomy and fusion in November 2004. After this surgery, she began working part-time from home. The pain in her back resolved, but the L5 radiculopathy did not improve.
Court orders review of medical exhibits.
The District Court chose to order Liberty Life to conduct an initial review of the information that Willcox’s disability attorney had presented to the Court. The disability insurance plan was also ordered to consider more than the 15 exhibits. If Willcox presented more information regarding her disability, Liberty was to consider it.
Willcox added medical records from treatments she underwent in 2006 and 2007, two questionnaires filled out by two of her treating physicians and two witness statements regarding her physical limitations (one statement was her own).
Court ordered review of file results in persistent denial of disability benefits.
Liberty Life retained a different neurologist to review her medical records. This physician concluded that despite the restrictions her condition created in her ability to walk, stand or lift objects, there was no reason to conclude that Willcox was barred from a position as sedentary as an insurance claims adjuster. Liberty Life reaffirmed its decision to deny Willcox’s long-term disability claim.
Willcox took her claim before the District Court once again. After reviewing Liberty Life’s disability determination using the abuse of discretion standard of review, this Minnesota District Court determined that Liberty Life had abused its discretion because it failed to evaluate Willcox’s medical record in its entirety and relied entirely on the shallow medical overview of the neurologist it hired.
When Court reverses disability plan’s decision, Liberty Life appeals.
Liberty Life appealed the lower courts reversal of the claim denial. Liberty Life chose to challenge both the District Court order to reopen Willcox’s claim and its conclusion that Liberty Life had abused its discretion.
When Willcox’s disability attorney and Liberty Life argued before the Court of Appeals, both sides were fully agreed that ERISA governed the disability insurance policy. They also agreed that the proper standard for reviewing Liberty Life’s decision was abuse of discretion, a review that is deferential to Liberty Life.
Liberty Life acknowledged that it had invited remand for consideration of the new evidence presented by Willcox’s disability attorney. Yet, Liberty Life was now arguing that the evidence should not have been considered. Willcox’s disability insurance attorney pointed to the significant difference between the exhibits he had presented to the Court for consideration and other cases where the reviewing courts had refused to consider extra material. In Rittenhouse v. UnitedHealth Group Long Term Disability Ins. Plan and Brown v. Seitz Foods, Inc. Disability Benefit Plan, the evidence had been specific to the plaintiff’s symptoms or diagnosis.
Willcox’s disability attorney pointed to the fact that each exhibit served only one purpose – to assist the court in its ability to interpret complex medical evidence. Each exhibit had been culled from medical publications and websites without thought of its effect on litigation. Considering that in Barnhart v. Unum Life Ins. Co. of Am. the Court had itself gone to public medical sources to establish a fair context for a decision and Vega v. Nat’l Life Ins. Servs., Inc. held that generic materials that assist “the district Court in understanding medical terminology or practice related to a claim would be “¦ admissible.”
The Court of Appeals found that the District Court’s decision to remand review of the new evidence to Liberty Life, instead of taking this upon itself, expressed the appropriate deference due to Liberty Life as the plan administrator. For Liberty Life to then complain that the District Court had abused its discretion by remanding consideration back to the disability insurance plan hinted at the capricious and arbitrary manner in which Liberty Life had handled the claim.
The Court of Appeals looked for any evidence that the District Court had used the additional medical evidence Willcox supplied for the remand to reach its conclusion that Liberty Life had abused its discretion, as this would have been problematic. No such evidence appeared in the District Court’s decision. Rather Liberty Life had clearly abused its discretion during its first review.
Liberty Life had originally sent Willcox’s file for review by an internist. This physician recommended that a neurologist or specialist in physical medicine review the file. Liberty Life then sent the file to a neurologist who listed all the medical records he reviewed. This neurologist’s report was full of errors. He stated that there was “no objective evidence” of radiculopathy, when in fact there were multiple tests demonstrating the symptoms of radiculopathy. He also stated that a nerve block that had provided relief for 24 hours had provided no relief at all.
Court finds disability insurance plan depended on faulty reports.
Based on this faulty report, Liberty Life had denied Willcox’s application for long-term disability benefits. While Liberty Life had no obligation to give more value to the opinions of physicians who had treated her, it was under obligation to weigh the evidence she provided fairly. The neurologist Liberty Mutual hired failed to do this.
When the District Court remanded Willcox’s case back to the disability insurance plan, Liberty Life had a second opportunity to get it right. The second neurologist had the same materials as the first neurologist, yet also stated that there was no evidence to support her claim. This physician also ignored the tests that supported her claim and only considered the tests that were inconclusive. It would appear that both physicians hired by Liberty Life had failed their fiduciary duty by combing the record for evidence to deny Willcox’s claim. The decision reached by Liberty Mutual could be nothing but arbitrary and capricious and an abuse of discretion when it depended upon these doctor’s opinions.
Liberty Life wasted the premiums paid into its disability insurance pool pursuing this appeal. The Court of Appeals affirmed the decision of the District Court. The District Court had neither abused its discretion by doing as Liberty Life suggested by remanding Willcox’s claim for further administrative review, nor had the Court made an error in concluding that Liberty Life had abused its discretion when it relied on medical reviews that ignored medical evidence or misread findings that confirmed Willcox’s disability.