LINA should be embarrassed and show some respect for a former payroll clerk that had no ability to work due to numerous medical conditions. After litigating for more 4.5 years since her wrongful denial of disability benefits, Ms. Dupree finally received a ruling in her favor from the United States Court of Appeal. LINA fought this disability claim until there were no more courts left for them to appeal to. While, Ms. Dupree eventually won her disability benefits, it is sad that she had to battle for 4.5 years without any payment from LINA. LINA essentially left Ms. Dupree out in the cold. Unfortunately, Dupree’s only remedy is payment of her benefits, interest and attorney fees. This case is a prime example of the wrongful conduct by LINA and the exact reason that punitive damages should be allowed.
The Court of Appeal recently rendered its opinion in the case of Rebecca Dupree v Life Insurance Company of North America (LINA). The plaintiff in this case won judgment against LINA in her challenge with LINA’s denial of her claim for long term disability benefits. LINA appealed against the decisions of the District Court for the Eastern District of North Carolina. Lets take a look at the reasoning of the Appellate Court.
The Facts of the Case Against LINA also known as Cigna Life Insurance Company
The plaintiff Rebecca Dupree was working as a payroll clerk with the Railroad Friction Products Corporation. On October 16th 2006, due to suffering from rheumatoid arthritis, osteoarthritis and fibromyalgia, the plaintiff filed a claim for long term disability benefits with LINA. The plaintiff, in support of her claim, submitted nearly 400 pages of documents to LINA. Nevertheless, LINA denied the plaintiff’s claim for long term disability benefits on November 10th 2006 on the ground that there is a lack of medical evidence of her disability.
The Appeals to LINA
Subsequently on May 7th 2007, the plaintiff appealed to LINA’s decision to deny her claim for long term disability benefit. In her appeal, the plaintiff again submitted additional documentation and testimonials from her attending physicians attesting to her worsening medical condition. The plaintiff’s former employer also submitted a testimonial stating that the plaintiff is “one of the most valuable employees” that had turned to a person “sitting at her desk trying valiantly to work with hands trembling so badly that she could hardly hold a pencil”. After being reviewed by LINA’s in-house physician, the in-house physician concluded that the additional documentation showed “minimal findings” supporting the plaintiff’s claim and recommended rejection of the appeal instead.
Hence on May 31st 2007, LINA upheld its prior decision to deny the plaintiff’s claim for long term disability benefits. The plaintiff made a second appeal to LINA on November 26th 2007. Although supposedly reviewed by an independent board certified rheumatology consultant that was engaged by LINA, the appeal was also rejected on February 15th 2008 on the ground that plaintiff’s doctor’s medical opinions were “not supported”.
The District Court’s Judgment
Following the denial of the appeals, the plaintiff filed a lawsuit against LINA to challenge LINA’s decision to deny her claim for disability benefits. On August 10th 2009, the District Court ruled in favor of the plaintiff and order LINA to:
- To pay the plaintiff’s disability income benefits as provided for under the plan.
- To pay the award of attorneys’ fees to the plaintiff.
Judicial Review by the Court of Appeal
LINA was not satisfied with the decision by the lower court and appealed to the Court of Appeal arguing that the District Court:
- Was wrong in finding that LINA abused its discretion
- Was wrong in requiring LINA to award disability benefits based on the plaintiff’s subjective complaints of pain and not based its decision on objective medical proof.
- Exceeded its discretion in awarding the plaintiff attorney fees.
- Abused its discretion in not ruling that the plaintiff did not exhaust all her administrative remedies. LINA argued that it did not receive a claim from the plaintiff after the 24 months proceeding the expiration period called the “any occupation period”.
The Opinion of the Court of Appeal
The Court of Appeal denied LINA’s appeal and ruled that:
- LINA had abused its discretion as the independent board certified rheumatology consultant conclusion was flawed because no principled reason was provided to justify the denial of the plaintiff’s claim.
- The District Court was not wrong in requiring LINA to take into account the plaintiff’s subjective complaint of pain as it was a common sense interpretation of the language used in plan issued by LINA.
Note: The issue of pain was important as it materially prevented the plaintiff from returning to work. It goes to reason that because of the pain, the plaintiff was indeed disabled and was unable to return to work on a sedentary occupation. Her failure to return to work was not without justification.
With this line of reasoning, the District Court was able to find that LINA had abused its discretion by denying the plaintiff her claim for disability benefits. And because of this abuse of discretion, the District Court could rule for the award of disability benefits to the plaintiff.
Although generally, all administrative remedies must be exhausted before a lawsuit under ERISA can come before the Federal Court here, it was inherently obvious that LINA would also deny the plaintiff’s claim for long term disability benefits under the “any occupation” standard making her claim moot.
The District Court had arrived at the award of attorney fees by applying the “Quesinberry rule” correctly. Hence, the District Court did not exceed its discretion.