In Tracia v. Liberty Life Assurance Co., of Boston, despite an extended discussion of the history of the plaintiff’s disability, his various medical conditions, reports of treating physicians and analysis of independent reviewers, the court divided the case into two main issues:
#1- Liberty erred by failing to advise the plaintiff of the type of objective evidence it required in order to consider his claim, and in not giving him an opportunity to provide it;
#2- Liberty made its decision based on flawed peer reviews of Tracia’s medical records.
The court remanded the case to Liberty with instructions to, “identify the type of objective evidence it requires, and Tracia shall be given the opportunity to provide such information prior to Liberty’s reconsideration of his claim.”
Plaintiffs Must Be Informed of the Type of Objective Evidence Which is Required to Support Their Claim That Their Subjective Pain Makes It Impossible to Perform Job Duties
Bruce Tracia worked for Comcast for almost 20 years and was employed there as a Business Account Executive at the time he had surgery on his ankle and became disabled. Liberty initially awarded him disability benefits under the definition that he was disabled from performing the essential duties of his own occupation. When the definition changed to being disabled if unable to perform the duties of “any occupation,” Liberty determined he had not provided objective evidence of a disability and, since it determined he could work at a sedentary position, it denied his request for long term disability benefits.
The Massachusetts federal court clarified the “distinction between requiring objective evidence of the diagnosis, which is impermissible for a condition…that does not lend itself to objective verification, and requiring objective evidence that the plaintiff is unable to work, which is allowed.” Even though it is allowed to require claimants to provide objective evidence of how their subjective pain prevents them from working, the court clarified that “plan participants must be informed of those requirements.” Since Liberty never informed the claimant that he was required to provide evidence, and what type of evidence it was seeking, the court found Liberty’s failure “deprived Tracia of a full and fair review under ERISA.” It remanded to Liberty for further consideration consistent with the court proceedings.
Liberty Erroneously Relied on Flawed Opinions of Reviewing Physicians
Liberty essentially ignored the reports of Tracia’s treating physicians and relied solely on the opinions of two peer reviewers of Tracia’s medical records. Neither reviewer ever met or spoke with Tracia. Although the court acknowledged that plan administrators are not required to give any special weight to the opinions of treating physicians over those of reviewing physicians, when, as here, the reports are relied on to the exclusion of all other conflicting reports of both treating physicians and Liberty’s other peer reviewers, the reliance upon them is “arbitrary and capricious.”
Our office did not handle this case, but we believe it may be helpful to claimant’s who suffer from subjective pain that makes it impossible for them to perform the job duties of any occupation the plan administrator may deem appropriate. If you need assistance with a similar matter, or any other issue regarding your short term or long term disability claim, please contact any of our lawyers for a free consultation.