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Medical opinion by treating physician unreliable and unsupported by objective test

Citation: Reffkin v. N.Y. Life Ins., No. C 04-04953 CRB, 2005 U.S. Dist. LEXIS 19732, (N.D. Cal. Aug. 29, 2005).

Ruth Reffkin worked as an associate general manager for New York Life Insurance Company (hereinafter “N.Y. Life”) and was covered under the company’s group long-term disability plan. In 1994, Ms. Reffkin stopped working because she suffered from “occupationally induced asthma,” and “sick building syndrome.”

Upon receipt of Ms. Reffkin’s claim, N.Y. Life paid her benefits from May 1995 through August 1995, while her office building was being remodeled, and again from 1996 until 2004, when N.Y. Life determined that she was no longer totally disabled.

Disagreeing with N.Y. Life’s decision to terminate benefits, Ms. Reffkin brought suit seeking reinstatement of her benefits. Specifically, Ms. Reffkin claimed that her medical records support a finding that she is unable to work in an office environment. After reviewing Ms. Reffkin’s case, the judge found that the medical records produced by Ms. Reffkin’s treating physician, were not reliable. The judge found that there was no objective medical evidence to support Dr. Tufft’s opinion that Ms. Reffkin cannot work in an office environment. Moreover, the judge discredited Dr. Tufft’s medical opinion because of inconsistencies found in his medical recommendations concerning Ms. Reffkin’s ability to work. The judge found that Dr. Tufft’s inconsistent recommendations were without explanation and without additional tests that could not be relied upon. Moreover, the judge found that if Ms. Reffkin’s condition was as bad as Dr. Tufft’s assessment, at the very least, Ms. Reffkin should have been regularly treated by specialists, such as a pulmonologist or occupational health physician. Moreover, Ms. Reffkin’s claim file was devoid of any other treating physicians, aside from Dr. Tufft.



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