In Filthout v. AT&T Midwest Disability Benefit, et al., plaintiff Rebecca Filthout had worked several years for Michigan Bell Telephone Company as a service representative when she began having chest and back pain. She was initially diagnosed with kidney problems. Her first application for short term benefits under her employee disability insurance policy provided by AT&T Midwest Disability Benefit Plan (AT&T) was granted and she took about a month off of work.
She continued to suffer from chronic back pain and was examined by three different physicians who diagnosed her with lumbar degenerative disease, myofascial strain in the rib area and segmental somatic dysfunction. As a result, she made three additional requests for short term benefits: January 13, to February 23, 2014 (Claim 1); March 3 to April 14, 2014 (Claim 2); and April 16 to May 7, 2014 (Claim 3). AT&T denied all three requests, stating that she had not provided sufficient evidence to prove she could not perform her sedentary job. After exhausting her administrative remedies, she filed an ERISA lawsuit.
A Michigan federal District Court found that for two out of her three requests, AT&T acted in an arbitrary and capricious manner and reversed AT&T’s denial. The Court allowed the decision on Claim 1 to stand in favor of AT&T. The Court relied on the case of Shaw v. AT&T Umbrella Ben. Plan No 1, 795 F.3d. 538 (6th Cir.2015) which was nearly identical to plaintiff Filthout’s. The same issues were raised against the same defendant.
AT&T Ignored Favorable Evidence from Filthaut’s Treating Physicians
In denying plaintiff’s Claim 2, AT&T stated “there was no evidence in the medical record of a functional impairment” and no objective findings to support disability. In fact, plaintiff’s treating physicians had noted she could not ambulate and placed restrictions on her activity.
In rejecting Claim 3, AT&T had “improperly contradicted a treating physician without giving a reason. Although a plan administrator is not required to accept the opinion of treating physicians, a reason must be given when an opinion is contradicted. A reviewing physician acknowledged that a treating physician had placed many restrictions on the work of the plaintiff, but then he ignored the restrictions and stated she could do her “sedentary job without restriction.” No reason was given for ignoring the opinion of the treating physician.
AT&T Selectively Reviewed Evidence from Treating Physicians
AT&T’s reviewing physician selectively reviewed the evidence from the treating physicians by ignoring the conclusions about her musculoskeletal evidence of her pain. Instead they focused on the report of a physician who had ruled out a nephrology issue as the source of her pain. This required reversal of AT&T’s denial of Claim 2.
AT&T Failed to Conduct its Own Physical Evaluation
AT&T’s reviewing physicians determined plaintiff was not credible in reporting her pain symptoms. None of them ever examined her or had a conversation with her. AT&T’s credibility determination was in direct conflict with that of her treating physicians. In circumstances like this, when the plan provides for an independent medical exam (IME), it was arbitrary and capricious for AT&T to make a credibility determination without at least giving Filthout the benefit of an IME.
AT&T Relied Heavily on Non-treating Consultants
Although the Court remained suspect of the denial of plaintiff’s Claim 1, which was based solely on the opinion of a non-treating consultant, and looked at that conclusion “with some skepticism,” it allowed the denial of Claim 1 to stand.
This case was not handled by our office. It may be instructive to those faced with similar issues when their plan administrator seems to be ignoring the reports by treating physicians in favor of the opinion of its own non-treating consultants. If you have any questions about this or any aspect of your own disability case, feel free to call one of our disability attorneys and arrange for a free consultation.