A Minnesota Federal Court recently ruled against a claimant and in favor of the employer with regards to disability benefits. This case is a poignant reminder that even after being on claim for nearly 7 years, a claimant can be denied at any time. It further shows why it is important to have your claim sufficiently supported with evidence from your treating physician whether the claim administer requests it or not. Let’s take a closer look at the case of Richard P. v. Kohler Co.
The case involved Richard P., a former Kohler employee, who alleged that the company wrongfully terminated his long-term disability benefits in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) and breached its contract with Richard P.
Ruling on Motions for Summary Judgments by both parties, the district court ruled as follow:
- Granted Kohler’s Motion for Summary Judgment;
- Granted Summary Judgment in favor of Kohler on the ERISA claim; and
- Denied Richard P.’s Motion for Summary Judgment.
Background of the Case
Richard P. worked for Kohler as a full-time cabinet installer from September 13, 1998 until 2003 and qualified for Kohler’s disability benefits plans through an employee plan. Richard P. underwent surgery to repair a torn meniscus in 2003, and when he tried to return to work was unable to do so. His symptoms at the time included “lightheadedness, dizziness, fatigue, headaches, shortness of breath, double vision (diploia), droopy eyelids, and facial numbness.” He was diagnosed by his treating physician with “weakness and diplopia,” ceased working, and applied for and was awarded disability benefits. Over the next few years, Richard P. was examined and treated by an ophthalmologist for his headaches and visual disturbances and five neurologists for postural headache syndrome, postural orthostatic tachycardia syndrome (a diagnosis that was not confirmed at the time or since), and a decrease in blood pressure upon standing.
By 2005, Richard P. was provided with an Attending Physician’s Medical Report that reported that his blood pressure problem had been resolved but diagnosed Richard P. with “diabetic polyneuropathy, diplopia, orthostatic hypotension, and orthostatic headaches,” and stated that Richard P. might be “a suitable candidate for sedentary work.” However, by January 23, 2006, the same attending physician provided Kohler with a Disability Plan Attending Physician’s statement” in which he reported that Richard P.’s condition was unchanged and that he was not “a suitable candidate for any type of work. He backed this claim up in similar reports in 2006, 2007, 2008 and 2009.
Claimant Displays Additional Symptoms
In 2007, Richard P. again saw his treating physician for back pain. An MRI at that time revealed that Richard P. had “severe stenosis,” which was treated with laminectomy with decompression and reconditioning and core stabilization. After this 2007 exam, Richard P.’s medical records do not reveal any mention of headaches. In 2010, Richard P. went to his doctor for a diabetes follow-up appointment and his doctor recommended that he increase his activities, no mention of headaches was mentioned in the medical notes related to this visit.
Richard P. received short term disability from 2003 until 2004, at which time, he was awarded long term disability benefits. Then, in 2005 after initially being denied Social Security Disability (SSD) benefits in 2004, Richard P. began receiving SSDI benefits as well.(Does being awarded SSDI benefits guarantee your approval of LTD benefits?) In 2005, Kohler informed Richard P. that it was terminating his benefits. Shortly thereafter, Richard P.’s benefits were reinstated upon appeal and the favorable determination from the Social Security Administration concerning Richard P. In 2009, Richard P. was required to update Kohler and informed the company that he engaged in “gardening, fishing and hunting” occasionally, but continued to tire easily. Soon after, in 2010 Richard P.’s benefits were terminated, his appeals were exhausted, and with the help of his attorney filed the lawsuit against his employer.
Summary Judgment Proves Fatal to Minnesota Claimant’s Case
Agreeing that Richard P.’s case could be ruled on summary judgment standards and that Richard P’s “disability must be medically verified and satisfactory to the Company,” the Court was asked to consider that Kohler “committed a serious procedural irregularity by failing to utilize a specialist” to review the case. Unfortunately Richard P. and his Minnesota disability lawyer were disappointed to find that the Judge, finding that Richard P.’s various diagnoses were not “uncommon” nor required the treatment of a specialist, that Kohler did not need to have Richard P.’s claim reviewed by a neurologist as the two insisted in Richard P.’s complaint. And, since Kohler never disputed the medical findings of Richard P.’s neurologist, but rather disputed that after 2010 Richard P. was no longer totally disabled, the court had little to consider and ruled that a “reasonable person could have reached a similar decision” as that of Kohler. Stating numerous cases in Richard P.’s summary judgment brief, his disability attorney filed to convince the court that Kohler abused its discretion, made its decision under a conflict of interest, was capricious and arbitrary. Thus, according to the US District Court of Minnesota, Richard P.’s claim was properly evaluated and acted upon by Kohler.