Missouri Court Awards Full Disability Benefits in Mental Nervous Condition Case Against Hartford
Author: Attorney Gregory Dell
This ERISA lawsuit filed in Missouri Federal Court against Hartford is a textbook-like example of how Hartford will go to great lengths to ignore clear-cut medical evidence, including standing behind knowingly faulty and questionable reports from their paid physician file reviewers, as a means to justify denying claims of those who are truly disabled and entitled to benefits under the terms of their Long Term Disability Plan. Although it took nearly 6 years for the Plaintiff to be awarded benefits (he filed his LTD claim in 2007), justice did prevail in the end. The Court was able to clearly pinpoint the numerous inaccuracies in the information that Hartford relied on when making its decision to deny the Plaintiff’s long term disability benefits, and found that the denial decision was arbitrary and capricious. Additionally, the Court found that Hartford failed to follow its own claim handling procedure in the evaluation of the Plaintiff’s claim. This lawsuit was not handled by our law firm.
The Plaintiff in this case, Mr. T, was employed at a University as a Development Director – Planned Giving (fundraiser), which was an executive level, high functioning position. He claimed that his disability resulted from the aggravation of numerous mental and psychological impairments, including depression and anxiety. He was treated by his primary psychiatrist, Dr. Minchin, who diagnosed him with Major Depressive Disorder, recurrent, and noted his symptoms of increased anxiety, poor concentration, low mood and low energy level, as well as major impairment in several areas including work and family relations. Several months after ceasing work at the University, Mr. T took an unskilled labor position as a server at a local Winery. He worked part-time, 20 hours per week, but his hours temporarily increased to 40 hours per week during the Winery’s busy season
Hartford’s initial decision to deny Mr. T’s claim for long term disability benefits was based on a file review performed by licensed psychologist consultant, Dr. Wiger. On appeal, Hartford’s decision to uphold the denial of benefits was based on a file review performed by a peer review psychiatrist, Dr. Rater.
Hartford Failed To Consider The More Detailed And Consistent Reports Of The Claimant’s Treating Physician And Instead Relied On The Inconsistent Reports Of Its Reviewing Physician Consultants
Although ERISA plan administrators are not required to give special weight to the opinions of a claimant’s treating physicians, they may not arbitrarily refuse to credit reliable evidence, i.e., the contrary opinions of a treating physician, without explanation. In this case, Mr. T’s treating physician, Dr. Minchin, repeatedly opined that Mr. T was unable to perform his job duties due to poor concentration, high levels of anxiety, impaired reasoning and judgment.
After the initial denial, Dr. Minchin wrote a letter wherein she stated that, in her medical judgment, Mr. T was unable to perform a number of job-related activities due to serious impairment caused by his current exacerbation of Major Depressive Disorder. Mr. T was unable to influence people in their opinions, attitudes and judgments; his illness has severely impaired his ability to direct, control or plan the activities of others, perform effectively under stress, attain precise set limits, deal with people and make judgments and decisions; he had moderate impairment in expressing personal feelings and working under specific instructions. She further stated that it was her medical judgment, “within medical certainty”, that Mt. T was disabled by his psychiatric illness with respect to performing his prior job duties.
After the denial was upheld, Dr. Minchin wrote a second letter wherein she strongly disagreed with Hartford’s decision. First, she pointed out that Dr. Rater noted in his report that he attempted to contact Dr. Minchin on several occasions and left messages but the calls were never returned. She clarifies that, in fact, she and Dr. Rater spoke on 2 separate occasions. She states that they discussed Mr. T’s mental status at the time of his last appointment, as well as his cognitive abilities with respect to his prior occupation at the University compared to his responsibilities at his job at the Winery. She states that she emphasized the depressive symptoms Mr. T has been experiencing and their negative effect on his cognitive functioning. She clarifies that at no point during her phone conversations with Dr. Rater did she ever opine that Mr. T was capable of performing the job duties of his position at the University, and neither her office notes, nor her phone conversation with Dr. Rater, support Dr. Rater’s conclusion that Mr. T is not experiencing psychiatric restrictions or limitations. She addressed her concerns regarding statements Hartford made regarding Mr. T’s ability to function in his prior occupation and notes that his prior position was an executive level position which required excellent interpersonal skills, reasoning skills, persuasion skills and sound judgment. She compared his current position at the Winery, wherein Mr. T has minimal responsibilities which include, greeting customers, stocking shelves, pouring wine, and wiping down the counter. She notes that when he began orientation for another position at the Winery, he experienced such anxiety that he was unable to finish, his concentration waned considerably and his confidence suffered. She also expressed disapproval that Dr. Rater was willing to offer a clinical opinion regarding Mr. T’s mental status and capabilities without ever examining Mr. T himself.
The Court found that Hartford gave little, if any, weight to Dr. Minchin’s assessments in its review of Mr. T’s claim and instead relied almost entirely on the opinions of its paid physician file reviewers. Further, Hartford did not offer any reasoning for its decision to disregard Mr. Minchin’s opinions. Accordingly, the Court determined that, “Hartford’s failure to address Dr. Minchin’s observations in a meaningful manner rendered its denial of Plaintiff’s claim arbitrary and capricious.”
In its initial review of Mr. T’s claim, Hartford had a file review performed by Dr. Wiger. The Court recognized that Hartford’s reliance on Dr. Wiger’s conclusions initially may be been reasonable. Dr. Wiger concluded that, “There was no evidence of ongoing psychotherapy, nor evidence of more intensive treatment such as psychiatric hospitalizations. There was little evidence of ongoing treatment other than medical management once every three months. This level of treatment is not consistent with a mental health condition causing limitations and restrictions.”
However, Mr. T did, in fact, undergo a psychiatric hospitalization for 3 days in December 2007. Hartford had these hospitalization records in its possession but never provided them to Dr. Wiger for his review and consideration. As such, the Court found that Hartford’s continued reliance on Dr. Wiger’s conclusions without alteration in its subsequent decision was arbitrary and capricious because Dr. Wiger acknowledged that the hospitalization evidence may have changed his opinion.
The Court stated that it found Hartford’s reliance on Dr. Rater’s conclusions “even more troubling.” Dr. Rater provided 3 reports to Hartford. In the first report, he entirely failed to mention his phone conversation with Dr. Minchin and even misrepresents that he attempted to call her, left her messages, and she never returned his calls. In the second report, he acknowledges the phone conversation with Dr. Minchin but states that it did not change his prior opinion that Mr. T was not disabled. In the third report, the Court points out an inconsistency where Dr. Rater states he based his opinion in part on the fact that Mr. T had allegedly devoted time and effort to moving, which he states is “a complicated task with multiple cognitive tasks required.” Dr. Rater reached this conclusion despite having acknowledged that Dr. Minchin, who informed Dr. Rater of the move, had no idea how involved or uninvolved Mr. T was with the planning and execution of the move. Based on all of the inaccuracies and inconsistencies in Dr. Rater’s reports, the Court found that Hartford’s decision to rely on Dr. Rater’s opinion in denying Mr. T’s claim for benefits was arbitrary and capricious, especially considering the consistent opinions of Mr. T’s treating physician.
Hartford Failed To Adhere To Own Claim Handling Procedures And Failed To Evaluate The Non-Exertional Demands Of The Development Director Position
Mr. T states in his Complaint that Hartford failed to follow the procedures of its own claims manual which requires that, in cases where a claimant is claiming disability due to a mental illness, Hartford must consider the “non-exertional demands” of the occupation. The Court notes that, “examples of non-exertional demands include, but are not limited to: repetitive or short cycle work; directing, controlling or planning activities of others; dealing with people; working alone or apart in physical isolation from others; making judgments or decisions.”
Hartford never analyzed whether Mr. T could perform the non-exertional demands of his job, even though Hartford possessed the relevant job description. Instead, the Court notes that Hartford continually relied on the fact that Mr. T was able to work at his job in the Winery to support its denial of Mr. T’s claim. However, Hartford never offered an explanation as to how the 2 jobs could be considered comparable. The Courts notes that Dr. Minchin did provide a comparison of the 2 jobs.
The Court determined that Mr. T’s position as a Development Director was “patently distinguishable” from that of the unskilled labor position of server at a winery. Due to the fact that Hartford relied on Mr. T’s ability to perform the job of server at a winery to determine that he was, therefore, able to perform his job as a Development Director, indicates that Hartford’s decision to deny long term disability benefits was arbitrary and capricious.
The Court granted Mr. T’s Motion for Summary Judgment and denied Hartford’s Motion for Summary Judgment. The Court further awarded Mr. T long-term disability benefits for the full 24 months that were available to him pursuant to the terms of the Plan. Mr. T also requested an award of attorney’s fees and costs. However, the Court deferred ruling on that issue until the proper motions are submitted.
If you have questions regarding your claim for disability benefits with Hartford, or if your disability claim has been denied, feel free to call Disability Attorneys Dell & Schaefer for a free consultation.