In Anderson-Posey v. Unum Life Insurance Company of America, plaintiff Traselynn Anderson-Posey, a CVS pharmacist, tripped, fell and injured her coccyx. The next day, June 21, 2013, she visited her primary care doctor, Dr. Hunter. Plaintiff complained of severe pain and an inability to sit down. Hunter prescribed narcotics and, when an x-ray showed a fracture, Hunter referred Plaintiff to Dr. White, a pain management specialist.
White performed a coccyx repositioning treatment and a ligament injection designed to relieve her pain. Neither treatment worked and she continued on narcotics. She returned to Dr. Hunter for follow-up. Hunter sent a letter to Unum stating that “plaintiff was unable to work while on controlled substances.” Over the next few months, plaintiff saw a neurosurgeon, Dr. Baird, who treated her with injections that were not helpful. She remained on narcotics. Unum finally approved her claim for long-term disability benefits in January 2014.
In May 2014, Unum terminated her benefits after a nurse reviewed her records and noted that plaintiff had renewed her pharmacy license and was still driving her car. If she could do those two things, the nurse opined that she could return to work as a pharmacist. Plaintiff appealed.
On appeal, plaintiff’s medical record was reviewed by two consulting physicians who determined that there was no evidence in the record that taking narcotics impaired her cognitive ability. A third consultants stated that there was nothing in the record to support that she suffered from a condition requiring pain management with narcotics. Therefore, she could return to work.
After exhausting her administrative remedies, Plaintiff filed this ERISA lawsuit. The Oklahoma Federal District Court found that Unum’s denial of long-term disability benefits was arbitrary and capricious. The Court said it is clear that taking narcotics would impair the ability of the plaintiff to perform her duties as a pharmacist. The Court remanded to Unum for further investigation concerning whether plaintiff’s condition required the taking of narcotics.
Narcotic Pain Medication Impairs Cognitive Functioning
The Court almost scoffed at Unum, stating that “defendant’s decision that plaintiff could work as a pharmacist while on narcotics is unreasonable.” The Court cited the Oklahoma Administrative Code which states it is an ethical violation for a pharmacist to work while on narcotics. The Court stated that “common sense dictates that a pharmacist working with any narcotics in her system is not practicing with reasonable skill or safety. Working as a pharmacist takes a great deal of reasoning and cognitive focus…the consequences of error include serious injury and death.”
The Court also found plaintiff’s medical record replete with evidence that the narcotics interfered with her cognitive ability to perform. The renewal of her license meant nothing about her functioning, only that she wanted to keep “her license up to date so she could return to work as soon as she was off narcotics.”
The Court concluded that Unum’s “decision that she could return to work as a pharmacist while on narcotics was arbitrary and capricious because it was unreasonable and not supported by substantial evidence.”
Case Remanded for Further Inquiry About Whether Plaintiff Required Narcotics
One Unum consulting physician stated that the record did not show plaintiff suffered from a disabling condition that required a narcotic regimen. The Court held that one opinion was not enough evidence for “a reasonable mind to accept it as adequate support for defendant’s decision.” The Court remanded for Unum to fully investigate whether or not Plaintiff suffered a disabling condition and to allow Plaintiff the opportunity to respond.
This case was not handled by our office, but we believe it can provide guidance for those in similar situations. If you have any questions about this case or your own quest for disability benefits, contact any of our attorneys at Dell & Schaefer for a free consultation.