Is Plaintiff Entitled to LTD Benefits When Unable to Work in Any Occupation?
In Tiedel v. Reliance Standard life Insurance Company (Reliance), Plaintiff Tiedel, a full-time flight engineer for Kalitta Air, was in the pilot seat of a single engine plane that crashed in January 1979. He suffered numerous fractures and required surgery. He developed Hepatitis C due to a blood transfusion he received following the accident.
In December 2013, the Hepatitis C recurred and there was a remarkable increase in his viral load. He suffered from weight loss, fatigue, memory lapses, joint pain, and fluctuating blood pressure. These symptoms made it impossible for him to fly planes and he did not pass a requalification exam that was administered on or about March 17, 2014.
Plaintiff began a 12-week treatment for the Hepatitis, but the side effects of this medication, along with the side effects of medications he was taking to control his blood pressure, caused dizziness, tunnel vision, and fatigue. At the advice of his treating physician, Dr. Wagner, Plaintiff voluntarily relinquished his flying privileges while he waited for his health to improve.
Dr. Wagner also wrote to Plaintiff’s employer explaining that the recurrence of the Hepatitis C, along with the side effects of the medications, were the reasons Plaintiff did not pass the requalification exam. Reliance then granted Plaintiff both short-term disability (STD) and long-term disability (LTD) benefits effective March 18, 2014. He was told by letter that to continue receiving benefits, he would need to remain totally disabled.
Reliance terminated Plaintiff’s LTD benefits on March 10, 2015, but on administrative appeal, reinstated his benefits. The letter informing him that the termination of benefits decision was reversed did not explain why it made that decision.
On October 22, 2015, Reliance again terminated Plaintiff’s LTD benefits. The termination letter stated that a “claim specialist concluded that the medical records did not support the conclusion that [Plaintiff] could not perform the material duties of any occupation.” The claims specialist listed several “transferable skills” and for an example, identified one occupation Reliance believed Plaintiff could perform: An Aircraft Log Clerk. The claim specialist relied on a report authored by Carol Vroman called a “Residual Employability Analysis Report.”
Plaintiff filed another appeal. Both Plaintiff and Reliance provided additional reports concerning Plaintiff’ physical and mental abilities. Plaintiff submitted several medical reports supporting his claim.
Reliance required Plaintiff to undergo an IME with Dr. Mandel who provided a report. Reliance also submitted a report from a licensed psychologist who reviewed the opinion of Dr. Harris, Plaintiff’s psychologist.
Reliance then upheld its termination decision and Plaintiff filed this ERISA lawsuit in the U.S. District Court for the Western District of Michigan, Southern Division. The District Court reversed the decision of Reliance and held on April 15, 2020, that Plaintiff had proven he was totally disabled and deserved benefits dating back to the date of the erroneous termination decision of September 17, 2015.
De Novo Standard of Review Applied
Both parties agreed that de novo was the correct standard of review. This means that the Court reviewed the administrative record with a “fresh eye” and gave “no deference or presumption of correctness” to the plan administrator’s decision. The Court noted it was required to give “proper weight to each expert’s opinion in accordance with supporting medical tests and underlying objective findings.”
Relevant Plan Requirements
The plan provisions were fairly common. Plaintiff had the burden of proving he was totally disabled. At the time of the termination, he had to prove he was disabled from performing “any occupation” for which he was qualified based on his education, training, and experience. Reliance agreed that Plaintiff could not perform his job as a flight engineer. Instead, Reliance argued that he was “not so disabled that he cannot perform the material duties of any occupation.”
Although Reliance argued that “Plaintiff’s medical records… do not provide any evidence that would not allow Plaintiff to return to work in a sedentary exertion occupation…” the Court reviewed all the evidence provided by both Reliance and Plaintiff and reversed Reliance’s decision terminating LTD benefits. The Court did not remand the case to Reliance, but instead ordered Reliance to reinstate Plaintiff’s LTD benefits.
The Administrative Medical Record
The District Court conducted an extensive review of the administrative record and noted the weight it gave to each report. The court gave little weight to three letters from Plaintiff’s treating physician Dr. Wagner. The Court found them conclusionary without support by any medical evidence in the record. The Court did rely on medical evidence in the file from Dr. Harris that supported the Court’s finding of disability.
The Court gave short shrift to the report of Dr. Ilka, who was retained by Reliance and who submitted an initial IME report. The Court found this report to be “largely unhelpful to the inquiry” and afforded them “little weight.” This meant little weight was given to the transferable skills report provided by Reliance’s Carol Vroman since she based her report on Dr. Ilka’s conclusion that Plaintiff was capable of sedentary work.
The Court afforded greater weight to the report of Psychologist Harris which was submitted by Plaintiff. Dr. Harris met with Plaintiff twice and conducted six tests. He concluded that the tests provided “objective evidence of impaired speed of information processing, divided attention, short-term recall, and executive function.” Harris concluded that Plaintiff suffered from “neurocognitive dysfunction” with “underlying organic pathology.”
The Court finally concluded: “On this record, as of September 17, 2015, [Plaintiff] could no longer perform the duties of Any Occupation. Accordingly, Reliance should have awarded him long-term disability benefits… Plaintiff Michael Tidal cannot perform the duties of any occupation, as that term is defined in his disability insurance plan… He provided objective medical evidence to show a cognitive impairment and expert opinion evidence that the impairments prevent him from working. The evidence offered by Defendant Reliance Standard Life Insurance does not undermine Tiedel’s evidence.”
This case was not handled by our office, but we feel it may be helpful to claimants who need to prove they are unable to work in any occupation. For questions about this case, or any question concerning your STD or LTD benefits, contact a disability insurance attorney at Dell & Schaefer for a free consultation.
Resources to Help You Win Disability Benefits
Get Your Reliance Standard Disability Application Approved
Prevent a Reliance Standard Disability Benefit Denial
Negotiate a Reliance Standard Lump-Sum Settlement
Our goal is to negotiate the highest possible buyout of your long-term disability policy.
Policy Holder Rating
Reliance Standard denied my LTD benefits because COVID-19 limited my ability to provide proof of continued disability.
Reliance Standard cut off my LTD benefits claiming I'm fit enough to work even though I'm more sick than before.
I was receiving LTD from Reliance Standard due to breast cancer until they suddenly denied me my benefits.
Reliance Standard never answers or returns my calls, has not provided me my benefits, and falsely claims I never provided necessary paperwork.
The appeals process with Reliance Standard is very frustrating. I'm not sure how to get an answer from them.
Reliance Standard is trying to reduce my LTD benefits because of once-a-month work in the military reserve.
Q: Do I have to provide additional proof of my disability that's specifically requested by Reliance Standard?
Q: If I'm not receiving the SSDI benefits for my children from Reliance Standard due to custody, should my SSDI benefits increase?
Reliance Standard overturned its previous denial of long term disability benefits for Texas Retail Store Manager
Reliance Standard overturns decision to deny long-term disability benefits to Paediatrician with Ovarian Cancer
Reliance Standard Reinstates Benefits for Former Employee of Parent Company, Delphi Financial, Following Successful Appeal
Reliance Standard Overturns Denial of Benefits on Appeal After Claiming It Failed to Receive Medical Records
After sending claimant to a psychiatric IME, Reliance Standard realizes its decision to deny benefits was incorrect
Reliance's Termination of Disability Benefits was Arbitrary and Capricious When it Discounted Supporting Medical Evidence Without Reason
District Court Holds That Reliance Standard Did Not Properly Consider Whether Traveling Nurse Could Perform The Material Duties Of Her Regular Occupation
Reviews from Our Clients
Very satisfied with the work of this team. Took well care of my case and took all the necessary time to be responsive and attentive when I had questions. Guided me through recovery and returning to normalcy. All thanks to Jason & Tabitha, thank you!
I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
I could not have been happier or more appreciative of the hard work they performed on my behalf. I was well briefed on my case and it was closed in a timely manner with a financially successful resolution.
Mr. Symonds and Sonia as well as everyone else we have worked with throughout this process have been very helpful, professional and caring to our situation. We are very thankful to have this great team on our side.
Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
I have had nothing but a great experience with Dell Disability Law Firm. Mr. Alex Palamara and his team went above and beyond my expectations. They will respond to emails and phone calls in a timely manner. Thank you once again for taking my case.
This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.