Sun Life reinstated LTD benefits after Dell & Schaefer appealed wrongful termination of LTD benefits of registered nurse suffering from rheumatoid arthritis demonstrating Sun Life ignored the overwhelming volume of objective evidence supporting the claim for total disability including their own peer review physician’s opinions that the claimant could not perform sedentary work.
At the time of the onset of the claimant’s disabling symptomology the claimant was employed as a Neonatal Intensive Care Unit nurse. Due to her severe rheumatoid arthritis and other disabling conditions, she was unable to sit or stand for significant periods of time, had extreme difficulty using her hands and fingers for typing and was unable to lift in any capacity, therefore, rendering her disabled from working in a sedentary capacity.
According to the claimant’s treating rheumatologist she had the following restrictions and limitations:
Lifting – Limited to 10 pounds
Sitting – Occasional (up to 33 % of the day)
Walking – Occasional (up to 33 % of the day)
Standing – Occasional (up to 33 % of the day)
Bending – Never
Squatting – Never
Climbing – Never
Twisting – Never
Pushing – Never
Kneeling – Never
Crawling – Never
Reaching – Never
Sun Life’s Board Certified Physician in Physical and Rehabilitation conducted a medical file review of the claim and concurred with her restrictions thus establishing that she does not meet the physical demand level of sedentary work. Sun Life’s physician in his review also states that he felt that the claimant should have the following additional restrictions:
Repetitive simple and hand grasping – Never
Reaching at and below shoulder / desk level – Never
Hand manipulation – Never
Sun Life ignores its own peer review physician’s opinions
Sun Life terminated the claimant’s LTD benefits ignoring the treating physician’s recommendations that she not perform even sedentary work due to the severity of her rheumatoid arthritis, as well as its own peer review physician’s opinions that clearly indicated she was incapable of sedentary work due to severe rheumatoid arthritis. Sun Life claimed in its denial letter that she could work in other occupations such as; a Nurse Consultant, Medical Case Manager, Discharge Planner or Utilization Coordinator on a full-time basis. Based on the permanent restrictions placed on her by her treating physicians as well as Sun life’s peer review doctor, the claimant would not be an eligible candidate for ANY of the positions Sun Life claims she was qualified and capable of performing.
Definition of Sedentary work
Sedentary work requires the ability to lift no more than 10 pounds at a time and occasionally to lift or carry articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met. “Occasionally” means occurring from very little up to one – third of the time, and would generally total no more than about 2 hours of an 8-hour workday. Sitting would generally total about 6 hours of an 8-hour workday.
Lifting/carrying and pushing/pulling: If an individual is unable to lift 10 pounds or occasionally lift and carry items like docket files, ledgers, and small tools throughout the workday, the unskilled sedentary occupational base will be eroded.
Standing and walking: The full range of sedentary work requires that an individual be able to stand and walk for a total of approximately 2 hours during an 8-hour workday.
Sitting: In order to perform a full range of sedentary work, an individual must be able to remain in a seated position for approximately 6 hours of an 8-hour workday, with a morning break, a lunch period, and an afternoon break at approximately 2-hour intervals.
Sun Life is surely well aware of the physical functional requirements for and the definition of “sedentary” capacity as it relates to disability. The fact that Sun Life attempted to represent that it was their peer review physician’s opinion that the claimant could perform “sedentary” level work on a full time basis is evidence that its decision-making process is clearly arbitrary and capricious.
Sun Life eventually overturned its decision to terminate her claim after reviewing the appeal prepared by Attorney Alters of Dell & Schaefer. The claimant received all of her past benefits and is currently on claim.