Sandra Mikolajczyk, an employee of ABN AMBRO North America Inc., was awarded disability benefits for her depression, fatigue, chronic C6 radiculopathy, carpel tunnel syndrome, cholloid brain cyst, multivalve prolapse, cervical disc surgery, anterior cervical neural decompression and other disorders. Ms. Mikolajczyk was insured by her company’s group disability policy with Broadspire Services, Inc.
After two years of benefits, Broadspire terminated Ms. Mikolajczyk’s coverage. Prior to canceling Ms. Mikolajczyk’s benefits, Broadspire had select documents from her medical record reviewed by Dr. Vaughn Cohen. Dr. Cohen determined that Ms. Mikolajczyk lacked functional impairment that prevented her from working as a bank branch manager. Broadspire physician, Dr. Jamie Wancier, conducted a medical record review and found Ms. Mikolajczyk able to perform full-time sedentary work. Ms. Mikolajczyk promptly filed suit seeking benefits under the Employee Retirement Income Security Act (ERISA).
Judge Katz of the Northern District of Ohio stated that Broadspire “relied on document reviews that were incomplete and went against the weight of the administrative evidence”. Judge Katz further noted that “Broadspire’s refusal to conduct a physical examination, even when tests were recommended by its own reviewing physician, is another factor that weighs against the reasonableness of defendant’s denial of benefits.” Lastly, the court held that Broadspire should have considered the favorable award of social security disability benefits. Broadspire was ordered to pay disability benefits.
Opinion available at Sandra Mikolajczyk v. Broadspire Services Inc., No. 3:05-CV-7039, N.D. Ohio.