Rheumatoid arthritis, osteoarthritis and fibromyalgia and the cumulative effects they inflict supported a finding of disability and entitlement to disability insurance benefits ruled the Fourth Circuit Court of Appeals recently in DuPerry v. Life Insurance Company of North America.
The court's decision comes nearly 4 1/2 years after the claim was submitted initially. The decision is a textbook illustration of a disability insurance companies efforts to "cherry pick" from the medical records and use those cherry-pick tidbits to try and justify denial of the claim.
The insured, Rebecca DuPerry, work as a payroll and benefits clerk for the Railroad Friction Products Corporation. Through her employment she had a long-term disability insurance policy both administered and underwritten by the Life Insurance Company of North America (LINA). On October 16, 2006, she filed a claim for disability insurance benefit, claiming that she was disabled because of her rheumatoid arthritis, osteoarthritis and fibromyalgia. She supported medical records as well as opinions and statements from her primary care physician in treating rheumatologist attesting to her limitations and to her occupational disability. Her claim was turned down. The insurance company claimed that it did not have enough diagnostic testing to show the severity of DuPerry's illness.
DuPerry appealed her claim's denial and submitted nearly 400 pages of documents in support of her claim. These included letters from both her treating rheumatologist and her primary care physician, a letter from her former supervisor describing her work ethic as "unsurpassed," a DVD filming her at home, supporting statements from several relatives, her prescription medication list and evidence showing her dependence on family for most common, every-day household chores and her need for assistance simply to walk or move around. Nevertheless, her claim was again denied.
DuPerry appealed again, this time submitting additional records from her primary care physician, her treating rheumatologist, another doctor and a second DVD documenting her condition. The insurance company referred her file for review to Dr. Marc Levesque of the Duke University Medical Center. And again the claim was denied.
Having exhausted the claims appeal process, DuPerry filed suit. The federal district court ruled that the disability insurance company had wrongly denied the claim. This time the insurance company appealed.
The Fourth Circuit viewed the insurance company's attempt to rely on isolated pieces of evidence as unreasonable:
Initially, we note, as a global matter, that the pieces of evidence LINA identifies 10 to show, first, that DuPerry was able to perform, for relatively brief periods, certain task involved in sedentary work and, second, that certain individual diseases and physical problems that afflicted her were not sufficient, in isolation, to render her unable to do such work. However, to perform her job, DuPerry, obviously would be required to do much more than perform a small subset of her duties for a relatively short duration. Moreover, in so doing, she would have to overcome the combined effect of all of the problems caused by her diseases, not just a select few.
The court was also unsympathetic to Dr. Levesque's skepticism regarding the debilitating effects of DuPerry's pain, remarking that "DuPerry produce the only types of evidence a claimant in her situation could produce, her own description of the severity of her subjective symptoms, video showing how she moved in her condition, and her treating physician's opinions that the pain and fatigue rendered her unable to work." The court further noted that the policy contained no provision that precluded DuPerry from relying on her subjective complaints of pain as evidence supporting her disability claim.
The Fourth Circuit also approved the award of attorney's fees quoting approvingly from the District Court that LINA "patently abused the claim review procedure" by "overlooking substantial evidence from [DuPerry's] treating physicians that she was unable to work" and instead relied on "minor inconsistencies in and disingenuous interpretations of these physicians reports." Also, there was value in awarding attorneys fees as a deterrent effect to encourage plan administrators to inquire more meaningfully and fairly and disability claims that rely on subjective complaints of pain.
Robert L. Abell
www.RobertAbellLaw.com
