A Federal Court in Ohio has issued a decision granting the application of a claimant with a long term disability insurance claim, finding that CIGNA’s denial of the claim was arbitrary and capricious. The Court chastised CIGNA for relying upon isolated office visit notes, one of which noted the claimant was “doing well”. The Court correctly determined that such a statement is merely relative, and that it offered no evidence of the claimant’s ability to work.
The claimant had previous brain surgery, so the term doing well was in regard to the recovery from the procedure, rather than an indication of her overall level of functionality. As noted by the Court, “getting better”, without more, does not equal able to work. This critical point highlighted CIGNA’s selective medical review, and the Court took issue with such conduct.
The Court was also troubled by CIGNA’s vocational review, holding that it failed to properly consider the ability to perform her actual work duties, rather than simply a classification of functional levels, as sedentary. By failing to consider the actual duties performed, and relying upon the generic classification of sedentary, CIGNA acted improperly.
The claimant supported her claim for impairment largely upon the support of co-workers, who articulated the functional deficits and inability to perform her work, without a lot of medical documentation. Nonetheless, the Court was convinced that CIGNA failed to properly evaluate the claim, and that its conduct lacked a “deliberate, principled reasoning process.”
These issues are quite common in our practice, and we often see this type of claim handling conduct, lacking in deliberate, principled reasoning process, which results in unfair denials and terminations of claims for long term disability benefits.
Connors v. CIGNA