Another Federal Court has determined that a long term disability insurance company failed to engage in a reasoned and principled decision making process in the review and consideration of a claimant’s benefits. In determining that United of Omaha failed its obligations under ERISA, a Federal judge denied a motion for summary judgment and remanded the claim to the insurer.
The Court determined that United of Omaha’s interpretation of its policy was inconsistent with its earlier interpretations of the policy, where it had thrice previously determined the claimant to be disabled under the same definition of disability. The claimant, who initially was disabled due to shoulder problems, including tendinitis and impingement in his shoulder, was observed on surveillance which failed to yield any information inconsistent with his disability. United of Omaha also conducted a medical examination, which determined that the claimant should be capable of working a job that required keyboarding for 75% of the time. United of Omaha, through its in house medical personnel, further determined that the claimant provided a lack of effort and engaged in symptom magnification, ultimately determining that the severe pain complaints were not consistent with the lack of medications.
Following this, United of Omaha conducted a vocational evaluation, which created a watered down comparison of the claimant’s occupation and determined that he was able to engage in his “occupation” and terminated benefits. The claimant filed his administrative appeal, which was supported by numerous medical providers, and showed a worsening of his condition. The Court determined that United of Omaha had relied on improper vocational data in arriving at his occupation, and failed to show that his condition had improved since his claim was initially accepted.
Thus, the Court remanded the claim back to United of Omaha for further consideration.
Patel v. United of Omaha