A Federal Judge in Wisconsin has determined that CUNA Mutual acted arbitrarily and capriciously in denying a claim for long term disability insurance benefits to a claimant suffering from orthopedic problems, including lumbar radiculopathy, degenerative disc disease, and chronic pain. The claimant worked for CUNA Mutual and was seeking benefits under its own Long Term Disability insurance plan.
The Court determined that CUNA Mutual abused its discretion in its handling of the claim, by engaging in conduct which was considered to be arbitrary and capricious. This included the selective review of various medical records, as well as relying upon medical reports that failed to provide any reasoned explanation for not agreeing with the medical support provided by the treating medical providers, and by creating a “moving target” for what documentation would suffice to support the claim and then changing the requirements.
The claimant also argued, unsuccessfully, that it was improper to rely upon the same medical provider’s review for both levels of appeal. The Court did not have an issue with this conduct, but did take issue with the substance of the medical review. While the Court noted that CUNA Mutual was not required to adopt the opinions of the claimant’s doctors, the Court also noted that it was improper to fail to explain why it rejected outright the support offered by the claimant’s doctors. The Court noted that “bare conclusions are not a rationale” in finding problematic the medical review relied upon by CUNA Mutual.
The Court therefore remanded the action for a further, more appropriate review, and permitted Plaintiff to move for his attorneys’ fees and costs.
Clark v. CUNA Mutual