A federal Court in Michigan has reversed the decision of a Long Term Disability Insurance company, Liberty Life, who denied a claim for long term disability insurance benefits, for a claimant who suffered from significant orthopedic problems, including lumbar degenerative disc disease, lumbar facet arthropathy, lumbar stenosis and cervical disc disease. Liberty Life denied the claim on the basis of a purported lack of objective evidence, ignoring the various MRIs and clinical examinations.
Liberty Life relied upon doctors provided by its vendor, MLS, a company well known in the insurance community as pandering to insurance companies. In this case, Liberty Life relied upon Dr. Judith Esman, another regularly engaged doctor for MLS, who formed her opinions without the benefit of any actual examination of the claimant. Instead, she formed her opinion solely upon the review of records. Liberty Life’s doctors rejected the subjective elements of pain when considering the level of functional impairment.
In determining that Liberty Life’s decision must be reversed, the Court took the doctor’s report to task for its credibility determinations made on the paper records, rather than through an examination or evaluation. The Court found this conduct to be evidence that the claim was improperly denied.
The Court thus ordered the payment of the claim, along with interest, costs and attorneys’ fees.
Pierzynski v. Liberty Life