Opinions of Treating Physicians May Be Afforded Greater Weight in LTD Claims- USDC Arizona

The Opinions of Treating, Examining Physicians May Be Afforded Greater Weight Than Those of Nontreating Physicians in Long Term Disability Claims

Case Name: Brown v. Life Insurance Company of North America

Court: United States District Court for the District of Arizona.

Type of Claim: Long Term Disability.

Insurance Company: Life Insurance Company of North America (LINA).

Disabilities: Complex Regional Pain Syndrome (CRPS), frequently referred to as Reflex Sympathetic Dystrophy (RSD); Nutcracker Syndrome; connective tissue disease; an autoimmune ailment diagnosed as scleraderma; and lupus.

Benefits Paid? Yes. During two year “own occupation” period. Benefits cut-off after two years with transition to “own occupation”.

Issues: Whether the Court could afford a greater weight to the opinions of a claimant’s treating examining physicians over those of nontreating, nonexamining physician opinions.

Summary: In Brown, the Plaintiff sought Long Term Disability benefits with LINA. Three of the Plaintiff’s treating physicians opined that she is disabled and those opinions were uncontroverted. The United States District Court for the District of Arizona found that LINA wrongfully denied plaintiff benefits, and granted the plaintiff judgment with an award of retroactive benefits.

The District Court evaluated plaintiff’s claim under a de novo standard rather than a deferential standard of review. In so doing, the court determined that the opinions of plaintiff’s treating physicians should carry more weight than the opinions of the non-examining reviewing doctors hired by LINA:

In addition, this Court afforded a greater weight to the opinions of treating examining physicians over those of nontreating, nonexamining opinions. See, e.g., Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 1228 (9th Cir. 2009)(a treating physician’s opinion is entitled to substantial weight in social security disability claims). Further, LINA produced no treating doctor opinions contradicting Plaintiff’s treating physicians and the Court finds no reason to reject the well-considered opinions of her treating physicians, who are in the best position to know their patient. Medical opinions and conclusions of treating physicians are accorded special weight because these physicians are in a unique position to know claimants as individuals, and because the continuity of their dealings with claimants enhances their ability to assess the claimants’ problems. See, Embrey v. Bowen, 849 F.2d 418, 421-22 (9th Cir. 1988). The fact is that three of Plaintiff’s treating physicians opined that she is disabled and those opinions are uncontroverted; disabled under both definitions of “disabled” under the Plan.

Disclaimer: This was not a case handled by disability attorney Nick A. Ortiz. The court case is summarized here to give readers a better understanding of how Federal Courts decide long term disability ERISA claims.

A complete copy of the decision is embedded below:

 

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