In Mozdzierz v. Aetna Life Insurance Company, the plaintiff (claimant) seeks disability benefits from Aetna, the insurer of his ERISA-governed long term disability plan. The Federal District Court (for the Eastern District of Pennsylvania) found that Aetna did not abuse its discretion in denying plaintiff’s claim based upon the record. In other words, Aetna’s denial of benefits was upheld.
It is a relatively standard court opinion. However, it is worth noting here because of the court’s discussion on the use of video surveillance in the evaluation of a long term disability claim.
Use of Video Surveillance in a Long Term Disability Claim
In Mozdzierz, the Plaintiff demonstrated poor performance on the functional capability evaluation, and there was significant evidence – both from his treating physicians and Defendant’s independent medical reviewers – suggesting that Plaintiff may be exaggerating his condition. Because of this, Aetna obtained video surveillance of the claimant doing some pretty heavy duty yard work. The court found that such surveillance is significant support for denying a plaintiff’s claim:
As mentioned above, Defendant’s decision finds significant support in the surveillance video itself. The video depicts activity levels inconsistent with a claim of total disability. Surveillance is a legitimate investigatory tool used by plan administrators. Russell v. Paul Revere Life Ins. Co., 288 F.3d 78, 81 (3d Cir. 2002). Courts are reluctant to find a benefits termination to be arbitrary and capricious where a surveillance video “indicates that a claimant’s physical limitations do not match either his own description of his limitation or the opinions of his treating physicians.” Eppley, 789 F. Supp. 2d at 573. The surveillance video of Plaintiff shows him performing strenuous activities in his yard, including raking, digging, and mending a fence. He is seen bending, kneeling, walking, and lifting without any problems. Although not dispositive of the question of whether or not he is capable of performing the sedentary occupation of computer programmer, the video does not support his claims of total disability and of an inability to sit and drive longer than ten minutes. The surveillance video is part of a record that, when viewed as a whole, calls into serious question Plaintiff’s claims. Nothing contained in the Administrative Record, or in the initial termination letter or subsequent appeal denial letters, suggest that Defendant relied upon the surveillance video alone in terminating Plaintiff’s disability benefits. The surveillance video did, however, provide Defendant with additional proof to conclude Plaintiff did not meet the definition of “totally disabled” under the Plan, when viewed along with all of the available medical information.
If you have a long term disability claim and you have questions about the use of video surveillance in your claim, contact long term disability attorney Nick A. Ortiz for a free case evaluation at (888) 321-8131.
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.
Here is a PDF copy of the decision:
