Marybeth M. Donlick (“Donlick”) was employed as a truck driver for Chesapeake Energy Corporation (“Chesapeake”). Through her employment, Donlick received coverage for a long-term disability benefits plan, which was administered by Standard Insurance Company (“Standard”). On August 7, 2012, Donlick was in a motorcycle crash which caused her to have an amputation below her right knee, back wounds, and a left ankle fracture. In December, she filed a claim for long-term disability benefits.
On January 16, 2013, Standard granted Donlick long-term disability benefits. Her approval letter stated that Standard would periodically review Donlick’s eligibility for benefits. After twenty-four months of payments, Standard examined Donlick’s claim under the “any occupation” standard which is defined as:
“any occupation or employment which you are able to perform, whether due to education, training, or experience which is available at one or more locations in the national economy and in which you can be expected to earn at least 60% of your Indexed Predisability Earnings within twelve months following your return to work, regardless of whether you are working in that or any other occupation.”
In order to decide whether Donlick fit the “any occupation” requirement, Standard had an orthopedic physician review her medical records and also sought out a vocational expert. Standard then chose to terminate Donlick’s benefits because it believed that the “any occupation” requirement was not sufficiently met. Donlick appealed, providing a single-page letter and report from a vocational expert which indicated that she was unable to be employed in any occupation.
During the review of the appeal, Standard consulted another orthopedic specialist and a vocational expert. The vocational expert reviewed the medical records but did not agree with the conclusions of the vocational expert’s report. In fact, the vocational expert provided examples of other work that Donlick could perform. On March 15, 2016, Standard affirmed its denial decision, and Donlick then chose to file the present suit.
Donlick argued that Standard gave its experts more weight than the weight of her medical providers, vocation expert, and Social Security Administration’s determination. However, the court believed that she did not have any reason to support her suspicion. Therefore, the court chose not to give any weight to this allegation in its determination as to whether Standard acted in an arbitrary and capricious manner. Instead, the court decided to look to whether Donlick could meet her burden of proving her continued disability.
Donlick initially simply had to prove that she could not perform the “material duties” or her “own occupation.” However, as mentioned before, Standard indicated that it would have to confirm her disability and “[a]fter a period of time the definition of disability may change, which would require a review of [her] claim.” After twenty-four months passed, Donlick then had to prove that she could not perform the “material duties” of “any occupation.”At that point, Standard then asked Donlick to provide it with any information that she would like for it to consider. She subsequently submitted an Education, Training, and Experience form as part of this process.
Next, Standard had a Dr. Joseph Mandiberg review Donlick’s medical records, and he indicated that she was “not a candidate for a medium level occupation in the future” but “[s]he will be capable of performing a sedentary level occupation.” Following this, a Dr. James Roe reviewed Donlick’s files, which involved any updated medical information following Dr. Mandiberg’s review and anything provided to the Social Security Administration such as “multiple other Social Security documents in September and October 2012.”
Dr. Roe cited that Donlick had functional limitations that included problems with walking, standing, bending, balancing, kneeling, crawling, climbing, or walking on uneven surfaces. He did indicate, however, that she would be able to push and pull 1 – 10 pounds frequently, and 11 – 20 pounds on occasion. This also included no limitations regarding hand use such as finger dexterity, simple grasping, pulling, pushing, or fine manipulation. Dr. Roe stated that “[t]he available medical information describes a claimant with a satisfactorily healed right below-knee amputation with a prosthesis that is wearable. The claimant is capable of working full time in a sedentary occupation.” He also indicated that Donlick “is taking no pain mediation, has well-healed wounds over the amputation site, and an x-ray of the leg is considered satisfactory.”
As a result of Dr. Roe’s opinions, Brian Petersen, a Vocational Consultant, provided alternative jobs and duties that Donlick would have been able to perform even with her restrictions. Because of these evaluations, Standard chose to deny Donlick long-term disability benefits. More specifically, the letter sent to Donlick provided that she was capable of performing sedentary work with a few limitations.
At that point, Donlick’s attorney provided additional information in support of the opinion that she is disabled. As a result, Standard obtained a Dr. Rue to conduct an independent medical review and Steve Cooper to conduct an independent vocational review of the existing report. Dr. Rue consulted all available medical records and concluded that Donlick’s
“supported work restrictions would be no restrictions to sitting, keyboarding, fingering or reach at, above or below desk level, limit lift, carry, push and pull to 15 pounds frequently and 20 pounds occasionally, limit bend and twist to occasionally, no climbing, crawling, crouching or kneeling and limit stand/walk to 1 hour at a time combined for a combined total of 3 hours per 8 hour day.”
Following this, Mr. Cooper explained that there were available jobs that would be suitable for Donlick, even with her limitations and restrictions.
Overall, the court decided that because of the above steps that it took, Standard had clearly based its decision-making process on the opinions of Dr. Mandiberg, Dr. Roe, and Dr. Rue, along with independent vocational experts. As a result, it felt that overall, Standard had not acted in an arbitrary and capricious manner when denying Donlick’s long-term disability benefits. Therefore, the court ruled in favor of Standard and against Donlick, affirming the denial of her claim.
[Note: this claim was not handled by the Ortiz Law Firm. It is merely summarized here for a better understanding of how Federal Courts are handling long term disability insurance claims.]Here is a copy of the decision in PDF: