• Menu
  • Skip to right header navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

Before Header

Has your disability claim been wrongfully denied or terminated? Call us today for help!  (888) 321-8131

  • Facebook
  • LinkedIn
  • YouTube

OLF Ortiz Law Firm National Disability Attorneys

Ortiz Law Firm is dedicated to helping people recover the disability benefits they deserve. We handle group Long Term Disability (LTD) claims, individual disability insurance policy claims, ERISA disability claims, and Social Security Disability claims.

  • ABOUT US
    • Nick Ortiz
    • Our Team
    • Case Results
    • Testimonials
  • PRACTICE AREAS
    • Long Term Disability
      • Long Term Disability Appeals
      • Long Term Disability Lawsuits
      • Lump Sum Buyouts/Settlements
    • ERISA Disability Claims
    • Individual Disability Insurance
    • Social Security Disability Claims
      • Initial Applications for Social Security Disability
      • Request for Reconsideration
      • Hearing Before an Administrative Law Judge
    • Long Term Care Insurance Claims
    • Personal Injury Claims
  • DISABLING CONDITIONS
    • Long Term Disability
    • Social Security Disability
  • INSURANCE CARRIERS
    • View All
    • Insurance Company Tricks And Tactics
  • RESOURCES
    • Blog
    • eBooks, Guides, and More
    • Lump Sum Disability Buyout Calculator
    • Long Term Disability FAQs
    • Social Security Disability FAQs
    • Long Term Disability Glossary
    • Individual Disability Insurance Policy Analysis
    • Long Term Disability Federal Court Case Summaries
    • Abbreviations in Social Security Disability Claims
  • Search
  • CONTACT

Mobile Menu

Call us today for help!

(888) 321-8131
  • ABOUT US
    • Nick Ortiz
    • Our Team
    • Case Results
    • Testimonials
  • PRACTICE AREAS
    • Long Term Disability
      • Long Term Disability Appeals
      • Long Term Disability Lawsuits
      • Lump Sum Buyouts/Settlements
    • ERISA Disability Claims
    • Individual Disability Insurance
    • Social Security Disability Claims
      • Initial Applications for Social Security Disability
      • Request for Reconsideration
      • Hearing Before an Administrative Law Judge
    • Long Term Care Insurance Claims
    • Personal Injury Claims
  • DISABLING CONDITIONS
    • Long Term Disability
    • Social Security Disability
  • INSURANCE CARRIERS
    • View All
    • Insurance Company Tricks And Tactics
  • RESOURCES
    • Blog
    • eBooks, Guides, and More
    • Lump Sum Disability Buyout Calculator
    • Long Term Disability FAQs
    • Social Security Disability FAQs
    • Long Term Disability Glossary
    • Individual Disability Insurance Policy Analysis
    • Long Term Disability Federal Court Case Summaries
    • Abbreviations in Social Security Disability Claims
  • Search
  • CONTACT
You are here: Home / Case Summary Blog / Christmas v. Sun Life – Court Rules Evidence Plainly Supports Sun Life’s Conclusion

Christmas v. Sun Life – Court Rules Evidence Plainly Supports Sun Life’s Conclusion

April 7, 2020 //  by Ortiz Law Firm//  Leave a Comment

The case Meghan Christmas v. Sun Life Assurance Company of Canada was decided by the U.S. District Court for the District of Connecticut on December 13, 2018.

In this case, Meghan Christmas (“Christmas”), a Manager of Global Solutions Integration for ISGN Corporation, sought Long Term Disability (“LTD”) benefits from Sun Life Assurance Company of Canada (“Sun Life”). Between the years of 2012 and 2015, Christmas was diagnosed with a number of health issues; of those included psoriasis, back and joint pain, fatigue, arthritis, fibromyalgia, and several gastrointestinal issues (more particularly, Crohn’s disease, reflux, and irritable bowel syndrome). She later filed a claim for LTD benefits in 2014, which Sun Life initially denied; Christmas then sought to appeal, which also resulted in a denial. Her pursuit to overturn the denial of her benefits is the crux of this case.

Christmas submitted both medical records and opinion evidence in support of her claim, including two statements from a Dr. Skola dated June 6, 2014, and November 6, 2014, respectively. The June 2014 statement noted her psoriatic arthritis, right and left wrist synovial tenderness, bilateral hand stiffness, foot plantar fasciitis, and low back stiffness. With respect to limitations, Dr. Skola opined that Christmas could not stand or walk at all, could sit for only one to three hours a day, and could drive for only one to three hours a day. He further opined that she was unable to perform “fine manipulating” and restricted her from lifting more than ten pounds. He stated that she was “unable to work due to active psoriatic arthritis” and classified her with a Class 5 rating for her physical impairment rendering her “incapable of minimum (sedentary) activity.” Dr. Skola concluded that Christmas is unable to work within the limitations described in any capacity and that her limitations are permanent.

After denying her initial claim and when Christmas sought to appeal, Sun Life hired National Medical Review, Co. Ltd. (“NMR”) to evaluate and review the records provided by Christmas’ physicians: Dr. Michael Karasik, gastroenterologist, and Dr. Christopher Skola, rheumatologist. NMR’s three physicians, Steven Channick, M.D., David Hoenig, M.D., and D. Dennis Payne, M.D. assessed Christmas’ situation according to their own knowledge and expertise in their respective fields. As a result of those evaluations and in harmony with its initial findings, Sun Life denied Christmas’ appeal for LTD benefits.

The three physicians stated that Christmas’ medical records did not indicate sufficient evidence of her claims for disability. Further, they remarked that there were no major changes to her conditions prior to or after 2014, nor was there enough information to support her grievances, restrictions, or diagnoses. Each of NMR’s physicians explained their findings as follows:

Dr. Steven Channick, Board Certified in Internal Medicine, articulated that Christmas’ records did not point to a diagnosis of Crohn’s disease. Alternatively, he observed that she had irritable bowel syndrome. Though Christmas’ gastroenterologist Dr. Karasik diagnosed her with Crohn’s disease, her second gastroenterologist argued that he was unconvinced that she had Crohn’s. Further, a third gastroenterologist additionally stated that he did not believe Christmas’ symptoms indicated Crohn’s either. Aside from the lack of Crohn’s indicators, Dr. Channick felt that Christmas had “no restrictions needed for the work place other than free ability of bathroom breaks for her IBS symptoms” and “there were no diagnoses that would cause fatigue that would prevent sedentary employment.” Christmas’ own Dr. Karasik previously stated that while she experienced abdominal and joint pain on a daily basis, she did not have any physical limitations.

Dr. Hoenig, Board Certified in Neurology and Pain Medicine, examined Christmas’ records and noted no relevant neurological treatment history or diagnoses during the period in question, no documentation of neurological pathology, and no documentation of neurological deficits. Dr. Hoenig then suggested that Christmas was not limited in full-time sedentary work and that her condition did not “appear to be primarily neurological.” His assertions are supported by Christmas’ records which allege that there were limited neurological examinations during her doctor visits. Further, Christmas’ neurosurgeon Dr. Howard Lantner indicated that while she may have experienced some pain, she had the ability to move about without difficulty overall. Dr. Sharon Katz, a rheumatologist who also examined Christmas, stated that she had a “full range of motion of the cervical spine. No tenderness with palpitation of the vertebral column. No sign of synovitis.”

Dr. D. Dennis Payne, Board Certified in Internal Medicine and Rheumatology, opined that there was no diagnosis of a rheumatological condition which would prevent Christmas from working or would limit her functionality. Further Christmas’ lab results and medical records did not support a rheumatological diagnosis. Though Christmas saw Dr. Skola and Dr. Katz, they both indicated that she had a full range of motion and that she appeared to be comfortable and without distress.

In sum, the Court held that Sun Life’s reliance upon the three independent reviewing physicians’ assessments when denying Christmas’s claim for LTD benefits, was not arbitrary and capricious: “Indeed, these assessments and the medical records that they were based upon provide well more than substantial evidence to support Sun Life’s denial of benefits.”

The Court further rejected several arguments set forth by Christmas. First, Christmas argued that the requirement of objective proof is not included as a requisite under the Plan and therefore cannot be a basis upon which benefits are denied. The Court rejected this argument, stating bluntly “she is incorrect”.

“’[I]t is not unreasonable for ERISA plan administrators to accord weight to objective evidence that claimant’s medical ailments are debilitating in order to guard against fraudulent of unsupported claims of disability.’ [citation for quotation omitted]. Thus, Sun Life is entitled to require Plan participants to submit objective medical evidence to support a claim of total disability.”

Christmas also argued that Sun Life should have requested an Independent Medical Examination (“IME”) of her and that its failure to do so was arbitrary and capricious. The Court rejected this argument as well.

“The Second Circuit has held that “requiring the plan administrator to order an IME, despite the absence of objective evidence supporting the applicant’s claim for benefits, risks casting doubt upon, and inhibiting ‘the commonplace practice of doctors arriving at professional opinions after reviewing medical files,’ which reduces the ‘financial burden of conducting repetitive tests and examinations.’” [citation omitted] Thus, in the absence of objective medical evidence to support a claimant’s disability, the plan administrator is not required to request an IME and the failure to do so is not considered arbitrary and capricious.”

This quote summarizes the Court’s overall opinion of the case: “As discussed above, the objective evidence plainly supports Sun Life’s conclusion that Christmas was not disabled.” As a result, the court granted judgment in favor of Sun Life and against Christmas.

[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: Christmas v. Sun Life

FacebookTweetPinLinkedInPrintEmail

Category: Case Summary Blog, Long Term DisabilityTag: Sun Life

Recent Posts

  • How to Win a Long Term Disability Appeal: Do’s and Don’ts
  • 3 Steps You Must Take Right Now If Your LTD Benefits Are Terminated!
  • Leveraging the Grid Rules to Secure SSDI Benefits After Age 50
  • What Is an On-The-Record Decision in a Social Security Disability Claim?
  • Understanding the Difference Between Diagnosis and Functional Impairment in Long Term Disability Claims
Previous Post: « Dawson v. LINA – Court Rules Plaintiff Didn’t Provide Enough Objective Evidence
Next Post: Warner v. Unum – A Claimant Friendly ERISA Federal Court Decision »

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

Top Ten Mistakes That Will Destroy Your Long Term Disability Claim

View All Resources

"I highly recommend Ortiz Law Firm. Very friendly staff. They helped me win my appeal against Liberty Mutual. Thank you all for being the best!!"

Lavanda T.

View All Testimonials

Learn More About Long Term Disability

  • Areas We Serve
  • Frequently Asked Questions
  • Denials and Appeals
  • Your Chances of Getting Approved
  • Medical Eligibility
  • Additional Parts That Do Not Happen in Every Case
  • Medical Conditions That May Qualify
  • Long Term Disability Insurance Carriers
  • Occupations That May Qualify
  • LTD Federal Court Case Summaries

Footer

Contact Us

Our experienced disability law firm is ready to fight for you. Contact us today for a free case evaluation.

(888) 321-8131
316 S Baylen St., Ste 590
Pensacola, FL 32502

  • Email
  • Facebook
  • LinkedIn
  • YouTube

Claims We Handle

  • Group Long Term Disability
  • ERISA Disability Claims
  • Individual Disability Insurance
  • Social Security Disability Claims
  • Long Term Care Insurance
  • Florida Personal Injury

Quick Links

  • About Us
  • Free Resources
  • Client Testimonials
  • Case Results
  • Nationwide Representation
  • Refer a Case

Site Footer

© 2023 Ortiz Law Firm

Sitemap | Disclaimer | Privacy Policy

Share this ArticleLike this article? Email it to a friend!

Email sent!