{"id":7436,"date":"2020-04-23T17:11:06","date_gmt":"2020-04-23T22:11:06","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7436"},"modified":"2024-03-04T13:36:26","modified_gmt":"2024-03-04T18:36:26","slug":"shaw-v-lina-plaintiff-refused-to-follow-recommended-treatment-plan","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/shaw-v-lina-plaintiff-refused-to-follow-recommended-treatment-plan\/","title":{"rendered":"Shaw v. LINA – Plaintiff Refused to Follow Recommended Treatment Plan"},"content":{"rendered":"\n

Case Name: <\/strong>Stephanie Shaw v. Life Insurance Company of North America<\/p>\n\n\n\n

Court: <\/strong>United States District Court for the Central District of California<\/p>\n\n\n\n

Type of Claim:\u00a0<\/strong>Long-Term Disability<\/a><\/p>\n\n\n\n

Insurance Company: <\/strong>Life Insurance Company of North America (\u201cLINA\u201d)<\/a><\/p>\n\n\n\n

Claimant\u2019s Employer: <\/strong>Colony Advisors, LLC<\/p>\n\n\n\n

Claimant\u2019s Occupation \/ Job Position: <\/strong>Legal Assistant<\/p>\n\n\n\n

Disabilities: <\/strong>Severe anxiety<\/a>, depression<\/a>, sleeping problems<\/a>, tachycardia, and headaches.<\/p>\n\n\n\n

Definition of Disability: <\/strong>Under the Plan, an employee is considered disabled and entitled to payments if, \u201csolely because of Injury or Sickness, he or she is (1) unable to perform the material duties<\/a> of his or her Regular Occupation; and (2) unable to earn 80% or more of his or her indexed earnings from working in his or her Regular Occupation.\u201d<\/p>\n\n\n\n

An employee\u2019s \u201cRegular Occupation\u201d is \u201c[t]he occupation the Employee routinely performs at the time the Disability begins. In evaluating the Disability, the Insurance Company will consider the duties of the occupation as it is normally performed in the general labor market in the national economy. It is not work tasks that are performed for a specific employer or at a specific location.\u201d<\/p>\n\n\n\n

The Plan also provides that \u201c[a]fter Disability benefits have been payable for 24 months, the Employee is considered Disabled if, solely due to Injury or Sickness, he or she is: (1) unable to perform the material duties of any occupation for which he or she is, or may reasonably become, qualified based on education, training or experience; and (2) unable to earn 60% or more of his or her Indexed Earnings.\u201d<\/p>\n\n\n\n

Benefits Paid?\u00a0<\/strong>No. Benefits were never approved. The claimant exhausted her administrative appeals with LINA.<\/p>\n\n\n\n

Issues:\u00a0<\/strong>(1) Whether the Court should consider evidence that was outside the administrative claim file: \u201cLINA requests the Court take judicial notice of (1) the civil Complaint in Stephanie Shaw v. Colony Advisors, LLC, et al., Los Angeles Superior Court Case No. BC500153, filed January 30, 2013; and (2) the Confidential Separation Agreement and General Release, which memorializes the parties\u2019 settlement in that case.\u201d<\/p>\n\n\n\n

(2) Whether the claimant provided \u201csatisfactory proof\u201d of disability: the claimant must proffer evidence that she has a relevant diagnosis and that the illness or injury precludes her from performing the tasks required by her regular occupation.<\/p>\n\n\n\n

(3) The claimant asks the Court to give significant weight to the opinions of her treating physicians, particularly Dr. Levy.<\/p>\n\n\n\n

(4) Whether the claimant\u2019s failure to follow a recommended treatment plan is sufficient to deny a disability claim.<\/p>\n\n\n\n

Holdings: <\/strong>(1) \u201cThe court thus declines to expand the administrative record to consider the complaint and settlement agreement in Shaw\u2019s suit against her employer at the present time.\u201d<\/p>\n\n\n\n

(2) Under the policy, Shaw was required to provide \u201csatisfactory proof\u201d that she was unable to perform the material duties of her regular occupation solely because of injury or sickness. She was also required to provide \u201cany information or documents needed to determine whether benefits [were] payable.\u201d The Court held, \u201cIn sum, the medical information in the administrative record is not sufficient to satisfy Shaw\u2019s burden of showing by a preponderance of the evidence that she was unable to perform the material duties of her regular occupation. The medical evidence is conclusory and inadequate to determine Shaw\u2019s occupational abilities.\u201d <\/p>\n\n\n\n

The Court also considered other non-medical evidence: \u201cThe administrative record contains several other pieces of evidence that the parties cite to prove or disprove Shaw\u2019s entitlement to disability benefits; none, however, is ultimately persuasive. \u2026 In addition to medical records, Shaw included with her appeal a narrative statement concerning her symptoms as well as letters from her family and friends. These letters paint a more dramatic picture of Shaw\u2019s condition than the medical records, and describe the impact Shaw\u2019s mental illness has had on her personality and lifestyle. While the Court does not doubt that Shaw struggles with symptoms of her condition, ultimately it cannot rely on these narratives to find that Shaw is entitled to disability benefits.\u201d<\/p>\n\n\n\n

(3) \u201cThe records supply little, if any, evidence \u2013 beyond Dr. Levy\u2019s word \u2013 that Shaw was unable to perform the duties of her regular occupation. Nor do his reports include any descriptive or objective information that would support such a finding. Given the potential for bias, Dr. Levy\u2019s assessment alone is not sufficient to support a finding of disability.\u201d<\/p>\n\n\n\n

(4) \u201cDr. Eroshevich\u2019s records also show that Shaw refused psychiatric medication, requested alternative and holistic treatments, and was not motivated to comply fully with Dr. Eroshevich\u2019s treatment plan. \u2026 Courts discredit a plaintiff\u2019s subjective belief that she is disabled if she refuses treatment or is not diligent in following a treatment plan that could alleviate her symptoms. \u2026 Shaw\u2019s failure to comply with recommended treatment plans and her refusal to seek certain types of treatment do not preclude her from demonstrating that she was disabled and entitled to benefits. Rather, they are factors to weigh in assessing credibility, and carry more or less weight depending on her diagnosis and her reasons for failing to follow recommended treatments. \u2026 Here, the record contains no evidence as to why Shaw refused psychotropic medications. Nor is there any particular explanation as to why she declined to follow the treatment plan Dr. Eroshevich prescribed\u2026 .\u201d<\/p>\n\n\n\n

Summary: <\/strong>The Court granted Defendant LINA\u2019s Motion for Summary Judgment: \u201cIn sum, the medical reports in the administrative record are not sufficient to show by a preponderance of the evidence that Shaw was unable to perform the material duties of her regular occupation. The only reports that support her claim are conclusory, and provide insufficient information concerning Shaw\u2019s functional capacity.\u201d<\/p>\n\n\n\n

Disclaimer: This case was not 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.<\/p>\n\n\n\n

Here is a PDF copy of the decision: Shaw v. LINA<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

In this case, the medical reports in the administrative record were not sufficient to show by a preponderance of the evidence that Shaw was unable to perform the material duties of her regular occupation. The only reports that supported her claim were conclusory, and provide insufficient information concerning Shaw\u2019s functional capacity.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[253],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7436"}],"collection":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/comments?post=7436"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7436\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=7436"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=7436"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=7436"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}