{"id":7449,"date":"2020-04-06T14:40:37","date_gmt":"2020-04-06T19:40:37","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7449"},"modified":"2024-01-04T17:40:49","modified_gmt":"2024-01-04T22:40:49","slug":"bowman-v-reliance-standard-court-rules-denial-not-arbitrary-capricious","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/bowman-v-reliance-standard-court-rules-denial-not-arbitrary-capricious\/","title":{"rendered":"Bowman v. Reliance Standard – Court Rules Denial Not Arbitrary & Capricious"},"content":{"rendered":"

Anthony Bowman (\u201cBowman\u201d) was employed as a Maintenance Mechanic which required the ability to do heavy lifting between fifty and sixty pounds. Injuries throughout his life caused him to have a number of surgeries and resulted in chronic neck<\/a> and back pain<\/a>. Bowman also had issues with a sleep disorder<\/a> and pain medication, which led to problems with concentrating and performing sedentary tasks. As a result of his injuries, Bowman applied for long term disability benefits with Reliance Standard Life Insurance Co.\u00a0(\u201cReliance\u201d)<\/a>.<\/p>\n

Reliance approved the disability application because Bowman could not perform his duties as a Maintenance Mechanic. Subsequently, he was also approved for disability benefits by the Social Security Administration. After a two-year period of paying benefits, Reliance\u2019s policy required a re-evaluation of the long-term disability benefits. The definition of total disability after the two years required that the claimant be unable to perform any job duties, not simply his previous job\u2019s duties.<\/p>\n

At this time, Reliance provided Bowman with a questionnaire and contacted his three physicians: Dr. Cordover, Dr. Connolly, and Dr. DeBerry. Dr. Cordover suggested that Bowman could \u201cperform[] full-time work\u201d with few limitations, but had concerns about \u201crepetitive bending, squatting, stopping, etc.\u201d In addition, a specific part of the questionnaire asked whether Bowman\u2019s medications caused: \u201c(1) no significant effect, (2) some limitations, (3) severe and limiting side effects, or (4) total restriction and inability to function productively.\u201d Dr. Cordover cited that the medications that Bowman was taking caused \u201csevere and limiting side effects.\u201d<\/p>\n

Dr. DeBarry stated that \u201c[i]t has been determined that [Bowman] is disabled . . . and in my opinion has not improved over the past 2-3 years.\u201d He did, however, \u201cdefer all functional capacity evaluations and further prognosis to [Bowman\u2019s] back specialist Dr. Cordover.\u201d Dr. Connolly, Bowman\u2019s doctor who treated him for idiopathic hypersomnia and obstructive sleep apnea, was also contacted but provided no comments on Bowman\u2019s disability level.<\/p>\n

Reliance then decided that while Bowman did have a disability, he was not totally disabled under their definition because he was not unable to work in any capacity. Therefore, Reliance denied Bowman\u2019s claim. Bowman then appealed, and in the meantime, Reliance received information from Dr. Cordover citing Bowman\u2019s \u201cprogressing\u201d neck symptoms, but also citing \u201cno change in [Bowman\u2019s] restrictions or forms that [Dr. Cordover] ha[d] filled out previously.\u201d Reliance then sought to obtain evaluations from a Dr. Denver and Dr. Goldstein, both independent medical examiners<\/a>.<\/p>\n

Dr. Denver reviewed Bowman\u2019s medical files and eventually opined that Bowman was able to perform full-time work with light physical demand, as long as he could change positions every forty minutes. He cited that Bowman\u2019s \u201ccurrent medications . . . do not contribute to any significant limiting physical or cognitive deficits\u201d and that he \u201creports hydrocodone worsens insomnia and dulls his senses[,] but the documentation fails to substantiate significant impairment in cognition or physical function resulting from hydrocodone use.\u201d<\/p>\n

Dr. Goldstein also evaluated Bowman and believed that he would be able to work if he only had issues related to narcolepsy, sleep apnea<\/a>, and hypersomnia. However, he also stated that Bowman could not \u201creturn to his work as [Bowman] described\u201d which meant the Maintenance Mechanic work. Overall, because of these two independent medical examinations, Reliance chose to deny Bowman\u2019s appeal. Bowman then filed the instant suit, arguing that Reliance\u2019s decision was arbitrary and capricious. However, more particularly, the question is whether Bowman is able to do the work of any job or not.<\/p>\n

An arbitrary and capricious \u201cstandard of review does not mean that the plan administrator will prevail on the merits. It means only that the plan administrator\u2019s interpretation of the plan \u2018will not be disturbed if reasonable.\u2019\u201d If \u201cno reasonable basis exists for the decision,\u201d then Reliance\u2019s decision will be considered to have been arbitrary and capricious. Further, \u201c[w]hile an administrator may not arbitrarily ignore relevant medical evidence, it is not arbitrary and capricious to deny a disability claim \u2018on the basis of conflicting, reliable evidence.\u2019\u201d<\/p>\n

Bowman first argued that his treating physicians cited a \u201csubstantial and progressive decline in health,\u201d while Reliance \u201carbitrarily and capriciously relied on a May 2009 claim form to support its contention that it had grounds to deny [his] claim in 2011 . . .\u201d However, the Court held that even though Reliance had reviewed the form, it supplemented that information with the independent medical examiners\u2019 opinions. Therefore, its decision had focused on \u201cthe facts as known to the administrator at the time the decision was made,\u201d and the Court believed that that action was reasonable.<\/p>\n

Secondly, Bowman argued that he had provided \u201csignificant probative evidence\u201d of his disability by citing information from his doctors. However, the Court explained that providing such evidence is not the baseline of what Bowman needed to do to overcome Reliance\u2019s decision. The standard of review that Bowman needed to prove was that he was unable to perform the work of any job. Here, he did not do that.<\/p>\n

Third, Bowman claimed that Reliance had not properly evaluated the effects his medications had. He specifically stated that they \u201caffect his ability to perform work functions, drive to and from work, [and] to stay awake during the workday.\u201d This argument was based on a case called Adams v. Prudential Insurance Company of America<\/em>, where treating physicians completely ignored the claimants\u2019 medications. However, the Court cited that Dr. Denver opined that Bowman\u2019s medications \u201cdo not contribute to any significant limiting physical or cognitive deficits.\u201d Because Reliance had indeed considered Bowman\u2019s medications, it did not act in an arbitrary and capricious manner.<\/p>\n

Overall, the Court\u2019s decision was to determine whether Reliance acted in a reasonable manner when denying Bowman\u2019s claim. It opined that \u201cit is not arbitrary and capricious to deny a disability claim \u2018on the basis of conflicting, reliable evidence.\u2019\u201d Here, Reliance based its decisions on evidence that was reliable, therefore, its decision to deny Bowman\u2019s claim was not unreasonable. Thus, the Court ruled in favor of Reliance and against Bowman.<\/p>\n[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.]\n

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

Anthony Bowman (\u201cBowman\u201d) was employed as a Maintenance Mechanic which required the ability to do heavy lifting between fifty and sixty pounds. Injuries throughout his life caused him to have a number of surgeries and resulted in chronic neck and back pain. Bowman also had issues with a sleep disorder and pain medication, which led …<\/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":[259],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7449"}],"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=7449"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7449\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=7449"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=7449"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=7449"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}