{"id":7518,"date":"2020-04-08T17:04:06","date_gmt":"2020-04-08T22:04:06","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7518"},"modified":"2024-01-04T17:32:13","modified_gmt":"2024-01-04T22:32:13","slug":"khalil-v-liberty-life-surveillance-supports-long-term-disability-claim-denial","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/khalil-v-liberty-life-surveillance-supports-long-term-disability-claim-denial\/","title":{"rendered":"Khalil v. Liberty Life – Surveillance Supports Long-Term Disability Claim Denial"},"content":{"rendered":"

Case Name:\u00a0<\/strong>Khalil v. Liberty Life Assurance Company of Boston, a\/k\/a Liberty Mutual Insurance Company<\/p>\n

Court:\u00a0<\/strong>United States District Court for the District of Rhode Island<\/p>\n

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

Insurance Company:\u00a0<\/strong>Liberty Life Assurance Company of Boston a\/k\/a Liberty Mutual Insurance Company (hereinafter \u201cLiberty Life\u201d)<\/a><\/p>\n

Claimant\u2019s Employer:\u00a0<\/strong>Zurich American Insurance Company<\/p>\n

Claimant\u2019s Occupation: <\/strong>Finance and Insurance Executive<\/p>\n

Disabilities: <\/strong>Injuries to the upper back, neck, right shoulder, and wrist after an accident.<\/p>\n

Definition of Disability:\u00a0<\/strong>The policy provides coverage if a participant is disabled from performing the material and substantial duties of his \u201cown occupation\u201d for a twenty-four-month period and, thereafter if he is disabled from performing the material and substantial duties of \u201cany occupation\u201d for which he is reasonably fitted by training, education experience, age, and physical and mental capacity.<\/p>\n

Benefits Paid?\u00a0<\/strong>Liberty approved the claimant\u2019s claim for long-term disability benefits under the \u201cown occupation\u201d definition of the policy and for a brief period under the \u201cany occupation\u201d definition.<\/p>\n

Other Important Factors: <\/strong>Liberty periodically commissioned surveillance of the claimant\u2019s functional activities<\/a> throughout the time benefits were paid, the results of which were captured both in written reports and on video.<\/p>\n

Key Physician Opinions:\u00a0<\/strong>The video surveillance continued, and Liberty retained Dr. Gale Brown to review Plaintiff\u2019s claims. Dr. Brown concluded in a written report that, based on the medical records and the videos, Plaintiff\u2019s actual functional abilities were better than he reported to Liberty; he was capable of sedentary work with some restrictions to accommodate neck and shoulder pain if he experienced any.<\/p>\n

Issues:\u00a0<\/strong>Whether Plaintiff is entitled to judgment because Liberty\u2019s decision to deny his LTD benefits was arbitrary and capricious as it was made through the lens of a structural conflict rooted in Liberty\u2019s dual role as plan administrator and benefits payer. The plaintiff argued Liberty adopted an adversarial attitude toward him by putting him under surveillance.<\/p>\n

Holdings:\u00a0<\/strong>The Court held, \u201cThe level of activity or the lack thereof that Mr. Khalil reported to Liberty in support of his claim of continued disability was undermined by the video evidence that Liberty collected during the three years of review.\u201d The claimant\u2019s claim was further undermined by the fact that his own treating physicians ultimately opined that he was not disabled. The Court stated, \u201cIt does not appear to the Court that Liberty acted in a rash or arbitrary manner in its decision-making in Mr. Khalil\u2019s case. Because the Court cannot say that the evidence in this case was insufficient to support Liberty\u2019s decision to terminate Mr. Khalil\u2019s benefits, it is affirmed and Liberty\u2019s motion for summary judgment is granted.\u201d<\/p>\n

Summary:\u00a0<\/strong>The Court denied Plaintiff\u2019s Motion for Summary Judgment and granted Liberty\u2019s Motion for Summary Judgment: \u201cLiberty\u2019s termination of Mr. Khalil\u2019s LTD benefits was reasonable and not arbitrary or capricious. Its dual role was not an impermissible conflict that affected its decision to terminate his benefits.\u201d<\/p>\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

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

The Court held, \u201cThe level of activity or the lack thereof that Mr. Khalil reported to Liberty in support of his claim of continued disability was undermined by the video evidence that Liberty collected during the three years of review.\u201d The claimant\u2019s claim was further undermined by the fact that his own treating physicians ultimately opined that he was not disabled. The Court denied Plaintiff\u2019s Motion for Summary Judgment and granted Liberty\u2019s Motion for Summary Judgment.<\/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":[246],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7518"}],"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=7518"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/7518\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=7518"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=7518"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=7518"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}