Can My Long Term Disability Be Terminated?
Many clients have the impression that once their long-term disability benefit has been approved, they need only to complete annual forms to maintain their approval. The case Boatright v. Aetna Life Insurance Company recently decided by Judge Tom Barber in the Middle District of Florida on April 5, 2022, shows this is false. If you believe that your long-term disability cannot be terminated, then you have misunderstood the unfairness of ERISA.
Facts of the Case:
In Boatright v. Aetna Life Insurance Company, Tracy Boatright had worked for many years as a home care registered nurse.
In 2003, she began to suffer from several conditions including interstitial cystitis (IC) with Hunner’s ulcers, peripheral neuropathy, and fibromyalgia.
When she began to have more bad days than good, she filed a long-term disability claim with Aetna.
Aetna found her to be disabled and approved her long-term disability benefits in October 2003.
In 2018, after the claim had been paid for over 15 years, Aetna did a more aggressive review.
Aetna hired three different doctors to review medical records and provide an opinion that Ms. Boatright was no longer disabled and, in fact, had improved.
Aetna also made several attempts to contact her treating physician to obtain an update, but no information was ever received.
Two days of video surveillance were conducted, which showed Ms. Boatright walking with a normal gait, lifting things with slightly restricted movement, driving, pushing a shopping cart, closing her car trunk, carrying objects, and going up and downstairs.
The claim was terminated, and she appealed.
However, in her appeal, Ms. Boatright failed to provide updated disability opinions or evaluations, and any explanation of the video surveillance (such as after having a good day, needing to remain in bed, or at home resting the next day).
A vocational evaluation based on two "independent" physician reviews identified five different jobs Ms. Boatright could perform. Whether the jobs were available to Ms. Boatright or not was irrelevant. It only mattered that they were federally recognized occupations that existed somewhere.
After her appeal was rejected, Ms. Boatright filed a lawsuit and lost her case.
Based on the video surveillance (of just two days), the court found Ms. Boatright was able to work a full-time occupation for 40 hours per week.
The court noted that Ms. Boatright did submit any evidence from her treating physicians further documenting her disability, but then noted it would not have mattered.
Aetna had a right to rely solely on its physician reviewers and did not have to show any deference to the opinion of a treating physician.
She noted that the Social Security Administration found her disabled, and that demonstrated further inconsistency with Aetna. The court found the Social Security Administration determination was not dispositive, particularly so if Aetna relied on new evidence that had not been provided to the Social Security Administration, such as the video surveillance.
If Ms. Boatright only had her long-term disability and Social Security disability benefits to live on, she was now entirely reliant on the Social Security disability benefit alone. The Social Security Administration never intended individuals to rely exclusively on that benefit to survive. If that is all Ms. Boatright has, she will now be forced to rely more on public services. In essence, Aetna will save more money, and the American public will pay more in taxes.