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Court Determines That Liberty Life Unreasonably Refused To Consider A Claimant's Subjective Complaints Of Pain In A Disability Insurance Claim Involving Fibromyalgia.

Another district court has found that Liberty Life failed to give a claimant a full and fair review of her claim for long-term disability benefits. Ruth Ann Hare suffered from fibromyalgia, forcing her to leave her physically demanding job and request disability benefits. While she received Short Term Disability benefits for some time, Liberty Life denied her request for Long-Term Disability benefits at the application and administrative appeals stages based on the assertion that Ms. Hare failed to provide objective evidence of her condition. Accordingly, Ms. Hare sued Liberty Life seeking payment of the denied benefits.

The Eastern District of Arkansas first addressed the plan's requirement for objective evidence to prove disability. The court stated that objective evidence of fibromyalgia could be shown via an 'eighteen-point 'trigger test,' where pain in eleven of the eighteen trigger points supported a fibromyalgia diagnosis. Since Ms. Hare had eleven trigger points, the court determined that her diagnosis was supported by objective evidence.

The court also chastised Liberty Life for failing to consider Ms. Hare's subjective complaints. The court noted that while some individuals suffering from fibromyalgia are disabled by the resulting pain, others may not be and therefore, Liberty Life should have considered subjective evidence of pain. Therefore, the court found that Liberty Life erred by failing to address Ms. Hare's subjective complaints. The Court also found that Liberty Life erred in basing its denials on the opinion of a reviewing physician, which included a factual misstatement and a "misfire on the diagnosis." As such, the court required Liberty Life to reconsider the reviewer's conclusions while taking the objective evidence supporting Ms. Hare's diagnosis into account. The claim was remanded to Liberty Life for further evaluation of Ms. Hare's subjective complaints and for a determination that considered the whole record.

Such actions by insurance carriers such as Liberty Life are all too common in group short-term and long-term disability claims, especially if they are governed by the Employee Retirement Income Security Act of 1974 (ERISA). Insurance carriers count on claimants not understanding their rights or being unaware of how essential it is to properly and sufficiently support their claims during the application and administrative appeals stages. At Disability Insurance Law Group we understand the common tactics employed by insurance carriers like Liberty Life and prepare our clients' disability claim applications and appeals with this information in mind.   

See Hare v. Liberty Life Assur. Co. of Boston, No. 4:13-cv-87-DPM, 2013 WL 5574480 (E.D. Ark. 2013).

 

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