The case of Kindig v. Anthem Life Insurance Company provides an example of how claimants of long term disability benefits may sabotage their own case. A New York Federal Court concluded that Anthem did not act arbitrarily or capriciously by terminating benefits to its claimant following his hip replacement surgery when the court found:

1) his treating physician concurred with the reviewing physician’s report that he was not disabled; and
2) the claimant was actively seeking similar employment with other companies.

Although this is not a recent case and was not handled by our disability insurance lawyers, it is instructive on how claimants can ruin their own case by searching for employment in the same career field with the same job description as the one from which they claim they are disabled.

The plaintiff was employed as the Chief Financial Officer of a New England Supermarket chain which provided disability benefits through Anthem Life Insurance Company. Eighteen months after his hiring date, he underwent hip replacement surgery. He voluntary quit his job just one week after the operation. His initial application for long term disability benefits was granted due to his inability to perform the duties of his regular occupation. The decision to award benefits was based on reports from his surgeon and primary care physician, Dr. Little, that he was disabled.

A few months later, Anthem terminated his long term disability benefits based on a new report from Dr. Little stating that “patient is not disabled.” Additionally, the plaintiff was working with a vocational consultant in search of an executive job with a large retail chain similar to the job he had voluntarily left shortly after his surgery. Plaintiff appealed the termination of benefits.

In support of plaintiff’s administrative appeal, Little issued a report saying that he now believed the plaintiff “cannot return to work.” In response, Anthem ordered a review of the medical records by Dr. Gendron who spoke with Little before preparing a report. Little signed Gendron’s report indicating Little agreed with Gendron’s assessment that the plaintiff was not disabled. This prompted Anthem to deny his appeal leading plaintiff to file the ERISA lawsuit. Plaintiff was found totally disabled by the Social Security Administration one year after Anthem terminated his benefits.

Reasons the Court Agreed with Anthem

In reviewing the decision of Anthem, the federal court concluded the termination of benefits was not arbitrary and capricious for the following reasons:

• Plaintiff “fails to provide a convincing explanation for his extensive job seeking activities” during the time he was pursuing his appeal and claiming he was totally disabled.
• Dr. Little gave no explanation as to why “he agreed with Gendron’s opinion that plaintiff could work.”
• The finding by the SSA that plaintiff was disabled is evidence of disability, but is not binding on the court. Additionally, the SSA decision was not issued until one year after the termination of benefits was upheld pursuant to the administrative appeal.

If you have questions about your claim for disability benefits, call Disability Attorneys Dell & Schaefer for a free consultation.