We recently wrote about the unique needs of physicians who file claims for long-term disability. In that post, we talked about the difficulty for doctors — who may run expensive professional practices and rely on relatively high incomes for personal and business needs — to have their ability to practice medicine suddenly interrupted by the onset of disabling medical conditions.
On August 17, the U.S. District Court in the Northern District of Oklahoma issued an opinion reversing a long-term disability insurer’s denial of benefits, ordering that the insurer pay the claimant 24 months of benefits based largely on mental-health impairments. In Redden v. Aetna Life Insurance Company, the judge explained the inherent conflict of interest that a LTD insurer has when it has both the role of discretionary decision maker on the question of claimant eligibility and is in the position of financial responsibility when it finds for the claimant.
Physicians play a key role in their patients’ claims for long-term disability or LTD. A treating doctor’s observations and testing provide key evidence for an insurer to understand whether a claimant’s medical disability meets the definition of disability provided in his or her policy.
On August 13, the U.S. Court of Appeals for the 10th Circuit issued an opinion that found the short-term disability insurance company defendant had acted arbitrarily and capriciously in denying the plaintiff’s claim for a full 26 weeks of benefits. The court also said that some of the insurer’s findings were not supported by substantial evidence.