On November 9, 2010, the United States District Court for the Southern District of Ohio held in the case of Mennucci v. Hartford Life & Accident Insurance Company that Hartford abused its discretion in terminating Ms. Mennucci’s disability benefits. Ms. Mennucci underwent spinal fusion surgery for cervical neck pain that radiated into her right arm. Hartford initially paid short term and long term disability benefits to Mennucci. However, when she failed to fully recover from her surgery and complained of continuing neck pain radiating into her right shoulder Hartford Insurance terminated her benefits based on a medical record review by Dr. Richard Kaplan.
Even though Mennucci’s treating physician indicated she could not return to her prior occupation, Dr. Kaplan, citing the lack of any objective evidence supporting nerve damage, indicated that she could return to sedentary work.
Hartford Insurance’s Doctor Did Not Follow ERISA Guidelines In the Review Of Medical Evidence
Dr. Kaplan’s report did not reference the treating physician’s final report that explained his rationale in concluding that Mennucci could not return to work. Because the administrative record was unclear as to whether Dr. Kaplan had reviewed this report, the Court held that Hartford Insurance could not conclude that its physician “provided a fair assessment of the medical evidence so that Hartford could properly rely on the reviewing physician’s opinions.”
Complaints Of Pain Are Sufficient To Support Long Term Disability Claim
Mennucci’s diagnoses were degenerative disk disease and myofacial pain syndrome. Though the physicians could not measure the amount of pain Ms. Mennucci was suffering they were able to confirm that her pain was consistent with her diagnoses and findings on examinations. The Court held that to deny disability benefits necessarily required Hartford to determine that Mennucci’s complaints of pain were not credible. Yet Hartford had no basis upon which to find Ms. Mennucci’s complaints of pain uncredible and further stated: “Any determinations of credibility made without having met or examined a claimant and contrary to the findings of a treating physician supports findings that the denial of benefits was arbitrary and capricious.”
The case can be found at Mennucci v. Hartford Life & Accident Insurance Company, 2010 U.S. Dist. LEXIS 123598.