The Federal District Court in San Diego issued an opinion granting disability benefits to a client of Stennett & Casino that contains several quotable statements relevant to ERISA disability claims. Stennett & Casino’s client’s claim was that side effects from medication taken to control seizures (fatigue and cognitive slowing) prevented him from returning to work.
The disability insurer, Lincoln National, initially paid disability benefits while our client was actively having seizures. But once the medication successfully controlled his seizures Lincoln National, terminated his benefits based on the opinions of two physicians retained by Lincoln National who neither examined nor talked to our client. These two physicians gave little weight to the subjective complaints of fatigue and cognitive slowing even though they were known potential side effects of his medication because they were not supported by objective testing.
The Court finding that the evidence supported our client’s claim for disability stated:
“It is unreasonable to reject a claimant’s self-reported evidence [of fatigue] where the plan administrator has no basis for believing it is unreliable, and where the ERISA plan does not limit proof to objective evidence.”
“Seeing plaintiff’s physical demeanor in response to questions was critical to determining his reaction to medications and ability to perform work.”
The court thus accorded “less weight to the physicians who merely conducted a paper review of the claimant’s medical records” verses the opinion of the treating physician who examined and observed her patient.
Lincoln National’s doctors “indicated in their reports that the plaintiff’s subjective complaints were considered. But this appears to be nothing more than lip service to symptoms that would have been clearly visible had they observed plaintiff instead of merely reviewing his files.”
The bottom line is that a claimant’s subjective symptoms such as fatigue and pain are sufficient to prove a disability despite the contrary opinions of “paper review” physicians.
The entire opinion can be found at Viani v. Lincoln Nat’l Life Insurance Co., 2022 U.S. Dist. LEXIS 146913.
Leave A Comment