O’Ryan Law Firm, on behalf of our client, Deborah P., recently filed a lawsuit against Madison National after they wrongfully terminated her disability benefits. Our client was employed as a Teacher with the Hanover Community School Corporation, which made her eligible for disability benefits offered through the Hanover Community School Corporation employee benefit plan. Madison National is often times the insurance company for long term disability coverage offered to most teachers.
Deborah began her teaching career in 1984. After 30 years of teaching, Deborah was forced to stop working in December 2014 due to infiltrating ductal carcinoma, hypothyroid, chronic fatigue syndrome, GERD, neuropathy, knee pain, chest pain, shortness of breath, weakness, edema, nausea, palpations, cardiomyopathy, Hashimoto’s thyroiditis, migraines, and insomnia.
In October 2013, Deborah received a devastating diagnosis of invasive ductal carcinoma stage 2. Her life became overfilled with treatments, doctor visits, tests, decisions on treatments, etc. Since the tumor was almost 5cm, Deborah underwent chemotherapy first to see if the tumor would shrink and offer her more options. Deborah underwent extremely aggressive chemotherapy and continued to teach during treatments in hopes of beating the cancer and returning to teaching full time. Deborah began experiencing pain in her joints, profound fatigue, and was nauseous all the time. In March 2014, Deborah underwent a lumpectomy. Since 3 out of 5 lymph nodes were removed and tested positive, Deborah lives in daily fear that her cancer will return. In addition to chemotherapy and surgery, Deborah also underwent proton radiation. Deborah has tried to return to work, but became too profoundly fatigue to make it through a normal school day.
Due to the profound fatigue, Deborah’s radiation oncologist recommended she have her thyroid hormone levels tested. Deborah’s treating physicians believe, due to the radiation, she suffers from Hashimoto’s thyroiditis that causes hypothyroidism. Deborah has treated with a number of physicians who have been unsuccessful in controlling her thyroid.
A February 2015 MRI checking Deborah for cancer, showed an aneurysm in her ascending aorta. Additional tests and specialty appointments showed Deborah suffers from cardiomyopathy as a result of the chemotherapy. Deborah is expecting to need open heart surgery in the future. For now, the aneurysm has to be routinely checked as it is 4.8 cm and could dissect at any point in time. Deborah experiences chest pain on and off and must take several medications. These medications cause Deborah to feel fatigue and give her migraines. In addition, Deborah uses a CPAP machine with oxygen for obstructive sleep apnea.
There is no question that Deborah is disabled under Madison National’s LTD policy. Madison National originally denied Deborah’s LTD benefits on April 1, 2015. On July 29, 2015, O’Ryan Law Firm submitted an appeal on Ms. Deborah behalf. On October 17, 2015, a denial letter was received by Madison National upholding their decision to deny Deborah’s benefits. Prior to denying our appeal, Madison National hired two contracted physicians to review Deborah’s claim file. These contracted physicians acted in bad faith and misreported the conversations had with Deborah’s treating physician. O’Ryan Law firm submitted a 2nd appeal on January 11, 2016 to Madison National. On May 19, 2016, Madison National overturned their decision to deny Debroah’s LTD benefits and approved her benefits beginning March 20, 2015.
Madison National approved Deborah’s benefits from March 20, 2015-March 20, 2017 under the “own occupation” period. On February 2, 2017, despite no change in Ms. Deborah condition, Madison National terminated her LTD benefits claiming, “As of March 20, 2017 the definition of disability changes to inability to perform any occupation versus own occupation. Based on our review of the available information, we have determined you are no longer eligible for LTD effective March 20, 2017 because the medical information in your claim file does not support that you are impaired from performing any occupation.”
Prior to initially approving Deborah’s LTD benefits Madison National hired Dr. Elizabeth Haglind with Reliable Review Services to review Deborah’s claim file on May 12, 2016. Within the 18-page report, Dr. Haglind states she spoke to three treating physicians who all agreed Deborah suffers from significant, genuine fatigue that prevents her from working. Dr. Haglind agreed with Deborah’s treating physicians and found her disabled.
Despite no change in Deborah’s condition, Madison National hired yet another physician to review her claim file just 8 months later. On January 30, 2017, Dr. Joseph Rea completed a claim file review. Dr. Rea made one phone call to Deborah’s treating physician. Dr. Rea’s report states Deborah’s treating physician claimed she did not have any specific limitations to advise. However, Deborah’s treating physician has been very clear in his support for her LTD benefits. In fact, he went as far as responding to Madison National’s previous denial letter sent by Madison National on October 27, 2015 where the reviewing physician acted in bad faith and falsely reported their conversation.
In addition, the reviewing physician highlighted attending physician statements (APS’s) submitted by Deborah’s cardiologist. Deborah’s cardiologist states on every APS he signs: “Patient has been disabled by another physician. Discuss with doctor who disabled patient. Will defer to the doctors who disabled the patient.” It is in bad faith to highlight restrictions/abilities from a physician who blatantly defers his opinion to another physician.
The reviewing physician hired by Madison National specializes is Occupational Medicine and resides in Alabama. He has never met or examined Deborah. Despite the unequivocal statements by Deborah’s FIVE supportive treating physicians, the reviewing physician still insisted that Deborah was not disabled and her benefits were subsequently terminated by Madison National. Deborah’s treating physicians submitted repeated APS’s outlining her disability and her inability to return work. Deborah’s treating physicians see her on a regular basis and have direct knowledge of her condition. However, their opinions were dismissed by the reviewing physician hired by Madison National who has no first-hand clinical observations of Deborah and is not specialized in her condition.
Madison National hired back to back contracted physicians to review Deborah’s claim file despite no change in her condition. Madison National continues to discredit Deborah’s fatigue despite substantial support from her treating physicians.
O’Ryan Law Firm submitted a third appeal on July 20, 2017. Unfortunately, on September 15, 2017, Madison National upheld their decision to terminate Deborah’s benefits. On behalf of Deborah, O’Ryan Law Firm filed a complaint for this case in the Lake county district in Northern Indiana on September 20, 2017.