Court Overturns Aetna’s Denial of Long Term Disability Benefits to Amazon Employee Suffering from Severe Urinary Incontinence

The United States District Court for the Southern District of Indiana recently overturned Aetna Life Insurance Company’s denial of long term disability benefits to Kimberly Garner, an O’Ryan Law Firm client who was forced to leave her job as an Amazon fulfillment center associate after complications from surgery left her with severe and persistent urinary incontinence. The Court’s opinion, written by Chief Judge Jane Magnus-Stinson, is the result of several months of zealous litigation by the O’Ryan Law Firm on behalf of Ms. Garner. [1]

 

After several years of working for Amazon, Ms. Garner underwent a surgical procedure that unfortunately caused her to suffer from severe mixed urinary incontinence – meaning she experienced severe and uncontrolled leakage of urine during physical activity or exertion, and due to involuntary and unpredictable spasms of the bladder muscles. Sophisticated diagnostic imaging and testing procedures confirmed that Ms. Garner’s incontinence was severe and uncontrolled. Although she was prescribed various medications and underwent several follow-up procedures intended to address her profound incontinence, including Botox injections and cystoscopy, Ms. Garner experienced no relief from this incredibly frustrating, embarrassing, and debilitating condition.

 

Although Ms. Garner attempted to return to work, she found herself unable to make it through the day without numerous emergency trips to the bathroom, and frequently had to leave her work area to change clothes when her leakage came on so quickly and unexpectedly that she was unable to reach the bathroom in time. Ultimately, she was forced to leave her job due to her medical condition, and she applied for disability benefits under the policy that Amazon provided through Aetna. Her primary care physician referred her to urogynecologist Dr. Douglass Hale for a specialist’s opinion, and he suggested an implantation of an InterStim device – a last-resort procedure in which electrodes are implanted on the nerves controlling the bladder, in an attempt to prevent the bladder from involuntarily emptying. Unfortunately, because she lost her health insurance when she was forced to leave her job, she was unable to afford the procedure.

 

Although Ms. Garner’s primary care physician adamantly supported her application for long term disability benefits, repeatedly certifying that she was totally disabled due to her incontinence, Aetna nonetheless denied Ms. Garner’s claim based on a review of her medical records by an in-house Aetna nurse. When Ms. Garner appealed the denial of her claim, Aetna denied the appeal based on an “independent” medical review by Dr. Stuart Fine, a urologist consultant it hired to issue an opinion that misrepresented the records and conclusions of Ms. Garner’s treating physicians in order to reach the conclusion that her incontinence was not actually disabling.

 

After Ms. Garner’s appeal was denied, she hired O’Ryan law firm to file suit against Aetna in the United States District Court for the Southern District of Indiana. In its briefing, O’Ryan Law Firm pointed out that Dr. Fine, Aetna’s reviewing physician, falsely represented that Dr. Hale had not recommended any interventional surgical procedures and completely ignored the objective diagnostic testing that confirmed the severity of Ms. Garner’s incontinence. Dr. Fine also ignored the conclusions of Ms. Garner’s primary care physician, who repeatedly and consistently concluded that her incontinence was so severe as to be completely disabling.

 

After carefully considering the arguments of Ms. Garner and Aetna, Judge Magnus-Stinson issued her opinion overturning Aetna’s decision. In her written opinion, Judge Magnus-Stinson agreed with O’Ryan Law Firm’s arguments that Aetna’s decision was impermissible because it was not supported by substantial evidence and instead relied on the opinion of Dr. Fine, which Judge Magnus-Stinson deemed “critically flawed” due to the factual inaccuracies identified by O’Ryan Law Firm. Concluding that Aetna’s decision to deny Ms. Garner’s claim was arbitrary and capricious, Judge Magnus-Stinson remanded the claim back to Aetna for a determination that properly accounts for the objective evidence and treating physicians’ records and conclusions supporting Ms. Garner’s disability.

 

If you are unable to work due to incontinence and have been denied disability benefits, please contact the O’Ryan Law Firm for a free consultation.

[1] The Court’s full opinion is available here: https://ecf.insd.uscourts.gov/cgi-bin/show_public_doc?12017cv1307-28.