Articles Posted in Liberty Mutual

O’Ryan Law Firm, on behalf of our client, Jeremy C., recently filed a lawsuit against Liberty Life Mutual after they wrongfully terminated Jeremy’s disability benefits. Our client was employed as a Store Manager with Wal-Mart, which made him eligible for disability benefits offered through the Wal-Mart Stores, Inc. employee benefit plan.  Liberty Mutual is actually the insurance company for the long term disability coverage offered to Wal-Mart employees.

Jeremy worked for many years at Wal-Mart, the last several years as a Store Manager, until he was forced to stop working in March 2015, because of his medical conditions the worst of which was Sjogren’s Syndrome.  Sjögren’s is a systemic autoimmune disease that affects the entire body. The symptoms from this disease include profound fatigue, memory loss, recurrent sinusitis, difficulty with speech, reflux, esophagitis, muscle pain, upset stomach, irritable bowel, peripheral neuropathy and many more.

As a result of Sjogren’s Syndrome, our client suffered specifically from gait instability, memory loss, episodes of dysarthria and slurred speech, overall weakness/fatigue, numbness and tingling in the right arm and right leg, tremors after physical activity, abdominal pain, acute sinusitis, colon polyps, gastroesophogeal reflux disease with esophagitis, exhaustion, and continuous headaches.  The multitude and severity of these symptoms made it impossible for our client to continue handling the responsibilities of a store manager at a large Wal-Mart store located in Lebanon, Indiana.

O’Ryan Law Firm recently filed an appeal for Long Term Disability benefits against Liberty Life Assurance Company of Boston (Liberty Mutual) for wrongfully denying a participant’s benefits. The client was a long time employee of a large financial institution and was forced to stop working due to coronary artery disease, hypertension, diabetes, and ischemic cardiomyopathy. The client underwent a coronary bypass in 2010 and had a dual-chamber cardioverter defibrillator implanted in 2015. He suffers from shortness of breath, fatigue, chest pain, and experiences confusion. The high level of stress with the client’s occupation exacerbated the symptoms correlated to his illness. This stress exposed him to a possibility of a severe cardiac event or even death.

Despite the client’s treating physicians providing objective medical proof that he was unable to continue working full time due to his condition, Liberty Mutual hired a contracted physician to review his claim file. The hired contracted physician contended the client could perform a Sedentary occupation on a full time basis. In addition, the hired contracted physician erroneously claimed the client’s treating physician could perform a Sedentary occupation on a full time basis. When in fact, the treating physician never released the client to return to work full time.

Liberty Mutual originally approved the short term disability claim in full, but then turned around and denied his long term disability benefits based on the hired contracted physician review. In an attempt to solidify the client’s denial, Liberty Mutual hired a private investigator to perform surveillance. The private investigator failed to observe any real activity for four entire days, which was consistent with the client’s limitations. Liberty Mutual cited the following definition of “Disability” within the long term disability denial letter:

At the O’Ryan Law Firm, we have represented several clients who have become disabled due to the severe symptoms of Scleroderma.

According to the American College of Rheumatology:

WHAT IS SCLERODERMA?

The Dow Chemical Company is a multinational chemical corporation headquartered in Midland, Michigan.  Dow manufactures plastics, chemicals, and agricultural products. With a presence in about 160 countries, it employs about 54,000 people worldwide.  Dow Chemical also has a large complex on the northwest side of Indianapolis.

Liberty Mutual provides disability insurance to employees of Dow.  Liberty Mutual Insurance is an American diversified global insurer, and the second-largest property and casualty insurer in the  world.   Based in Boston, Massachusetts, it employs over 50,000 people in more than 900 locations throughout the world.

In the disability policy provided to Dow employees, Liberty Mutual defines disability as follows:

Disability insurance companies may look to more than just medical records and reports when determining whether a claimant qualifies for disability insurance benefits. Insurers have long used private investigators to perform surveillance of claimants in order to obtain additional information regarding the claimant’s restrictions and limitations. Oftentimes, the private investigators are asked to document their observations with video to provide tangible evidence of the claimant’s daily activities and abilities. Depending on the information gathered, reports from the investigators’ surveillance and the associated video evidence can lead to a denial of disability benefits. Generally, when courts review video evidence they look at whether the observations in the surveillance video are consistent with the claimant’s reported restrictions and limitations.

A common strategy for disability insurers is to schedule surveillance at a time when the claimant has a scheduled appointment with their doctor or a previously scheduled medical examination. This provides the private investigators with a known opportunity to observe the claimant outside of their home. Inevitably, this allows the surveillance team to observe the claimant driving or riding in a vehicle. In Mote v. Aetna Life Insurance Co., 502 F.3d 601 (7th Cir.2007), Aetna’s decision to deny the plaintiff’s disability benefits was upheld by the court. Aetna based their decision in part on video surveillance showing the plaintiff running errands, driving to medical appointments, and loading groceries into her car. This evidence was used to establish that the plaintiff could work in “any occupation.” However, video surveillance in Gessling v. Grp. Long Term Disability Plan for Employees of Sprint/United Mgmt. Co., 693 F. Supp. 2d 856, 864 (S.D. Ind. 2010) only showed that the claimant was capable of driving a little longer than the fifteen minutes he reported to a Hartford Life representative. The court in Gessling found that this video evidence “says nothing useful about (the claimant’s) ability to work in his own occupation.”

Similarly, the Northern District of California found that surveillance evidence depicting a plaintiff “walking, driving and doing errands … for a couple of hours … does not mean that [that p]laintiff is able to work an eight-hour a day job.” Thivierge v. Hartford Life & Accident Ins. Co., 2006 WL 823751, at *11 (N.D.Cal. March 28, 2006). The Eastern District of California reached the same conclusion in a case where Hartford procured surveillance video of the plaintiff driving to the store, visiting a friend, carrying a small bag, and sitting through an interview while taking numerous breaks. Leick v. Hartford Life & Acc. Ins. Co., 2008 WL 1882850 (E.D. Cal. Apr. 24, 2008). The court determined that the plaintiff’s documented activity on a “good day” did not contradict that the plaintiff was unable to perform a full-time sedentary job. Id. See also Hunter v. Life Ins. Co. of N. Am., 437 F. App’x 372, 378-79 (6th Cir. 2011) (surveillance of a plaintiff driving to her functional capacity evaluation, as well as other activities of daily living, did not indicate that Hunter can perform all the physical duties of her former occupation).

Based in Boston, Massachusetts, Liberty Mutual employs over 50,000 people in more than 900 locations throughout the world. As of December 31, 2012, Liberty Mutual Insurance had $120.1 billion in consolidated assets, $101.5 billion in consolidated liabilities, and $36.9 billion in annual consolidated revenue. The company, founded in 1912, offers a wide range of insurance products and services, including personal automobile, homeowners, workers compensation, commercial multiple peril, commercial automobile, general liability, global specialty, group disability, fire and surety.

Liberty Mutual Group Benefits department provides mid-sized and large businesses with short- and long-term disability insurance products and group life insurance. Many Indiana employers, such as Dow Chemical and Subaru, have purchased short term disability group coverage and long term disability group coverage through Liberty Mutual. Although, oftentimes Liberty Mutual is only the claims administrator for the short term disability coverage and does not insure the short term disability benefits. By issuing the short term and long term disability policies, Liberty Mutual agrees to pay income replacement benefits to employees who become disabled due to injury or illness.

On their website Liberty Mutual notes that as far as Long-Term Disability: