Court Overturns Life Insurance Company of North America’s Termination of OVEC/IKEC Maintenance Mechanic’s Long Term Disability Benefits

The United States District Court for the Southern District of Indiana overturned Life Insurance Company of North America’s (LINA) Termination of long term disability benefits owed to Greg D., an O’Ryan Law Firm client who was forced to leave his job as a maintenance mechanic with Ohio Valley Electric Corporation/Indiana-Kentucky Electrical Corporation (OVEC/IKEC) after he was forced to stop working due to severe back, neck, shoulder, hip, and leg pain. The Court’s opinion, written by District Judge William T. Lawrence, is the result of several months of zealous litigation by the O’Ryan Law Firm on behalf of Greg.

 

After working for OVEC/IKEC for more than 27 years, Greg underwent shoulder surgery in December of 2006 to locate and repair a tear in his rotator cuff. Unfortunately, his shoulder pain did not subside after the surgery, despite diligent treatment by Greg’s physicians and a rigorous course of more than 50 physical therapy sessions between February and July of 2007. As a result, Greg was unable to return to work in his heavy-duty occupation as a maintenance mechanic. Meanwhile, he also continued to seek treatment for his chronic neck and back pain.

 

After the shoulder surgery, LINA awarded Greg benefits under the long term disability policy it had issued through his employer. A few months after it began paying Greg’s benefits, LINA hired an investigator to perform surveillance on Greg because they believed he was working while collecting benefits. The investigator’s surveillance revealed no evidence of activity that would be inconsistent with Greg’s disability, and LINA continued paying his benefits for 24 months. After 24 months of benefits, the definition of “disability” under the LINA policy changed to require that Greg be disabled from performing any occupation, not just his own heavy duty occupation. Upon this change in the definition of “disability,” LINA terminated Greg’s benefits, arguing that he could perform some sedentary work.

 

Greg hired O’Ryan Law Firm to appeal the termination of his benefits, and when LINA denied his appeal, O’Ryan Law Firm filed a lawsuit in federal court on his behalf, challenging LINA’s termination of his benefits. O’Ryan Law Firm presented the court with overwhelming evidence proving that LINA had abused its discretion in terminating Greg’s benefits, including the fact that LINA ignored his award of Social Security Disability benefits as well as numerous unequivocal statements from his treating physicians that he was unable to work in any capacity, and that LINA’s reviewing physicians had failed to fully evaluate Greg or explain their conclusions that he was capable of sedentary work.

 

After carefully considering the arguments of both Greg and LINA, Judge Lawrence issued his opinion overturning LINA’s decision. In his written opinion, Judge Lawrence agreed with O’Ryan Law Firm’s arguments that LINA’s decision was impermissible because it was not supported by substantial evidence and instead relied on the opinions of LINA’s reviewing physicians, which Judge Lawrence deemed “error-ridden, internally inconsistent, and lacking in any real analysis” due to numerous factual inaccuracies identified by O’Ryan Law Firm. Concluding that LINA’s decision to terminate Greg’s benefits was arbitrary and capricious, Judge Lawrence remanded the claim back to LINA for a determination that properly accounts for the objective evidence and treating physicians’ records and conclusions supporting Greg’s disability.

 

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