In Corey v. Sedgwick Claims Management Services, Inc., plaintiff Bruce Corey began working as a machine operator for Eaton Corporation in 1987. Beginning in February 2014, he was periodically granted short term disability benefits when he took a few days off of work due to cluster headaches. On May 8, 2014, Corey quit working completely and again applied for short term benefits.
A specific term of the disability policy required applicants to provide objective evidence of their disabling conditions. Since Corey was unable to comply with this contract provision, his application was denied. After Corey exhausted his administrative remedies, he filed this ERISA lawsuit. The Ohio federal district court upheld Sedgwick’s denial, finding that it “was supported by a deliberate, principled reasoning process and substantial evidence.”
The Ohio District Court Found the Denial of Short Term Disability Benefits Was Supported by Medical Evidence
The contract provision that required objective evidence of a disability itemized the types of evidence that could be presented in order to comply with the term:
· Physical examination findings (functional impairments/capacity).
· Diagnostic test results/imaging studies.
· X-ray results.
· Observation of anatomical, physiological or psychological abnormalities and
· Medications and/or treatment plan.
In this case, neither plaintiff’s treating physicians nor reviewing physicians found any objective evidence to support plaintiff’s claims. The medical records of two treating physicians included plaintiff’s own reports about his pain. Both physicians said that his workday would occasionally be interrupted for a few hours, based on Corey’s own subjective reports of his symptoms. Neither physician claimed that Corey could not perform his job.
Corey argued that the prescription for Imitrex should meet the criteria of being disabled due to medications and a treatment plan. There was nothing in the record to indicate that any side effects of the medication interfered with plaintiff’s ability to do his job. In fact, the opposite was true. The evidence showed that the Imitrex helped control his headaches.
Two physicians reviewed the medical record and found nothing to substantiate plaintiff’s claims of inability to do his job. They credited plaintiff’s statements of headaches, but could not find objective evidence of how those headaches prevented him from doing his job.
The court concluded that, “Here, the quality and quantity of the evidence show that defendants’ denial of plaintiff’s short term disability benefits claim was not arbitrary and capricious.”
Sedgwick Was Not Required to Order a Vocational Evaluation
Corey asserted that Sedgwick did not fairly evaluate his claim since it failed to order a vocational evaluation to see if he was able to perform his job duties. The court disagreed and found no precedent requiring a plan administrator to order a vocational evaluation and concluded that the plaintiff could have himself undergone a vocational evaluation and presented it as evidence. In light of the substantial evidence supporting Sedgwick’s denial of short term benefits, its failure to order a vocational evaluation was not arbitrary and capricious.
This case was not handled by our law office, but we believe it can be instructive to those who have a contract provision requiring them to provide objective evidence of a disability in order for their application for short term benefits to be granted. If you have any questions about this issue, or are having any other problems relevant to your disability claim, consult one of our disability attorneys at Dell & Schaefer. We offer a free consultation.