Wilcox v. Liberty Life Assurance Company of Boston

In Wilcox v. Liberty Life Assurance Company of Boston, 552 F.3d 693 (8th Cir. 2009), the plaintiff brought suit against Liberty Life Assurance for long term disability benefits.  Liberty Life denied Mrs. Wilcox’s claim for long term disability benefits based upon a so-called “independent peer review” performed by a doctor they hired to review the plaintiff’s medical records. 

According to Dr. McIntire, the physician hired by Liberty, Mrs. Wilcox was able to perform sedentary work.  Mrs. Wilcox submitted evidence from her treating physicians as well as a witness demonstrating that she was unable to work.  Liberty denied her claim twice. In federal court, the District Court ruled in favor of the plaintiff because,

Liberty Life had abused its discretion by failing to ‘evaluate Plaintiff’s medical records in their totality’ and by ‘blindly’ relying on Dr. McIntire’s ‘cursory’ medical opinion . . . .”  Id. 

The matter was appealed to the 8th Circuit. One interesting issue before the Court was the admissibility of material submitted by the plaintiff to the district court, but not submitted to the insurance company prior to litigation.  The material, according to the plaintiff, was “simply meant to provide context to assist the district court in interpreting complex medical evidence.”  The 8th Circuit noted that other courts have “held that generic materials may be introduced in the district court in ERISA cases to provide context and guidance.”  Id., citing Vega v. Nat’l Life Ins. Servs., Inc., 188 F.3d 287, 299 (5th Cir. 1999).  The 8th Circuit declined to adopt general rule permitting consideration of generic medical exhibits because the district court had not reviewed the material; but rather, had remanded the case to the insurance company to consider the material.  In essence, the Court seemed to imply that such materials may in some cases be appropriate, but the issue was not germane to the ultimate issue on appeal.  

As to the ultimate issue, the Court held that Liberty Life “abused its discretion.”  The Court noted that although Liberty Life was entitled to obtain a professional peer review opinion, “it was not free to accept this report without considering whether its conclusions follow logically from the underlying medical evidence.”  citing Abram v. Cargill, Inc., 395 F.3d 882, 887 (8th Cir. 2005).  The reviewing court noted multiple factual errors in Liberty Life’s peer review opinion. On the other hand, the plaintiff’s treating physicians “accepted that her symptoms were real.”  “While an ERISA plan administrator need not accord special deference to a treating physician’s opinion, an administrator may not ‘arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of a treating physician.'”  citing Black & Decker Disability Plan v. Nord, 538 U.S. 822 (2003). 

The Court further noted: “A plan administrator abuses its discretion when it ignores relevant evidence.”  The Court also cited 6th Circuit jurisprudence for the proposition that it is improper for a plan administrator to focus only on evidence that supports a denial, while ignoring evidence supporting a finding of disability.  Metropolitan Life Ins. Co. v. Conger, 474 F.3d 258 (6th Cir. 2007); Moon v. Unum Provident Corp., 405 F.3d 373 (6th Cir. 2005).  See also: Govindarajan v. FMC Corp., 932 F.2d 634, 637 (7th Cir. 1991)(“The plan administrator’s selective review of the medical evidence and its completely erroneous assertion that there was no physical cause for the subjective symptoms of pain renders its decision not only unreasonable but arbitrary and capricious.”)    

The Court concluded:

Liberty Life’s obligation as an ERISA fiduciary required more than combing the record for evidence in its favor. . . . Liberty Life was required to evaluate the available evidence in its entirety before reaching a determination. . . . The record does not show that the company met this duty, and we therefore conclude Liberty Life abused its discretion in denying Wilcox’s claim.


About tngainjurylawyer
Serious Injury Lawyer in Tennessee and Georgia.

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