Absence of “objective findings”

In Dunda v. Aetna Life Ins. Co., 2016 U.S.Dist. Lexis 85549 (W.D.N.Y. June 30, 2016), Aetna denied a claim for LTD benefits based on the absence of “objective findings” verifying the plaintiff’s subjective complaints of limitation.  Thus, Aetna’s denial of the claim was based essentially on a credibility determination. The Court found the determination to be arbitrary and capricious:

The Plan afforded Aetna the authority to require that Plaintiff undergo an IME. Under these circumstances, the Court finds that Aetna’s decision to not perform this examination supports the finding that its determination was arbitrary and capricious.

Dunda v. Aetna Life Ins. Co., 2016 U.S. Dist. LEXIS 85549 * (W.D.N.Y. June 30, 2016)