Was Eaton’s Denial of LTD Benefits for Ehlers-Danlos Syndrome Arbitrary and Capricious?
In Teresa Outward v. Eaton Corp. Disability Plan for U.S. Employees (Eaton), Plaintiff, who had a Bachelor of Science degree in electrical engineering, began her employment with the Eaton Corporation in 2001 as a medium voltage switch program manager. Through the years, she received promotions and by 2012, her position was that of a corporate marketing manager.
In late 2011, Plaintiff suffered a miscarriage and her health began to deteriorate. By May 2012, she proved she was unable to work in her own occupation and Eaton awarded her long-term disability (LTD) benefits. She suffered from a plethora of symptoms and was diagnosed with various illnesses at different times. The main diagnoses were Ehlers-Danlos Syndrome (EDS), Postural Orthostatic Tachycardia Syndrome (POTS) and dysautonomia.
Six months before her benefits were scheduled to expire Eaton informed Plaintiff that the definition of disability had changed. For her to continue receiving benefits for more than 24 months, she would have to prove she was disabled from performing the duties of any occupation for she was qualified by training or experience. Thus, Plaintiff’s saga began.
Eaton’s Termination of Benefits
Plaintiff provided detailed medical records from her treating physician, Dr. Doris Corey, who examined Plaintiff approximately every three weeks during all the relevant time periods. Plaintiff also provided reports of other treating physicians as well as reports from doctors who had reviewed her medical records. All supported her claim that she could not work full-time at any occupation.
On March 6, 2014, Dr. Corey concluded that Plaintiff’s activities would be restricted for the remainder of her life based on the diagnosis of POTS and joint hypermobility syndrome, a diagnosis added by a consulting physician to whom Corey referred Plaintiff. Corey described specifically the ways in which Plaintiff was disabled, including her extreme fatigue that often confined her to bed to a degree she was unable even to shower, feed herself, or read to her child.
Corey noted that Plaintiff was unable to sustain even sedentary work because the “patient requires complete freedom to rest frequently without restriction” and that she must be able to lay down for “minutes, hours or days.” Although many of the symptoms Plaintiff exhibited were not demonstrable by medical testing, they were symptoms consistent with the diagnosis. Plus, Dr. Corey “did list a number of verifiable medical findings supporting those major diagnoses.”
Eaton required Plaintiff to undergo three separate independent medical exams (IMEs). All of Eaton’s doctors concluded Plaintiff was not disabled for performing the duties of any occupation. Eaton also sent Plaintiff to Genex Services for a transferable skills analysis. The Court of Appeals noted that the Genex website “touts its ability to… improve return-to-work outcomes.” As expected Genex, identified three jobs it asserted Plaintiff could work at four days a week. All jobs required sales, call center, or customer service experience, none of which Plaintiff possess.
After review, Eaton informed Plaintiff her benefits were terminated as of March 31, 2014. Plaintiff then filed an administrative appeal.
Eaton Upheld its Decision to Terminate Plaintiff’s LTD Benefits
For the administrative appeal, Dr. Corey submitted a14-page letter in which she articulated in detail the medical findings and tests that supported Plaintiff’s claim that she was unable to work.
Kathleen Reiss, a vocational rehabilitation counselor, examined all medical reports and tests, including the Genex transferable skills analysis. She also met with Plaintiff for approximately 90 minutes and concluded that Plaintiff could not work at any occupation. Reiss faulted the Genex report as being “flawed to the point of being unusable as a reliable source of analysis of the data.”
Reiss noted that Genex used incorrect job titles for Plaintiff’s work history, relied on incorrect medical diagnoses, and “did not identify jobs and employers who would accommodate restrictions.” Reiss concluded her report with the finding that “the only vocational conclusion that can be reached is that there are no jobs this individual could sustain.”
Eaton had three more physicians review the medical records. The Court found them not very useful “given the almost identically worded synopses of [Plaintiff’s] medical history” in their reports. The Court noted this made it clear that someone had highlighted and identified the parts of the record that the physicians were supposed to rely upon in rendering their opinions.
Eaton also had Genex perform a second transferable skills analysis. This time, Genex identified two part-time jobs that it deemed suitable for Plaintiff; however, Genex conceded there were no such job openings at the time.
Eaton again denied Plaintiff’s appeal, so she filed an ERISA lawsuit in the U.S. District Court for the District of Ohio. That Court agreed with Eaton, so Plaintiff appealed that decision to the U.S. Court of Appeals for the Sixth Circuit.
The Sixth Circuit Court found Eaton had acted arbitrarily and capriciously in terminating benefits to Plaintiff. The Court remanded the case to the District Court with instructions to remand it to the Plan Administrator “for a full and fair review of all relevant evidence in accordance with the Plan’s own definition of acceptable, objective medical findings.”
Eaton’s Termination of LTD Benefits was Arbitrary and Capricious
The Court of Appeals confirmed that under the arbitrary and capricious standard of review, deference must be given to the Plan Administrator’s decision “a long as it is reasoned and based upon evidence in the record.” In this case, the Administrator discounted all opinions supporting Plaintiff’s entitlement to continued benefits.
Despite the Administrator’s statement that there was no objective evidence supporting Plaintiff’s claim, the Administrator failed “to consider the quality of certain contrary evidence.” The Court stated that this is what “makes the administrative finding arbitrary and capricious.”
The Court noted that Plaintiff had provided “voluminous evidence of her restrictions through the diagnoses from her treating physician, through the findings from physical exams, through doctors’ observations of her diminished capacities, and through the medications and treatment plans prescribed for her.” The Court found that the Administrator “cavalierly dismissed all evidence of the employee’s disabling conditions.”
Eaton’s reliance “on the medical opinions of doctors who fell into the trap of relying only upon cherry-picked evidence provides additional support for our conclusion that the decision was arbitrary and capricious.”
This case was not handled by our firm, but we believe it can be instructive for those who need to prove they are disabled from working in any occupation. For questions about this case, or any question about your disability claim, either for short-term disability (STD) benefits or LTD benefits, contact one of our disability attorneys at Dell & Schaefer for a free consultation.
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