Minnesota Disability Claimant Filed Suit Against Employer Over Terminated Disability Benefits
A Minnesota Federal Court recently ruled against a claimant and in favor of the employer with regards to disability benefits. This case is a poignant reminder that even after being on claim for nearly 7 years, a claimant can be denied at any time. It further shows why it is important to have your claim sufficiently supported with evidence from your treating physician whether the claim administer requests it or not. Let’s take a closer look at the case of Richard P. v. Kohler Co.
The case involved Richard P., a former Kohler employee, who alleged that the company wrongfully terminated his long-term disability benefits in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) and breached its contract with Richard P.
Ruling on Motions for Summary Judgments by both parties, the district court ruled as follow:
- Granted Kohler’s Motion for Summary Judgment;
- Granted Summary Judgment in favor of Kohler on the ERISA claim; and
- Denied Richard P.’s Motion for Summary Judgment.
Background of the Case
Richard P. worked for Kohler as a full-time cabinet installer from September 13, 1998 until 2003 and qualified for Kohler’s disability benefits plans through an employee plan. Richard P. underwent surgery to repair a torn meniscus in 2003, and when he tried to return to work was unable to do so. His symptoms at the time included “lightheadedness, dizziness, fatigue, headaches, shortness of breath, double vision (diploia), droopy eyelids, and facial numbness.” He was diagnosed by his treating physician with “weakness and diplopia,” ceased working, and applied for and was awarded disability benefits. Over the next few years, Richard P. was examined and treated by an ophthalmologist for his headaches and visual disturbances and five neurologists for postural headache syndrome, postural orthostatic tachycardia syndrome (a diagnosis that was not confirmed at the time or since), and a decrease in blood pressure upon standing.
By 2005, Richard P. was provided with an Attending Physician’s Medical Report that reported that his blood pressure problem had been resolved but diagnosed Richard P. with “diabetic polyneuropathy, diplopia, orthostatic hypotension, and orthostatic headaches,” and stated that Richard P. might be “a suitable candidate for sedentary work.” However, by January 23, 2006, the same attending physician provided Kohler with a Disability Plan Attending Physician’s statement” in which he reported that Richard P.’s condition was unchanged and that he was not “a suitable candidate for any type of work. He backed this claim up in similar reports in 2006, 2007, 2008 and 2009.
Claimant Displays Additional Symptoms
In 2007, Richard P. again saw his treating physician for back pain. An MRI at that time revealed that Richard P. had “severe stenosis,” which was treated with laminectomy with decompression and reconditioning and core stabilization. After this 2007 exam, Richard P.’s medical records do not reveal any mention of headaches. In 2010, Richard P. went to his doctor for a diabetes follow-up appointment and his doctor recommended that he increase his activities, no mention of headaches was mentioned in the medical notes related to this visit.
Richard P. received short term disability from 2003 until 2004, at which time, he was awarded long term disability benefits. Then, in 2005 after initially being denied Social Security Disability (SSD) benefits in 2004, Richard P. began receiving SSDI benefits as well.(Does being awarded SSDI benefits guarantee your approval of LTD benefits?) In 2005, Kohler informed Richard P. that it was terminating his benefits. Shortly thereafter, Richard P.’s benefits were reinstated upon appeal and the favorable determination from the Social Security Administration concerning Richard P. In 2009, Richard P. was required to update Kohler and informed the company that he engaged in “gardening, fishing and hunting” occasionally, but continued to tire easily. Soon after, in 2010 Richard P.’s benefits were terminated, his appeals were exhausted, and with the help of his attorney filed the lawsuit against his employer.
Summary Judgment Proves Fatal to Minnesota Claimant’s Case
Agreeing that Richard P.’s case could be ruled on summary judgment standards and that Richard P’s “disability must be medically verified and satisfactory to the Company,” the Court was asked to consider that Kohler “committed a serious procedural irregularity by failing to utilize a specialist” to review the case. Unfortunately Richard P. and his Minnesota disability lawyer were disappointed to find that the Judge, finding that Richard P.’s various diagnoses were not “uncommon” nor required the treatment of a specialist, that Kohler did not need to have Richard P.’s claim reviewed by a neurologist as the two insisted in Richard P.’s complaint. And, since Kohler never disputed the medical findings of Richard P.’s neurologist, but rather disputed that after 2010 Richard P. was no longer totally disabled, the court had little to consider and ruled that a “reasonable person could have reached a similar decision” as that of Kohler. Stating numerous cases in Richard P.’s summary judgment brief, his disability attorney filed to convince the court that Kohler abused its discretion, made its decision under a conflict of interest, was capricious and arbitrary. Thus, according to the US District Court of Minnesota, Richard P.’s claim was properly evaluated and acted upon by Kohler.
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Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
What are your fees?
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
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When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.