Employees in Chicago with claims for long-term disability often get a request from the long-term disability insurer to have an attending physician statement completed. Also called a physical capabilities questionnaire, depending on the insurer, this form is a statement by your doctor as to what your capabilities are, or what restrictions and limitations the doctor opines you have. Nothing in ERISA requires one of your doctors opine on your disability on a particular form in order to qualify for benefits. But a recent case demonstrated why a simple “off work” note from the doctor can prevent your benefits from being paid.
In Collins v. Life Insurance Co. of North America, No. 6:21-cv-1756, 2023 WL 2633309 (M.D. Fla. Mar. 24, 2023), Collins worked as a dock worker, requiring him to lift up to 100 pounds and constantly move and handle materials. Collins’ doctor wrote a letter stating Collins should be off work until further notice. LINA approved and paid Collins claim for long-term disability. After 12 months of receiving benefits, however, the policy’s definition of disability changed from disability from Collins’ own occupation to disability from any occupation. LINA terminated benefits, contending Collins could perform a sedentary occupation. It relied on the opinion of a medical consultant who opined Collins could perform sedentary work. After Collins unsuccessfully appealed, he sued under ERISA § 502(a).
The United States District Court for the District of the Middle District of Florida ruled against Collins, and upheld LINA’s termination of Collins’ benefits. Under the arbitrary and capricious standard of review, the court explained there must only be a reasonable basis for the insurer’s decision. Collins contended LINA erred by ignoring his doctor’s opinion he must be off work. The court explained, however, that the off work note was not an opinion as to Collins’ capabilities, but tantamount to a note to be off work following a procedure. Therefore, LINA had no treating physician opinion with which to disagree, and it was reasonable to rely on the opinion of its medical consultant.
If your claim for long-term disability benefits has been denied or terminated, contact a skilled ERISA long-term disability lawyer immediately.