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October 2015

Gordon & Rees Team Prevails before U.S. District Court for the District of Montana on ERISA Lawsuit

Gordon & Rees partner Sarah N. Turner and associate Brittany F. Stevens of Seattle, succeeded in securing a judgment for the defendant insurer in the U.S. District Court for the District of Montana after the plaintiff filed a claim alleging that the insurer improperly denied her long term disability benefits.

The plaintiff alleged that she was unable to work due to chronic neck and back pain and “pseudoseizures,” which are seizures that can be brought on by stress and other psychiatric conditions. The insurer provided the plaintiff with long term disability benefits for several years. Upon further evaluation of the plaintiff’s disability under the “any occupation” standard, the insurer found that she no longer met the definition of disability under the terms of the disability plan. The plaintiff’s medical records stated that she had recovered from her back and neck pain, and that she had not been prescribed any medication or treatment for her pseudoseizures. In addition, the plaintiff had not sought out psychiatric care despite her doctor’s recommendations.

The District Court reviewed the insurer’s decision under the abuse of discretion standard and found that there was no evidence that the insurer’s decision was influenced by bias or conflicts of interest. The Court also found that the insurer took all necessary measures to avoid any inherent conflict of interest, including thoroughly reviewing plaintiff’s medical records, repeatedly seeking additional information directly from plaintiff and her health care providers, and fully reconsidering the information and records during the appeal process.

Plaintiff argued that the insurer did not properly take into account the fact that she was receiving Social Security Disability Income (“SSDI”) as evidence of her disability. On behalf of the insurer, the Gordon & Rees team argued that the plaintiff had been approved for SSDI in 2006, after her cervical surgery, and several years before the insurer evaluated her for disability benefits. The Gordon & Rees team further argued that there was no record of the Social Security Administration conducting a recent review, or any subsequent review of its decision, or making any determination that in 2013 the plaintiff would still be eligible for SSDI benefits. The Court adopted our argument and found that plaintiff’s medical condition had improved over time and that the SSDI benefits determination was less probative of her current condition.

The District Court’s opinion was well-reasoned, particularly the finding that there was no inherent conflict of interest in the insurer’s denial of the claim. The opinion was also notable because it demonstrated that the courts will not necessarily rely on the plaintiff’s SSDI benefits as evidence of a disability under the terms of the disability plan.

Sarah N. Turner



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