Gordon & Rees partner Ron Alberts and senior counsel Susan Meter won their motion for reconsideration and defeated plaintiff’s motion for reconsideration after waiting sixteen months following a bench trial where the judge issued a perplexing ruling, leaving both Plaintiff and Defendant scratching their heads.
The case involved a claim for long term disability benefits against Aetna Life Insurance Company by a woman diagnosed with relapsing-remitting multiple sclerosis who was originally diagnosed in 2001. Plaintiff was a successful business woman whose job entailed both physical and cognitive demands. Her disease remained in a state of remission for almost a decade during which she continued to work. However, in the summer of 2011, Plaintiff collapsed at work. Shortly thereafter she had a second collapse. She returned to her treating doctor concerned that her disease was progressing, but her doctor found her to be healthy and in no acute distress. Despite this finding, in April 2012, Plaintiff took an official leave of absence. Oddly, Plaintiff cancelled doctor’s appointments and refused to take any medication for her disease. When she finally did see her doctor, he again reported she was healthy.
In February 2013, Plaintiff filed for long term disability benefits. In May 2013, Aetna denied the claim for benefits. Aetna acknowledged that Plaintiff had remitting-relapsing multiple sclerosis but determined, based on the medical evidence, that her disease was not debilitating and did not meet the definition of disability under the terms of the Plan. Plaintiff retained an attorney and immediately appealed.
After Plaintiff retained counsel she began to see many physicians. The court found that the doctors did not observe a worsening of the disease and Plaintiff was capable of performing the physical and cognitive demands of her job. Aetna upheld its denial of the claim on March 12, 2014.
But the case didn’t end there. On March 19, 2014, Plaintiff submitted an updated MRI. Aetna reviewed the updated MRI but determined that it did not change its opinion. The court, on de novo review, analyzed the new MRI and determined that the MRI showed significant impairment and ruled Plaintiff was disabled as of March 19, 2014.
However, the court failed to take into consideration that Plaintiff was not covered under the Plan as of the date it found Plaintiff to be disabled. The Plan provided that coverage ends on the date of termination of employment or 12 months after the employee is no longer actively at work.
Both Plaintiff and Defendant were perplexed by the ruling and filed motions for reconsideration. After a sixteen month wait, the court issued a ruling holding in favor of Defendant stating that “…Defendant’s motion for reconsideration is warranted based on the Court’s manifest failure to consider the terms of the Plan.” After considering the terms of the Plan, the court reversed its findings and found that although Plaintiff did become disabled as of March 19, 2014, she was no longer covered under the terms of the Plan.
Click here to read a copy of the trial ruling, and here for the order on the motions for reconsideration.