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Judge Upholds Aetna Denial of Disability Claim Where Claimant Shows Symptoms But Fails to Prove Limitations and Restrictions

People call our law firm every day amazed that a disability insurance company denied their Long Term Disability claim.  We we ask what they gave the LTD company, the usual answer is “my doctor’s notes.”  Those notes usually just document a physical or mental exam and a diagnosis….almost always there is nothing more.  And, that is not enough to prove a disability case.  A recent federal court ERISA disability insurance case in Florida called Sweet v. Aetna Life Insurance Company and Federal Express, illustrates why you need more than a doctor’s notes.

In Sweet, the federal judge wrote:

It is not disputed that Plaintiff’s treating physicians diagnosed her as having a number of medical issues and conditions, such as COPD, blood closts, emphysema, and hypertension.  However, the law is clear that a “diagnosis does not by itself establish disability” for purposes of qualifying for a benefits under a LTD plan. See, e.g., Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 370 F.3d 869, 880 (9th Cir. 2003); Howard v. Hartford Life & Acc. Ins. Co., 929 F. Supp. 2d 1264, 1294 (M.D. Fla. 2013), aff’d 563 F. Appx. 658 (11th Cir. 2014) (“Indeed, doctors’ diagnoses do not in and of themselves, establish a disability and inability to work.”). Further, a claimant’s “subjective complaints do not become objective simply because a doctor wrote them down.” Id. at 1294-95. Thus, Plaintiff cannot carry her burden of proving a Total Disability by only pointing to doctors’ notes that included a diagnosis or her own subjective complaints.

It must be said that the other cases cited by the judge are distinguishable.  For example, in the 9th Circuit’s Jordan case, the court explained, “The administrator had before her conclusory statements from Jordan’s doctors that she was disabled, and the relatively more thorough and careful opinions from the plan’s doctors that, although she apparently suffered from the disease, she was not entirely disabled from working by it.”  Unlike Jordan, nothing in the Sweet case described the treating doctors as being conclusory.  In fact the decision seems to emphasize that the doctors actually recorded diagnosis and symptoms, as well as Ms. Sweet’s self-reported limitations.  The Florida judge simply says that is not enough.

Similarly, the Howard decision stated, “Although Howard’s treating physicians repeatedly documented Howard’s subjective complaints of pain, diagnosed her based upon those complaints, and prescribed a panoply of medications to treat them, none of the records confirm her disability status or assess her functional limitations in relation to her ability to perform her occupational duties with Fidelity, as defined by the Plan.”  That means that the doctor never gave an opinion about disability or limitations.

This underscores the importance of proving why you cannot work.  Disability is not only that you are diagnosed with condition (or conditions).  It is not just that a real diagnosed condition causes symptoms.  You must also show how those symptoms limit you, and find ways to prove that those limitations are real. According to this judge, Ms. Sweet did not do that.

Hiring an experienced disability attorney who knows ERISA  and disability insurance policies can help you create the evidence needed to prove your limitations and restrictions.

Case:  Patricia Sweet v Aetna Life Insurance Company, Case No: 8:15-cv-388-T-24 MAP, 2016 WL  2961556 (M.D. Fla. 5/23/2016).

RELATED POST:

It is not the diagnosis, but the symptoms that are disabling.

 

Talk to an experiened ERISA Disability attorney.  Call John V. Tucker at (866) 282-5260.

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