District Court Affirms Hartford’s Denial of Long-Term Disability Benefits for Claimant with Sjogren’s Disease

In Snowden v. Hartford Life and Accident Insurance Company, No. CV 5:21-144-KKC, 2023 WL 2586132 (E.D. Ky. Mar. 21, 2023), Judge Karen K. Caldwell found that Hartford Life and Accident Insurance Company (“Hartford”) did not abuse its discretion in denying disability benefits to Plaintiff Crystal Snowden under the terms of an ERISA-governed disability plan. Prior to her disability, Ms. Snowden was a clerk in a medical clinic. In 2019, she suffered from thigh pain and shortness of breath and was hospitalized for 5 days for her symptoms. Despite testing, medical practitioners could not determine the origin of her symptoms. After her discharge, she underwent additional tests however, with the exception of an abnormal gait, the results of the testing were all normal. Yet, she consistently continued to suffer from muscular weakness, pain, and shortness of breath.

Her family physician supported her disability, but specialists, including her cardiologist and neurologist opined that she could perform her occupation on a full-time basis. Ultimately, the family physician stated that Plaintiff suffered from myopathy due to Sjogren’s Disease. Plaintiff underwent a Functional Capacity Evaluation and had statements from family members showing that she suffered from disabling symptoms.

The Court employed an abuse of discretion review. It acknowledged that Hartford had an inherent conflict of interest due to its role as both the claims administrator and the payor of claims. The court held that the conflict was “but one factor” and proceeded to analyze the medical evidence without further discussion of the conflict factor.

As is typical in abuse of discretion cases, the Court did not independently determine whether Ms. Snowden was disabled. Rather, under this standard of review, the Court asked only whether the decision was “within the realm of reasonability” and if so, it would defer to Hartford’s decision even if there was substantial evidence to support an opposite conclusion. In justifying its finding for Hartford, the Court pointed out that (1) multiple diagnostic tests did not show any “significant abnormality” to support limitations, (2) Ms. Snowden’s reported symptoms were inconsistent and did not correlate to examination findings, and (3) the specialists were in disagreement and did not support disability.

In response, Plaintiff argued that the opinions of Hartford’s reviewers should be discounted because Hartford had the opportunity to conduct a medical examination (as opposed to a mere records review) and failed to do so. The Court acknowledged the rule that failure to conduct an examination may raise a question about the accuracy of the decision. However, in this case it did not render Hartford’s decision an abuse of discretion. Hartford’s medical reviewers explained why they disagreed with the attending physician’s opinion and gave “ample reasons” for rejecting their opinions.

The more disturbing aspect of this decision was the Court’s holding that under an abuse of discretion review, an administrator may require “objective evidence” of disability even when a plan does not expressly require such evidence. This holding is in direct conflict with authority in the Ninth Circuit where the rule of law is that an administrator may not insist on objective evidence when it is impossible to prove the disability, i.e., due to pain and fatigue, with this type of evidence. See Salomaa v Honda LTD Plan, 642 F.3d 666 (9th Cir. 2011) (Terming the reviewing physicians’ emphasis on the absence of objective evidence as “irrelevant.”) (Note that the district court here is governed by legal precedent of the Sixth Circuit.) Ultimately, the Court emphasized that it was not weighing the medical evidence, but rather determining whether Hartford’s decision was “reasonable” based on the medical evidence. Because it was possible to offer a “reasoned explanation” for the denial, the decision would be upheld.

The Snowden decision highlights the importance of de novo review, i.e., one that does not give deference to the insurance company. Under a different standard of review a court does not just review the evidence to see if there is a “reasonable basis” supporting a denial of benefits. Rather, it would be reviewing the evidence to determine whether the claimant is disabled. The decision also highlights the difficulty of prevailing in a long-term disability lawsuit. If you have a denied long-term disability claim, contact us for assistance.