Third Circuit Affirms Liberty Mutual’s Denial of Long-Term Disability Benefits Despite Lack of Independent Medical Examination

In Hocheiser v. Liberty Mut. Ins. Co., No. 21-1533, 2023 WL 1267070 (3d Cir. Jan. 31, 2023), a dispute over the termination of ERISA-governed long-term disability benefits, the Third Circuit affirmed the district court’s grant of summary judgment to Liberty Mutual Insurance Company, finding that its decision to deny Plaintiff David Hocheiser’s long-term disability benefits was not arbitrary and capricious.

Hocheiser worked as a mortgage consultant for Wells Fargo when he started suffering from lower back pain in 2005. He worked for nine years with this pain while seeking treatment from various medical providers. In 2013, Hocheiser stopped working and submitted a claim for short-term disability benefits. Liberty Mutual approved his short-term disability benefit claim and eventually his long-term disability claim (it initially denied his LTD application but then approved it based on the findings of its reviewing neurologist). However, after paying benefits for one year, Liberty Mutual terminated his LTD claim on the basis that he could perform full-time sedentary work. Hocheiser’s appeal was unsuccessful, and he filed suit.

The Third Circuit determined that Liberty Mutual’s decision was not an abuse of discretion because it was supported by the record, including “the opinions and reports from numerous medical professionals; the absence of a genetic disorder that could be the cause of Hocheiser’s pain; evidence of Hocheiser’s functionality; and a complete file review by multiple independent board-certified physicians.” The court rejected Hocheiser’s argument that Liberty Mutual’s failure to arrange for an independent medical examination (“IME”) was unreasonable. This is because the evidence in the file showed that Hocheiser could work at a full-time sedentary level so there was no need for an IME. Multiple physicians found that he could work and it was Hocheiser’s burden to establish his disability, which he did not do. Judgment Affirmed.