Woman granted Social Security Disability loses fight over insured ERISA disability claim
Kimberly Frazier worked as a sorter for Publishers Printing Company, LLC, which pays for a disability policy with Life Insurance Company of North America covering its employees. Frazier struggled with low back radiating pain and went throught the standard treatment regimens, including PT and spinal injections. At age 42, she gave up her job, citing the back pain, and applied for long term disability under the employer's ERISA plan. By the terms of the ERISA plan, she was also required to appy for Social Security Disability.
Frazier's claim was ultimately denied by the life insurance company, even though her SSD claim was granted. She sued the insurer, arguing that its decision was wrong and that it was not entitled to the discretion normally afforded the administrator of an ERISA plan. The Court found the language of the subject disability insurance policy somewhat unclear, but still held that it afforded the insurer discretion in matters of disability. As a result, the court examined the decision only from the perspective of confirming that it was not "arbitrary and capricious."
The Court held that Frazier was required to show that she had been "continuously disabled" for 180 days under the subject disability policy language, and that her medical records supported the conclusion that there were days when she was able to work during the operative period. The Court also held that the records justified the conclusion that she was able to perform her normal duties, even though she belatedly claimed that her job required more lifting than the Defendant's consultants had recognized. The Court also held that Frazier's doctor's disability letter was inadequate to support LTD because his report "lacks detail and reference no mesured tests to support the restrictions" he recommended.