Washington District Court Finds Standard Wrongly Denied Network Technician's Disability Benefits
A Washington District Court held Standard wrongly denied a Network Technician’s disability benefits. Under de novo review, the Court determined the plaintiff provided enough objective medical evidence to prove that he could not work in any sedentary occupation. The Standard was ordered to reinstate the plaintiff’s claim and pay him long-term disability benefits back to the date they were terminated.
Jason Pringle was a Century Link employee who stopped working in 2015 due to Type II Diabetes and resulting in severe neuropathy in both his legs as well as pain in both his knees and shoulders. Pringle informed Standard he needed to prop his legs up while lying on his back for most of the day and he could stand for a maximum of 30 to 60 minutes per day. The Standard accepted Pringle’s claim for long-term disability benefits and paid him for the entire 24 months of the insurance policy’s own occupation period. Once the definition of disability changed to any occupation Standard claimed Pringle could work a sedentary job and terminated benefits. Standard based its decision on the opinions of its physician consultants, who conducted a paper review of the record. Pringle appealed Standard’s termination. With his appeal, Pringle provided additional medical evidence proving his disability.
Colorado’s Discretionary Ban
The Standard’s long-term disability policy that governed Pringle’s claim was issued in Colorado. This state’s lawmakers passed a law that bans discretionary clauses in insurance policies. A discretionary clause is wording in an insurance contract that gives the insurance company the sole authority to decide who is entitled to benefits. When a discretionary clause is present in a disability insurance policy, the case is much harder to prove for the plaintiff. This is because the court must give deference to the insurance company’s prior decision unless you can prove that you are disabled under the contract and the decision had no reasonable basis. This is a difficult standard to overcome. State discretionary bans try to make the process fairer.
The Court’s Decision
Without giving deference to Standard’s decision, the Court held Pringle proved he was disabled under the policy. In order to continue receiving disability benefits, Standard’s insurance policy required Pringle provide objective medical evidence such as written documentation of observable, measurable, and reproducible findings from examinations and laboratory testing. The Court noted Pringle provided objective medical evidence from multiple treating physicians as well as the Social Security Administration that he could not perform any occupation.
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