A Kentucky Truck Driver won his case against The Standard Insurance Company for his disability resulting from multiple back conditions. The Court held Standard acted arbitrary and capricious in denying the claim for long-term disability benefits.
Mr. Bustetter suffered from multiple painful back conditions such as cervicalgia, spinal stenosis, shoulder tendinosis, and myelitis of the cervical spine. His condition prevented him from working as a truck driver, but it also prevented him working in a sedentary capacity. Despite his evidence of disability, the Standard denied his claim. He timely filed an administrative appeal.
As part of his appeal, Mr. Bustetter underwent a functional capacity evaluation with a physical therapist. The testing concluded that he could not meet the requirements of sedentary work, namely that he could not sit for the majority of a work day. His doctors also opined that he could not work.
Standard’s Unreasonable Denial of Benefits
The Standard conducted a review during which they had their own doctor’s review the medical evidence, including the FCE. Notably, they never physically examined him. Standard’s doctors maintained that he could do sedentary work but never provided an explanation as to why their opinion differed from the treating providers and the FCE results.
The medical conditions cause severe pain and pain cannot be objectively measured. TheCourt criticized Standard for relying on its doctor’s opinion disregarding the subjective complaints of pain. Specifically, the Court noted that it was unreasonable to rely on a non-examining physician's opinion discrediting complaints of pain.
Insurance companies are not required to adopt the opinions of the treating providers. However, they cannot reject it without good reason. Standard did not provide good reason for rejecting the evidence of disability.
Subjective Complaints of Pain are Hard to Prove
This case demonstrates an issue we often handle - how and when do subjective complaints of pain rise to the level of disability. It is important to provide as much medical evidence supporting complaints of pain. This type of evidence can include FCE’s, independent medical examinations, and physical examinations by the treating provider.
We have had great success obtaining disability benefits for our clients who suffer from chronic back pain conditions using the tools we have.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get help from a lawyer with expertise in disability law.
- Our lawyers specialize in disability insurance;
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Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
Dabdoub Law Firm represents clients nationwide with:
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Call to speak with a disability insurance attorney. No fees are costs unless clients are paid.