The Western District of Virginia found Guardian’s denial of a former physician specializing in neuro-ophthalmology long-term disability claim was both incorrect and unreasonable. So, the court ruled against Guardian and ordered payment of all unpaid long-term disability benefits.
Dr. Joseph Weisman’s Disability Claim
Before his disability, Dr. Weisman was the owner of Blue Ridge Eye Center. He was the sole doctor in the practice. He ultimately stopped working on December 31, 2021, because of the progression of tremors. These tremors made it impossible for him to continue evaluating and treating his patients.
Unable to work, Dr. Weisman filed for and was awarded all his short-term disability benefits. Guardian then proceeded to deny his claim for long-term disability benefits claiming that:
- there was no objective evidence of his disability, and
- that Dr. Weisman did not seek treatment until March 2022 when he was no longer insured under the Plan.
Dr. Weisman appealed the denial of benefits. Guardian denied his appeal and Dr. Weisman filed a lawsuit for his benefits.
The Court’s Decision
The court ruled for Dr. Weisman finding Guardian abused its discretion when it denied his benefits. The court dismissed all of Guardian’s reasons for denying his benefits.
- Guardian contends Dr. Weisman's claim is invalid because he applied after he stopped working and his coverage had ended. However, the court ruled that the crucial factor was Dr. Weisman's disability status when he ceased working, not the timing of his application.
- Guardian argues that Dr. Weisman was not under the care of a doctor when he became disabled and thus ineligible to receive benefits. The court disagreed and found that Dr. Weisman was under the regular care of a doctor whose opinion was that Dr. Weisman had received the appropriate treatment for his disability.
- Guardian contends that Dr. Weisman did not provide sufficient evidence of his disability. The court felt differently and found that the medical opinion of Dr. Weisman and his treating provider of disability was not been controverted by any other medical evidence in the case.
- The court also dismissed Guardian’s argument that Dr. Weisman cannot receive benefits because he had not provided objective clinical evidence. The court correctly noted that the long-term disability policy does not require objective evidence.
- The court also noted that Guardian failed to offer an explanation as to why it had approved short-term disability benefits all while denying long-term disability benefits based on the same definition of disability.
Because of these reasons, the court concluded Dr. Weisman must win the lawsuit because Guardian was unreasonable in denying his claim.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
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Our expertise in long-term disability claims means our clients have the backing of a law firm that has attorneys who:
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All our lawyers commit every day of their legal career to helping people get disability benefits from UNUM, MetLife, Prudential, Northwestern Mutual, Hartford, CIGNA, and others.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We represent clients nationwide.
Call to get experienced disability lawyers on your side with:
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