Plaintiff Christina Saunders was employed by Proctor & Gamble when she had surgery for an ectopic pregnancy. At that time, disability claims for those employed by Proctor & Gamble in Michigan, like the plaintiff, were handled by a third party administrator, the Reed Group (Reed). Even though plaintiff did not return to work on the date her doctor said she could, Reed approved her for total disability benefits.
For an entire year, plaintiff received benefits and continued her quest for a diagnosis and treatment of her unexplained pain. She was diagnosed at various times with several different ailments, but her treating physicians and physical therapist did not place any work restrictions on her.
After a year, Proctor and Gamble contracted with a new third-party administrator, GENEX Services, Inc. In reviewing plaintiff’s file, GENEX found no evidence supporting her claim that she was totally disabled and entitled to receive long term disability benefits, which prompted GENEX to terminate plaintiff’s benefits. As the Circuit Court noted, “Without a doctor’s note stating that Saunders could not work, the GENEX case manager recommended terminating Saunders disability benefits.” Saunders exhausted her administrative remedies in an attempt to have benefits reinstated. When she was unsuccessful, she filed an ERISA lawsuit arguing that she was entitled to total disability benefits. The District Court ruled in favor of Proctor & Gamble and the plaintiff appealed.
Plaintiff Failed to Show How Her Condition Disabled Her
Despite medical records acknowledging that the plaintiff complained of “unexplained, severe, and constant pain,” her treating medical professionals provided no information as to how her pain prevented her from working. In fact, the records noted that she cared for her 2-year-old son without assistance, drove a car and was able to perform other activities of daily living. Only one physician stated that she was “unable to focus enough to work.” That lone opinion did not trump other medical opinions. For example, one treating physician specifically wrote, “I do not have any work restrictions for her.”
No evidence was presented as to the length of time she could sit or stand or amount of weight she could lift or any other evidence of any physical restrictions. Accordingly, the court affirmed the termination of benefits finding, “Overall, the record does not support a finding that Saunder’s pain conditions renders her totally disabled.”
Unchanged Condition Does Not Require Proctor & Gamble to Continue Benefits
The plaintiff also argued that Proctor & Gamble could not terminate her benefits since her condition had not changed in the year that she had been receiving them. The Circuit Court found this not to be a logical argument. The court held that, “As Saunders stated, ironically, in her opening brief, ‘The best that can be said of [GENEX’s] review of Saunder’s claim is that Saunders was never disabled in the first place.’”
This case was not handled by our office, but we believe it can provide help to clients with pain they believe is debilitating and need to provide objective evidence as to how their pain interferes with their ability to perform their job. If you need assistance with a similar issue, or any issue related to your disability claim, contact one of our disability lawyers for a free consultation.