By | July 19, 2016

In Rassekh Sobh v. Hartford Life and Accident Insurance Company, Hartford paid the plaintiff benefits beyond his own occupation period as a Technical Operations Lead for Chase Bank and into the any occupation period. During that time, plaintiff had two back surgeries and claimed he was disabled. His medical records and reports from his treating physician supported his claim and he received disability benefits for many years from 2009 to 2014. His treating physician, Dr. Dryer, waffled between supporting his disability claim, failing to respond to Hartford’s request for an opinion and reporting plaintiff could work in a sedentary job.

Video Surveillance, Independent Medical Exam, Peer Review and Failure of Dr. Dryer to Respond

Hartford eventually conducted video surveillance of the plaintiff attending his gym over a two-day period of time. On both days, he walked to the gym without any assistance and stayed between 44 and 55 minutes. Hartford sent a copy of the video surveillance to Dr. Dryer for an opinion. When Dryer failed to respond, Hartford commissioned an independent medical exam (IME) by Dr. Dinenberg, a board certified orthopedic surgeon, who also conducted a peer review of plaintiff’s medical records. An Employability Analysis (EA) was also performed.

Dr. Dinenberg determined that plaintiff could work in a sedentary job and the EA discovered several different occupations for which he was suited. As a result of the reports, Hartford terminated plaintiff’s long term disability benefits. Plaintiff filed an administrative appeal.

Administrative Appeal

In response to plaintiff’s administrative appeal, Hartford sent the medical records for another peer review. The physician agreed plaintiff could engage in sedentary work. Meanwhile, Dr. Dinenberg was finally able to contact Dr. Dryer who agreed Sobh could perform sedentary work. Based on these opinions, and the video surveillance, Hartford upheld its decision to terminate benefits and plaintiff filed the ERISA lawsuit in the Florida district court which sided with Hartford and Plaintiff Appealed.

Eleventh Circuit Unpublished Appellate Opinion

The appellate court opinion came down on the side of Hartford and upheld the district court’s decision. The Eleventh Circuit court specifically stated that, “Here, the lack of response from Dr. Dryer, in conjunction with the surveillance video, the opinion of Dr. Dinenberg, and the Employability Analysis sufficiently substantiated Hartford’s decision to terminate Sobh’s benefits.”

The court concluded its analysis by holding, “In light of this evidence, we find no error in the administrator’s decision to terminate benefits. At the latest, Sobh was no longer disabled as of October/November 2014, and Hartford properly discontinued his benefits.”

This case was not handled by our firm, but we believe it can be instructive for those who have been under long term care by a physician who ignores requests by an insurer to respond to requests for disability opinions. If you have questions about this, or any other aspect of your disability claim, contact one of our experienced disability attorneys for a free consultation.

Leave a Reply

Your email address will not be published. Required fields are marked *