On March 15, 2016, Judge William Conley overturned CUNA Mutual’s decision to deny John Clark’s LTDI benefits. Clark v. CUNA Mutual Long Term Disability Plan et. al, No. 14-cv-412-wmc (W.D. Wis. Mar. 15, 2016). In ruling for Mr. Clark, the Court found that the defendants, CUNA Mutual Insurance Society and CUNA Mutual Long Term Disability Plan, violated Clark’s right to a full and fair review of his claim for benefits. The Court further ordered that CUNA Mutual reconsider its decision in light of the Court’s Order. This decision represents a major victory for long-term disability claimants, who face an extra challenge of a standard of review which gives an edge to defendants. Courts only overturn defendants’ decision to deny benefits if their decision was “arbitrary and capricious.” The attorneys at Hawks Quindel presented strong evidence of defendants’ arbitrary and capricious tactics. In finding for the plaintiff, the Court particularly weighed the following:
- Defendants ignored plaintiff’s medical evidence, including results of physical exams and office visit notes documenting persistent pain.
- Defendants failed to account for plaintiff’s extensive history of attempts to manage his pain.
- Defendants’ medical consultants’ opinions were largely unsubstantiated, while plaintiff’s doctors’ opinions were based on in person, long-standing treating relationships.
- Defendants failed to provide any reasoned explanation for rejecting plaintiff’s doctors’ opinions that he is disabled. It was unreasonable for defendants to dismiss their opinions as based on subjective reports of pain or as dated after the denial of benefits.