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6TH CIRCUIT COURT OF APPEALS OVERTURNS AETNA”S LTD DENIAL DECISION

A panel of the 6th Circuit Court of appeals recently overturned Aetna Life Insurance Company’s decision denying LTD benefits to one of our client’s. In Mckenna v Aetna Life Insurance Co. the court found that Aetna improperly rejected our client’s claim for benefits.

In sum, although it is Appellant’s burden to prove that she was entitled to LTD benefits, she unquestionably met that burden when she proved to Aetna’s satisfaction that her condition resulted in functional impairments that prevented her from performing the material duties of her own occupation through February 23, 2013.

The court explained:

Reviewing the evidence in context, we conclude that a fair reading of the administrative record is that Dr. Adams’s initial opinion about Appellant’s return to work date was just that-an initial opinion. For this reason, and because Dr. Rubin neither conducted his own physical examination of Appellant nor offered any other explanation as to why he believed Appellant’s condition and symptoms would continue only through February 23, 2013, we give little weight to his opinion that her abnormal findings would be expected to continue only through that date. Instead, we look at the entire administrative record to determine whether there was any indication of abnormal findings or continued disability beyond February 23, 2013.

Upon review of the record, we find there is sufficient evidence that her impairment continued beyond February 23, 2013. First, we note that Aetna’s partial finding of disability was based on abnormal examination findings up through December 2012, including lumbar tenderness on palpitation, facetogenic pain, abnormal gait, and painful range of motion, which caused Appellant to be unable to sit for prolonged periods of time. With the exception of the observation that Appellant had a steady gait on March 11, 2013, there is no evidence that any of these abnormal findings improved by February 24, 2013. Second, there is certainly no objective evidence of improvement of any of the bulging discs, collapsed discs, or annular tears that were noted in the October MRI and November discogram. Third, there is no record evidence of successful treatment, sustained pain relief, or even an examining physician opinion that her condition had improved or that she no longer suffered from functional limitations. As such, there is simply no record evidence suggesting that Appellant’s “chronic” condition did not continue beyond February 23, 2013.