Casenote of the Month

McLaren-Knipfer v. Arvinmeritor, Inc., 2012 U.S.Dist.LEXIS 88891 (E.D.Ky. June 27, 2012))(Issue: Scope of Review). This is yet another case to be added to the growing catalogue of rulings finding CIGNA guilty of acting arbitrarily. In this ruling, the court was especially critical of the insurer's denial of benefits due to a lack of reported "measured limitations," a mantra that a growing number of courts have deemed meaningless. The plaintiff, who suffered from advanced chronic obstructive pulmonary disease (COPD), and who had to use an oxygen tank on a full-time basis, was denied benefits. The court found that since there was no dispute as to the diagnosis, the need for oxygen, and that even minimal exertion led to shortness of breath, the insurer's determination was made in an evidentiary vacuum since none of the medical opinions obtained by CIGNA related those impairments to the claimant's job requirements. The court also criticized CIGNA for "wholly ignor[ing] Plaintiff's subjective assessment of her abilities and what they personally observed about her shortness of breath, instead using the latest pulmonary test results as a proxy for functionality." Since, as the court found, "nothing in those test results inherently reflects on the stamina or skills required of Plaintiff for her particular job," the insurer's assessment was arbitrary.

The court also deemed the consultants' evaluations "selective" and lacking in a reasonable basis for characterizing results marked as abnormal by the laboratory as normal or mild. The court also took judicial notice of easily obtained benchmarks from the National Institutes of Health, which showed that the test results and symptoms were neither "normal" nor "mild." Further, while acknowledging that deference is not automatically due the treating doctor's opinion, the court found that the reviewing doctor's findings vis a vis the treating doctor may be disregarded under circumstances catalogued in Combs v. Reliance Standard Life Ins. Co., No. 2:08-cv-102, 2012 WL 1309252, at *10 (S.D. Ohio Apr. 12, 2012)(relying on Evans v. Unum Provident Corp., 434 F.3d 866, 877 (6th Cir. 2006), and Curry v. Eaton Corp., 400 F. App'x 51, 59 (6th Cir. 2010)):

  • the reviewer "disregard[s] subjective reports of symptoms based solely on a review of medical records which do not contain objective support for the claimant's complaints," id. (citing Calvert v. Firstar Fin., Inc., 409 F.3d 286, 296 (6th Cir. 2005));
  • the reviewer relies on an "expert opinion that does not address crucial aspects of the claimant's former job and which is in conflict with other credible evidence in the record, including the opinion of the treating source," id. (citing Kalish v. Liberty Mut./Liberty Life Assurance Co. of Boston, 419 F.3d 501, 506 (6th Cir. 2005));
  • "evidence from the treating physicians is strong and the opposing evidence is equivocal, at best, and also lacking in evidentiary support," id. (citing McDonald v. Western-Southern Life Ins. Co., 347 F.3d 161, 172 (6th Cir. 2003)); or
  • a "contrary opinion of the non-treating physician was not based on an examination of the claimant and was supported only by a selective, rather than a fair, reading of the medical records," id. (citing Moon v. Unum Provident Corp., 405 F.3d 373, 379 (6th Cir. 2005)).

All of those examples were found here; and the court deemed "[s]uch 'cherry-picking" and lack of textual support are grounds to find the decision arbitrary and capricious." *23 (citing Lanier v. Metro. Life Ins. Co., 692 F. Supp. 2d 775, 786 (E.D. Mich. 2010)).