Life Insurance Company of North America (“LINA”) was recently ordered to continue paying disability benefits under an ERISA governed Plan. In that case, the our client was employed by UBS as a senior sales brokerage assistant earning over $100,000.00 a year. She left work as a result of a heart condition and fibromyalgia which caused severe pain, fatigue and shortness of breath. LINA approved her claim in 2005 and began paying benefits. Benefits were terminated in 2007 based on LINA’s finding that our client was not disabled from performing her own sedentary occupation.
In its denial, LINA demanded that its insured provide it with “objective” medical evidence of disability.
Under the applicable ERISA standard of Review, the Court found that it was unreasonable for LINA to require “objective” medical evidence. The Court found that LINA was required to engage in a meaningful dialogue with the claimant to advise precisely what evidence was necessary in order to support the claim. With respect to fibromyalgia, a condition characterized primarily by subjective complaints, it was noted that were no objective tests to measure plaintiff’s inability to function due to pain. In fact, the Court found that LINA’s request for objective medical evidence was a request for evidence that was not available.
The Court also criticized LINA’s attempt to terminate benefits when there had been no change in the our client’s condition. It noted that her cardiac condition had remained essentially static during the time benefits were paid and that LINA could not explain why benefits should be terminated in 2007 when there had been no change in her condition.