The district court found that the Plan's wholesale disregard of
Dr. Welshofer's affidavit in favor of his earlier April 2004
statement, which was based on incomplete information, was unreasonable.
Friday, September 08, 2006
Fourth Circuit Finds Disability Plan Abused Discretion By Failing to Credit Plaintiff's Doctor.
Individuals do win against insurance companies that deny disability claims. Donovan v. Eaton Corporation is a good example. A disability plan's own doctors denied Ms. Donovan's claim in part because her doctor changed his opinion during the course of treatment. But this doctor had a reasoned explanation for changing his opinion -- namely he was able to review additional evidence demonstrating the plaintiff's severe back pain. According to the Court:
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