Long Term Disability carriers  can’t shut their eyes to “readily available information when the evidence and record suggest that the information might confirm the beneficiary’s theory of entitlement.” In an interesting decision in Gaither v. ETNA, 394f3d792(10th Circuit 2004), the claimant found Mr. Gaither, was accepted as being entitled to Long Term Disability benefits under the own occupation standards, in part because of the narcotics he was taking as a result of his spinal condition.
ETNA later took the position that he was not entitled to any further disability benefits and chose to ignore medical evidence that the claimant had to continue to use medication which had significant side effects, the court reserved the denial and in doing so pointed out that the administrator didn’t have to pour over a person’s medical records for a possible basis of disability that hasn’t been raised or consider what further evidence might be honorable to make a favorable decision. The court did say that Long Term Disability carrier’s can’t turn a blind eye to the information in the record, that the carrier has a duty to investigate information that confirm your period of entitlement for Long Term Disability benefits.
ETNA suggested that it acts like a judge in a Long Term Disability matter and the priorities bear the responsibility for compiling evidence to support the claim for Long Term Disability. ETNA also argued that they had “little or no responsibility to see qualification even when the evidence suggested the possibility of a legitimate claim,” the court rejected that argument.
If a Long Term Disability carrier like ETNA is handling your case in an adversarial manner, you need the assistance of a Long Term Disability attorney like Nancy Cavey, who helps Long Term Disability applicants or those Long Term Disability ERISA  applicants who’s claim has been denied. Nancy Cavey  has written a free no obligation consumer guide entitled, “Robbed of Your Peace of Mind .”