Results

Plaintiff v. Major Insurer

August 2011

Sedgwick obtained judgment on behalf of our client, a major insurer, in an action heard in federal court in California. The court granted our client’s Rule 52 motion for judgment in this matter in which a claimant sought further long-term disability (LTD) benefits under an ERISA plan.  Our client paid the plaintiff LTD benefits for almost four years due to the plaintiff's complaints and multiple diagnoses, including fibromyalgia, that allegedly rendered the plaintiff unable to perform her occupation.  The court found that our client did not abuse its discretion in thereafter terminating the plaintiff's benefits under an "any occupation" standard.  The court found that our client had taken steps to reduce bias and promote accuracy, and therefore the court applied only a modest degree of skepticism to the benefit decision.  The court then found deficiencies in the evidence relied upon by the plaintiff as well as significant evidence weighing against a finding that the plaintiff was totally disabled, and further found that surveillance video brought the plaintiff's credibility into question when compared to her self-reports of pain.