Substantial Evidence Supported Termination of Disability Benefits, Despite Social Security Award Martin v. Hartford Life & Acc. Ins. Co., 2013 WL 5297146 (D. Md. Sept. 18, 2013)
The federal district court in Maryland upheld the termination of disability benefits despite the claimant’s award of Social Security disability benefits, explaining that “what qualifies as a disability for social security disability purposes does not necessarily qualify as a disability for purposes of an ERISA benefit plan [because] the benefits provided depend entirely on the language in the plan.” Martin was a former graphic designer whose job required him to work on a computer most of the day, read extensively, walk short distances, lift up to 20 pounds, and commute by car 18 miles to and from work. He participated in his employer’s group benefit plan that defined disability to mean “you are prevented from performing one or more of the Essential Duties of Your Occupation.” Martin alleged that he became disabled as the result of Meniere’s disease, which he claimed resulted in vertigo, dizziness, loss of balance, and tremors of the hands and head, which made him unable to drive or use the computer for long periods of time. He stopped working in April 2009. Martin saw several medical professionals for his illness, including a nurse practitioner who made the diagnosis of Meniere’s disease. However, the record was unclear whether his treating physicians independently verified the diagnosis or merely adopted the nurse practitioner’s diagnosis. One treating physician wrote that Martin’s “history [was] not strongly suggestive of Meniere’s disease.” Another 10
diagnosed diffuse arthralgia, and a third treating physician diagnosed benign essential tremors and titubation. One of the doctors noted that Martin “is disabled far out of proportion to his symptoms and physical examination and underlying psychiatric illness including anxiety and depression is considered the differential diagnosis.” Martin was also given a doctor’s note stating that he might not be able to pass a sobriety test. After contacting the nurse practitioner, who reported that Martin was “currently unable to work,” because he could only “use a computer for 15-30 [minutes] and read up to 20 [minutes] without triggering an episode,” that “[h]is episodes also increase in rainy weather,” and that he was “only able to drive 2–3 miles,” Hartford began paying long-term disability benefits in October 2009. In September 2010, Martin was awarded Social Security disability benefits, following examinations by two physicians working for the Social Security Administration. In February 2010, Hartford learned that Martin’s self-reported daily activities included watching television, checking his email, working in his yard, and playing guitar. Because Hartford believed that these activities were inconsistent with the reported limitations — the inability to look at a computer screen and hand tremors — it investigated the claim. In March 2010, an investigator video recorded Martin working on his cars and
| ERISA and Life Insurance News | December 2013
seeding his front lawn. In the surveillance videos, Martin was seen bending, reaching, squatting, rising, and walking normally without signs of dizziness or imbalance for several minutes at different times of day. Hartford concluded that the video footage also conflicted with Martin’s self-reported symptoms, and an investigator was sent to interview him at home. After the interview, Hartford hired an otolaryngologist and independent consultant to review Martin’s medical records and the surveillance videos. The consultant contacted one of the treating physicians, who reported that “in general, he does not regard patients with conditions like this as being permanently and continuously impaired — symptoms may be intermittent, and between episodes they may be able to function normally.” After his review, the independent consultant concluded that Martin could handle “a full-time light physical demand level up to 40 hours per week,” which was consistent with that required by his job as a graphic designer, classified as a “sedentary occupation” with light physical demands.