Clark v. Cuna Mutual Long Term Disability Insurance is a plaintiff friendly case where a Wisconsin federal district court found that CUMA “acted arbitrarily and capriciously in denying Clark benefits.” Clark was employed by CUNA for 21 years as a “Retirement Education Specialist, Virtual” before he became disabled in 2006 after injuring his back while moving a heavy couch. He reinjured his back in 2007 when he tried to save a swimmer from drowning. He was granted short term disability benefits. After being denied long term disability benefits and exhausting his administrative remedies, Clark filed this ERISA lawsuit.

The court issued a lengthy court opinion recounting in detail the facts of Clark’s various injuries, multiple surgeries, pain control remedies and issues with CUNA. Clark had a long and difficult struggle in his attempt to obtain disability benefits. Ultimately, the court found three specific errors committed by CUNA that resulted in it wrongfully denying plaintiff benefits. The court did not award benefits, but remanded to CUNA with specific instructions for it to follow when reconsidering Clark’s claim for long term disability benefits.

1. Cuna Selectively Reviewed Medical Records

CUNA acknowledged the existence of a questionnaire Clark’s treating physician, Dr. Leonard, presented to support Clark’s disability claim, but failed to address it. CUNA said the questionnaire postdated the relevant period. This ignored the fact that the questionnaire was provided to CUNA upon its request for further medical information. CUNA also discounted the opinion of Dr. Yeoman who was not a treating physician, but had examined Clark and provided a six-page report in support of Clark’s disability claim. The court noted that, according to precedent, “a Plan Administrator cannot request additional medical evidence and then simply reject that evidence on the basis that it post-dates the relevant termination or denial decision.”

2. CUNA Failed to Provide Reasoned Explanations for its Denial

CUNA accepted the opinions of medical consultants who reviewed Clark’s medical records even though none of those experts offered reasoned explanations for their conclusions that Clark was not disabled. The court noted that, under the plan, CUNA was required to offer a reasoned explanation “which reflects consideration of ‘the relevant factors that encompass the important aspects of the problem.’” The court found this record lacking, finding specifically that, “Normally, such an explanation would begin with a reasoned explanation by the medical experts upon which defendants purport to rely. Unfortunately, such an explanation is largely absent on this record.”

3. CUNA Created a Moving Target

CUNA asked Clark for evidence that he was disabled after January 2012. When he provided an MRI from July 2012, CUNA discounted it because it did not show he was disabled as of January 2012. The court agreed with Clark and ordered CUNA, on remand, to consider whether the July 2012 MRI may have reflected Clark’s condition as of January 2012.

This case was not handled by our office, but it may provide claimants guidance in their pursuit of long term disability benefits. If you need assistance with a similar matter, please contact any of our lawyers for a free consultation.