On August 27, 2010, San Francisco ERISA attorneys prevailed on a motion for summary judgment in favor of defendants Wilson, Sonsini, Goodrich & Rosati Long Term Disability Plan and Prudential Insurance Company of America (collectively “Defendants”) in an ERISA disability case where subjective evidence of pain was insufficient to prove disability on de novo review.
Plaintiff Pamela Jackson worked as a help desk analyst from 1979 until December 17, 1997 for Wilson, Sonsini, Goodrich & Rosati, LLP until she left work due to pain and numbness associated with a back condition. Plaintiff submitted a claim for long term disability benefits to Prudential Insurance Company of America (“Prudential”) indicating she suffered from back pain, causing numbness/loss of sensation due to ongoing problems from a ruptured disk. On March 31, 1998, Plaintiff underwent back surgery and Prudential approved Plaintiff’s request for benefits. Plaintiff’s treating physician found her to be “recovering very well” from surgery. Approximately a month prior to the time Plaintiff was scheduled to return to work, she began complaining of increased pain in her back and legs. Plaintiff’s treating physician found her fit to return to work with limited restrictions, based upon objective tests, including x-rays, CT scan, MRIs, and neurologic exams.
Prudential reviewed and evaluated Plaintiff’s medical information, job description and a vocational report. Prudential determined there was no objective evidence to support Plaintiff’s subjective pain complaints that would prevent her from performing the material and substantial duties of her occupation, and Prudential terminated Plaintiff’s long term disability benefits. Plaintiff appealed Prudential’s decision three times. Each of the three reviewing physicians retained by Prudential, one on each appeal, determined Plaintiff’s subjective complaints of pain were not supported by the objective medical evidence. Further, after Prudential's termination of benefits, Plaintiff's treating physician drafted a report documenting Plaintiff's complaints of ongoing pain and stated that Plaintiff was unable to return to work. None of Plaintiff's physician's reports prior to the termination of benefits contained findings that Plaintiff was unable to work. To the contrary, all prior reports documented recovery.
On de novo review, the Court decided the parties' cross motions for summary judgment and granted Defendants' motion and denied Plaintiff's, holding “the medical information in Plaintiff’s file does not support the severity of her complaints or indicate that she is unable to perform the material and substantial duties of her occupation.”
Based upon the decision in this matter, the ability to demonstrate a lack of objective evidence may be just the lynchpin insurers need to persuade the Court on a motion for summary judgment that a Plaintiff’s subjective complaints are unsupported.
On September 22, 2010, Plaintiff filed a notice of appeal of this decision with the Ninth Circuit Court of Appeals.
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