Reliance Standard’s Failure to Conduct IME Was Arbitrary and Capricious According to Pennsylvania Court

Pennsylvania Court holds that Reliance Standard’s failure to conduct an in-person independent medical examination of a plaintiff suffering from depression/anxiety was an abuse of discretion.

More often than not, insurance companies get away with conducting paper reviews on claimants with disability claims who suffer numerous physical and mentally disabling conditions. It seems unfair that an insurance company can hire a doctor to review a claimant’s medical records, never examine or meet the claimant, then render an opinion that he or she is perfectly capable of working.

A Paper Review Alone Is Insufficient to Determine Whether Claimant with Mental Nervous Condition is Disabled.

A Court in Pennsylvania said this conduct was unreasonable and overturned Reliance Standard’s decision to deny benefits based solely on a physician’s paper review. In Connelly v. Reliance Standard Life Insurance Company, the Plaintiff was suffering from depression and anxiety and according to his treating psychiatrist, unable to perform the material and substantial duties of his occupation. According to the court, “when a psychiatrist evaluates a patient’s mental condition, his opinion and diagnosis depends greatly on interviewing and spending time with the patient. The court felt that since the reviewing physician never examined the plaintiff and his opinion was quite different from his long-time treating physician’s opinions, suggested that the insurer was looking for a reason to deny benefits. The plan allowed for the insurance company to examine the claimant and the fact that Reliance failed to take advantage of that option was clearly suspect.

Therefore, the court held that the denial of the plaintiff’s claim based on a paper-review was an abuse of discretion. This is a huge victory for the plaintiff as well as for other claimant’s suffering from mental nervous conditions that have been denied based solely on paper-reviews.

The law firm of Dell & Schaefer was not involved in the Connelly case, but we do represent many claimants all over the country who have similarly been denied benefits based on paper reviews alone.