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N.D. Ala.: Specialist Opinions and their Impacts on Benefits

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  • N.D. Ala.: Specialist Opinions and their Impacts on Benefits

    In a rather lengthy case out of Alabama, the court reasons with the impact that the opinions of specialists can have on a claim.
    the Plan defined the term disabled as the inability “to perform all the essential functions of [the participant’s] job or another available job . . . with the same full-time or part-time classification . . . .” Initially, the defendant deemed plaintiff suffered a disability from an onset date of February 27, 2014, to May 15, 2014, and it conferred short-term disability benefits pursuant to that determination. Plaintiff’s appeal to secure further STD benefits post-May 15, 2014, occasioned the review by several physician advisers of plaintiff’s medical records, and their review resulted in the December 5, 2014, appeal determination that plaintiff did not suffer an STD from May 16, 2014, forward. Critically, however, the physicians limited their review to their respective specialties, and each of them deemed the plaintiff not disabled from their discipline’s perspective.
    Ultimately, despite the length of the opinion, the courts found all of the Plaintiff's arguments to be unpersuasive and granted the Defendant's motion for summary judgement. The opinion is attached below.
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