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Proper remedy for an Arbitrary and Capricious finding: N.D. Ohio

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  • Proper remedy for an Arbitrary and Capricious finding: N.D. Ohio

    Often, in this line of work, some of the cases we review are exceptionally unfortunate. This case falls into that category. From the Northern District of Ohio, this case involves a Plaintiff who worked in a WalMart distribution center. Tragically, her son died while working in the same center, and the Plaintiff received long-term disability benefits as a result of the physical and mental toll the event took on her. However, benefits were eventually discontinued and denied and the Plaintiff filed suit.

    The Defendant argues that:

    Defendant argues that its decision to deny long-term disability benefits complies with the disability policy, because Plaintiff is ineligible for disability benefits under her policy. Specifically, Plaintiff’s condition does not meet the policy’s definition of “disability.” Defendant contends that, to qualify for long-term disability benefits, Plaintiff
    would have to show that she could not perform her job “without regard for her work location.”
    The Plaintiff responds that as a result of her depression, she cannot perform the actual demands of her job. The court, however, spends most of the opinion exploring the Defendant's decision making process with respect to denying benefits; particularly in relying on it the reviewing doctor's opinion as opposed the Plaintiff's primary care providers.

    Dr. Sugerman’s claim that emotional lability was not present ignores Dr. Kissinger’s mark on the residual mental functional capacity questionnaire that Plaintiff suffered from emotional lability. See id. at PageID #: 198. Even if Dr. Sugerman concluded that Plaintiff did not suffer from emotional lability, he failed to provide reasons justifying his alternative conclusion. Dr. Sugerman offered support for his overall conclusion, but he has overlooked the emotional lability symptom, and, in fact, used the purported absence of emotional lability as a reason for his conclusion that Plaintiff did not suffer from an impairment disabling her from work. As the Sixth Circuit has held “cherry-picking symptoms ... and then reverse engineering a diagnosis ... is not the hallmark of a reasoned explanation.”
    Ultimately, the court finds that the Defendant has not proven that she suffers from a disability, but rather that the Defendant's process was arbitrary and capricious. Therefore, the court finds the appropriate remedy is to remand the case. The opinion is attached below.
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