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Constructive Refusal to Consider SSD Records: E.D. Ark.

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  • Constructive Refusal to Consider SSD Records: E.D. Ark.

    In a recent case out of Arkansas, the court remands the claim to the Defendant with instruction that it must consider the favorable SSD determination. In relevant part:

    Plaintiff received Defendant’s request for the SSD records on December 19, 2017, and onJanuary 8, 2018, he signed the appropriate documents permitting Defendant to review the SSD records. However, the next day Defendant denied Plaintiff’s appeal – just seven days after it requested an extension to evaluate the appeal, and, more importantly, before it received the requested SSD records. I believe this case is analogous to the issue in Harden v. American Express Financial Corporation. In Harden, the plaintiff had applied for, and received, Social Security benefits at the administrator’s request. The administrator, however, never obtained or reviewed the available Social Security documents in determining whether the plaintiff’s eligibility under its plan. The court found that, because the administrator made statements that it had reviewed “‘[a]ll available documentation,’” the plaintiff was justified in believing that the administrator had obtained the Social Security medical documents.Because the administrator did not consider the Social Security award, and had nevertheless denied the plaintiff’s claim, the “administrative record did not contain the Social Security records that were the basis of the Social Security Administrator’s grant of benefits to him.” All of this after Defendant led Plaintiff to believe the SSD would be considered. Likewise, in this case, Plaintiff had to present proof to Defendant that he has applied for Social Security disability benefits. Defendant required Plaintiff to execute a medical authorization that would allow it to obtain his Social Security Disability records, which he did. Defendant was aware of Plaintiff’s favorable SSD award and indicated it would consider it in evaluating his claim. Likewise, the administrator failed to obtain records concerning the SSD benefits, while leading Plaintiff to believe that it was considering “all available documentation” creates procedural irregularities by the administrator.
    The full opinion is attached below.
    Attached Files