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Austin, Bachrach and Suarez Defeat Cross-Motion for Summary Judgment against National Insurance Carrier

January 31, 2020

Heather Austin (Partner-Philadelphia), Joshua Bachrach (Partner-Philadelphia) and Tanya Suarez (Partner-Miami) obtained summary judgment and defeated a cross-motion for summary judgment filed against the firm’s client – a national insurance carrier – in the United States District Court for the Middle District of Florida. The plaintiff sought disability benefits under an ERISA-governed plan after alleging disability due to rheumatoid arthritis and was approved, but benefits were later discontinued when the plan concluded that the insured could no longer satisfy her burden of proof. The insured argued that the carrier should have accepted the opinion of her treating rheumatologist over that of two independent consulting physicians. The court instead accepted the carrier’s defense that it is not required to adopt the opinion of a treating physician and had been presented no objective evidence that would warrant the continuation of benefits. The court also acknowledged that the insured exaggerated her symptoms during the independent examinations and had admitted to, and was observed during surveillance, engaging in activity that was inconsistent with the claimed disability. Last, the court observed that it was actually the insured’s attorney who attempted to provide a more detailed criticism of the independent physician reports, and accepted the retort of the independent physician.

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