Opinion ID: 2966248
Heading Depth: 4
Heading Rank: 1

Heading: Inconsistent Medical Certificates

Text: Liberty doubted the correctness of the May 1997 certificate because it directly conflicted with the March 1997 medical certificate Dr. Blackwood inadvertently forwarded to it. (9) In its brief to this court, Liberty tries to explain this doubt on two bases. First, it suggests that Dr. Blackwood succumbed to pressure from his patient: regardless of whether Dr. Blackwood was actually confused by Liberty's August 18, 199[8] letter ... or was changing his prior opinion in response to pressure from Cook to help her with her 'problem with the insurance company.' (emphasis added). Second, it suggests that Dr. Blackwood fabricated the May certificate with its reference to the  purported May 5, 1997 medical certificate (emphasis added). These insinuations are not supported by the record. When it received Dr. Blackwood's letters and the May 5, 1997, certificate on November 5, 1998 (as part of Cook's internal appeal), Liberty never contended that the certificate was fraudulent or backdated. There is no indication in the record that the Liberty analysts assigned to Cook's case believed Dr. Blackwood fabricated this May 5, 1997, certificate to help Cook obtain her benefits, and no one mentioned this possibility in the internal memoranda exchanged while evaluating Cook's appeal. Additionally, the medical opinion proffered in the May 5, 1997, certificate was supported by evidence already in Cook's file. On May 5, 1997, Dr. Blackwood recorded on Cook's chart his intent to put her back out of work on an indefinite basis after she suffered a recurrence of chronic fatigue syndrome. Although the record does not establish that the May 5, 1997, certificate itself was forwarded to Liberty on or about that date, Liberty's internal memorandum of May 9, 1997, indicating that Cook's long-term disability benefits had been restored, permits a fair inference that the substance of Dr. Blackwood's opinion about Cook's severe work limitations was communicated to Liberty in some fashion on or about May 5, 1997. Also, Dr. Blackwood's chart notes, which had been forwarded to Liberty in December 1997 (and again in August 1998) upon its request as part of its regular review, all confirm Cook's severe work limitations. The Liberty analyst reviewing Cook's claim in August 1998 likely was confused by the apparent inconsistency between the chart notes (reporting Cook's inability to work) and the erroneously submitted March 1997 medical certificate attached to those chart notes (clearing her to work 40 hours a week). Although Liberty gave Dr. Blackwood the opportunity to explain this inconsistency, he erred again with his yes response to Liberty's questioning. Nevertheless, to support Cook's administrative appeal, Dr. Blackwood explained his mistake, reiterated the currently-applicable diagnosis, and submitted the May 1997 medical certificate to buttress his explanation. In submitting that certificate, Dr. Blackwood was not creating a new document or a new diagnosis. Instead, he was reminding Liberty of his long-standing diagnosis of Cook, modified only for that brief period of time when she returned to work in April 1997, and previously accepted by Liberty as a sound basis for the payment of disability benefits. Therefore, the highly charged suggestions of succumbing to pressure from a patient and fabrication have no support in the record.