Opinion ID: 752912
Heading Depth: 2
Heading Rank: 8

Heading: Aetna's Response

Text: 30 Southall called Harbour on February 24, 1993, and left a phone message the content of which was disputed at trial. It may have confirmed that the denial of the claim stood or it may have been a request for an independent medical examination (IME). In any event, after receiving the additional materials, Dr. Galvin and Southall had concluded that there was insufficient information to support a finding that Ace was disabled. Dr. Galvin considered Dr. Kiessling's letter as being of no value because of its tone, and asserted that he [did] not accept Dr. K's opinion, he is not a specialist and we are not providing a social benefit service. Southall testified that he discounted Dr. Kiessling's letter because it was unaccompanied by Dr. Kiessling's chart notes, examination results or other materials. Neither Southall nor Dr. Galvin contacted Dr. Kiessling to discuss his letter or to ask him to submit materials to support his conclusions. 31
32 On March 4 Aetna wrote Ace a letter, directing her to appear before a designated physician for an IME on April 5, 1993. On advice of counsel, Ace refused to appear. On March 15, Aetna wrote to Harbour, reaffirming its decision to deny the claim on the basis of Ace's failure to produce proof of [t]otal disability [which] is the inability to work at any gainful occupation due to sickness or injury. Ace then retained litigation counsel who attempted, unsuccessfully, to reschedule the IME. J. End of Ace's Disability 33 On April 8, 1993, Ace's previously-scheduled knee surgery was performed. Dr. Zorn successfully replaced Ace's knee. Within two months, Ace was walking without crutches and returned to work. Her disability ended June 1, 1993.