Opinion ID: 2966248
Heading Depth: 2
Heading Rank: 2

Heading: The Termination of Cook's Benefits

Text: In late July 1998, a Liberty analyst conducting a regular review of Cook's file wrote to Dr. Blackwood asking for Cook's updated medical information. In August, Dr. Blackwood returned to Liberty copies of Cook's chart notes from October 1996 to June 1998 along with a medical certificate dated March 24, 1997, and signed by Dr. Blackwood. This certificate stated that Cook could work no more than 40 hours per week and needed to have regular breaks. After receiving this information, Liberty wrote to Dr. Blackwood on August 18, 1998, and asked whether the restrictions and limitations listed in the March 24, 1997, certificate were still applicable to Cook. Liberty attached the certificate in question to the letter it sent to Dr. Blackwood. Dr. Blackwood responded by sending back the letter with the word Yes written on it and circled. As later became clear, Dr. Blackwood had misunderstood the medical certificate at issue. He thought he was saying Yes to a medical certificate he had issued on May 5, 1997, which stated that Cook was out of work indefinitely. The conclusion listed on this medical certificate was also recorded in Cook's chart notes from May 5, 1997, a copy of which had been presented to Liberty the last time it had reviewed Cook's claim in December 1997. Shortly after receiving Dr. Blackwood's response, Liberty forwarded Cook's file to Carol S. Vroman, a Vocational and Rehabilitation Consultant. Reviewing Cook's work restrictions and limitations as listed in the March 24, 1997, medical certificate, and taking into consideration her education and work history, Vroman concluded that Cook was not disabled from either her own or any other occupation. On October 16, 1998, Liberty informed Cook that she was no longer eligible for long-term disability benefits. The denial letter explained the contents of the March 1997 medical certificate Dr. Blackwood had provided Liberty and the fact that he had affirmed that those restrictions and limitations were still applicable. It then stated that [a] vocational assessment dated October 14, 1998 reveals that there are many employment options available to you based on her [sic] education with an MBA and your restrictions and limitations. ... Since you have the ability to perform occupations outside your previous position, you do not meet Lockheed Sander's [sic] definition of disability beyond October 31, 1998. Cook responded to this letter by asking Liberty to review its decision to terminate her eligibility. She forwarded to Liberty letters written by Dr. Blackwood stating that she was totally disabled due to stress, fatigue, and severe, chronic asthma. Dr. Blackwood explained to Liberty that he mistakenly thought your letter was referring to my disability form completed on May 5, 1997 which indicated that she was out of work indefinitely. He attached this disability form (medical certificate) to his letters. Cook also attached a letter Dr. Blackwood had written on March 23, 1998, to the attorney handling Cook's claim for Social Security Disability benefits. (5) This letter stated that Cook fit[] the diagnostic criteria for chronic fatigue syndrome, and concluded [t]he fatigue she feels after doing any normal daily activities makes it difficult to see how she could maintain a regular job, as she would have to be out of work intermittently to recover. Liberty added this information to its file but affirmed its termination of benefits on April 12, 1999. It explained its reasoning in another letter: We have reviewed the additional medical information submitted by Dr. Blackwood. The medical information submitted does not support limitations that would render you incapable of performing the material and substantial duties of any occupation. A Vocational Disability Review was performed taking into consideration your limitations, education and experience. Several occupations were identified and communicated to you in our letter of December 1, 1998, which is enclosed for your review. ... Based on the above cited information, and in the absence of objective medical documentation to substantiate total disability from any occupation, no further Long Term disability benefits are payable. Cook then hired counsel and again requested review of her termination. On May 22, 2000, Liberty apparently refused to reconsider Cook's arguments, responding: Ms. Cook was afforded an opportunity to appeal the initial denial of benefits under ERISA guidelines. Liberty reviewed this appeal and have rendered [sic] our final determination on Ms. Cook's claim for benefits beyond October 31, 1998.