Termination of Disability Benefits By Paul Revere and Provident Reversed

Paul Revere Life Insurance Company and Provident Life and Accident Insurance Company terminated the payment of disability insurance benefits, which had been paid for some five years, to Dr. Lois Kramer, an OB/GYN.  The Sixth Circuit reversed that decision in Kramer v. Paul Revere LIfe Insurance Company, No 07-1552 (April 8, 2009).  The court found that "there is no explanation for the decision to cancel benefits that had been paid for some five years based upon the initial determination of total disability in the absence of any medical evidence that the plaintiff's condition had improved during that time."  

Dr. Kramer suffered from back and spinal cord problems, underwent a laminectomy and eventually suffered diminished use of her left arm to the point that she was no longer able to safely perform surgical procedures and even routine office activity.  Her disability was confirmed by a number of treating physicians as the court recited: "Dr. William Sanders, Dr. Richard Silbergleit, Dr. Ghaus Malike, Dr. Ross Nickels, Dr. Ravi Kodali, Dr. Surest Patel, Dr. Maria Pleskacz, Dr. Silberman, Dr. Lois Michelle Butler-Jackson and Dr. Lasichak."  In addition there was evidence that Dr. Kramer could not obtain medical malpractice insurance because of her condition.  

Because of this overwhelming evidence of Dr. Kramer's disability both Paul Revere and Provident found that she was totally disabled and paid her disability benefits for five years, during which time at least two, maybe three, doctors reviewed her records and affirmed her disability.  Nonetheless, after paying benefits for five years, Paul Revere and Provident had her file reviewed by two other doctors, who opined that she was not disabled.  

The court found these two opinions unpersuasive:  "The best that can be said of [these opinions] is that they support the proposition that Dr. Kramer was, in fact, never disabled from her 'own occupation.'  But that conclusion flies in the face of all the other evidence in the record, and the plan administrator's reliance upon it can only be described as arbitrary and capricious."  The court reinstated Dr. Kramer's benefits.   

Robert L. Abell is a Lexington, Kentucky lawyer that represents claimants for disability insurance benefits.