In what is sure to be a win for the many who suffer from chronic pain, the Sixth Circuit Court of Appeals held in Corey v. Sedgwick Management Services, Inc., that prescriptions and treatment plans can be considered objective findings of an underlying disability. Bruce Corey, a machine operator, has long suffered from “cluster headaches,” which are extremely painful and debilitating. Corey received disability benefits for a short time, but the administrator of his plan, Sedgwick, decided to terminate them based on the common contention that there was a “lack of objective findings contained in the medical documentation.” The Court refuted this argument partly by pointing to the plain language of the plan, which stated that “objective findings include…medications and/or treatment plan,” among other things such as x-rays and physical examinations.
A second review conducted by Sedgwick resulted in another denial, on the grounds that there was “no objective evidence of disability.” The insurance company claimed that since some insureds are able to work while they are undergoing treatment or taking medication, they are not objective evidence of an underlying disability. The court noted the problem with this logic is, “an x-ray showing nerve compression suffers from the same defect: it bespeaks the existence of a back condition, but doesn’t demonstrate whether the condition prevents the employee from working. So too with every other example in the plan.” Essentially, it is an improper basis to deny benefits based on a treatment plan’s supposed failure to provide objective findings without giving a reasonable basis for why the treatment plan itself does not evidence an underlying disability. Likewise, discarding a prescription of medication as a lack of objective evidence that an insured may have the underlying illness or condition that medication is intended to help is improper. The court ultimately held for these reasons medication prescriptions and treatment plans are in fact able to serve as objective medical evidence, especially, as in this case the policy delineates that medication and treat plans can be objective medical evidence of a disability. Finally, the Court also took issue with the fact that in their denial letters the insurance company was only quoting the plain language of the plan and then stating that the evidence did not fulfill their requirements for disability. The Court held that only actual interpretations receive deference from the court, not conclusory denials that require “an attorney to craft a post-hoc explanation.”