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District Court Finds AT&T Abused Discretion in Denying Benefits to CFS Patient

Discussion in 'General ME/CFS News' started by Firestormm, Apr 5, 2012.

  1. Firestormm

    Firestormm Guest

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    Cornwall England
    http://www.prnewswire.com/news-releases/kantor--kantor-llp-district-court-finds-att-abused-discretion-in-denying-benefits-to-policyholder-with-cfs-146197155.html

    Kantor & Kantor, LLP: District Court Finds AT&T Abused Discretion in Denying Benefits to Policyholder With CFS

    Termination Based on Five Illogical Conclusions Lacking Factual Support


    LOS ANGELES, April 4, 2012

    Kantor & Kantor, LLP announced today a legal victory in the U.S. District Court for the Northern District of California on behalf of client Judi Peterson, who suffers from Chronic Fatigue Syndrome (CFS), against the AT&T Umbrella Benefit Plan No. 1 ("AT&T"), administered by third-party administrator Sedgwick CMS.

    In reaching its decision, the District Court ruled that AT&T abused its discretion and wrongfully denied Ms. Peterson long-term disability benefits. The court found AT&T's benefits termination was illogical and without support in inferences that may be drawn from the facts.

    In particular, the court determined that AT&T had abused its discretion five specific ways:

    Although the evidence showed that Ms. Peterson's condition in 2009 had remained unchanged since AT&T's initial finding that she suffered from disabling CFS in 2006, AT&T still terminated her benefits.

    The fact that there are no objective tests for CFS did not stop AT&T from terminating Ms. Peterson's benefits based, in part, on a lack of objective evidence.

    AT&T relied on a medical record review and a Transferrable Skills Analysis, neither of which considered her disabling fatigue.

    Even though AT&T had hired three medical professionals from Insurance Appeals, LTD (aka Network Medical Review or NMR) to conduct paper reviews of Ms. Peterson medical history, those medical professionals either failed to address Ms. Peterson's CFS or made incorrect diagnoses.

    AT&T failed to engage in a "meaningful dialogue" with Ms. Peterson surrounding its reasons for denying benefits. In other words, AT&T did not follow the law requiring it to ensure that the reasons for the termination of benefits actually had factual support.

    "This decision illustrates that policyholders cannot always rely on an 'unbiased' third-party administrator to make logical and fact-based benefits decisions," said Brent Dorian Brehm, a litigation associate at Kantor & Kantor and the lead trial attorney representing Ms. Peterson. "Denials must be carefully scrutinized, and if the conclusions appear unfair, incorrect, or ridiculous, they probably are."

    For more information about Peterson v. AT&T Umbrella Benefit Plan No. 1, C-10-03097 JCS, follow this link: http://www.kantorlaw.net/Cases_Resources/Document_Library.aspx.
     
    Ema, ggingues, CJB and 2 others like this.
  2. Googsta

    Googsta Doing Well

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    Thanks Firestorm.

    :victory: For Judi & all M.E patients!
     
  3. Cort

    Cort Phoenix Rising Founder

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    Very nice Firestorm - great to hear....Thanks for posting. :)
     
  4. Enid

    Enid Senior Member

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    Nice find Firestormm.:victory:
     
  5. usedtobeperkytina

    usedtobeperkytina Senior Member

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    Noticed this is in district court. Means she has been fighting this for years. Glad to get a win. Need to set precedent and make them pay interest on back pay.
     

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