How Did Procter & Gamble Change the Claimant’s Status From Total to Partial Disability?

The episode revolves around the denial of the claimant's claim for long-term disability benefits. The claimant was an employee at Procter & Gamble for many years. His role required him to perform various duties, which he could no longer carry out due to medical issues. Specifically, in June 2012, he underwent gallbladder removal surgery for gallbladder cancer. Following his surgery, he was initially approved for total disability benefits under the company’s Disability Benefit Plan.However, in April 2013, after undergoing an Independent Medical Examination (IME) and a Functional Capacity Evaluation (FCE), it was determined that he was only partially disabled. The evaluations indicated that while the claimant could not perform the tasks required for his line operator position, he was capable of performing medium-demand-level work on a full-time basis, subject to certain limitations. Consequently, Procter & Gamble transitioned him to partial disability benefits, which ended after 52 weeks.The claimant appealed the decision on several grounds:Failure to produce the correct plan documents, specifically a 2012 plan which was referenced but never provided.Inconsistencies in the definition of "totally disabled" provided to treating doctors versus the plan's definition.Failure to consider new evidence submitted during the appeal, including vocational assessments and additional medical records.The core of the case rests on whether the denial of benefits was handled appropriately, both procedurally and substantively. LET'S TUNE IN!This is the oral argument in the Eighth circuit court of appeals.These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.