Diamond v. Reliance Standard Life Insurance Company

Justia Dockets & Filings Second Circuit New York Southern District Diamond v. Reliance Standard Life Insurance Company

Diamond v. Reliance Standard Life Insurance Company

Plaintiff:	Elizabeth Diamond
Defendant:	Reliance Standard Life Insurance Company
Case Number:	1:2008cv07562
Filed:	August 27, 2008
Court:	US District Court for the Southern District of New York
Office:	Labor: E.R.I.S.A. Office
County:	Rockland
Presiding Judge:	Unassigned
Nature of Suit:	Plaintiff
Cause of Action:	Federal Question
Jury Demanded By:	29:1001 E.R.I.S.A.: Employee Retirement

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Date Filed	Document Text
December 1, 2009	Filing 27 OPINION:#98294 The Court has weighed the relevant factors in this case and concludes that Reliances decision to terminate Diamonds benefits was arbitrary and capricious. Plaintiff is, therefore, entitled to summary judgment on her claim for the foll owing reasons: (1) As a matter of law, Reliance has a conflict of interest since it both has the discretion to decide whether benefits will be paid, and it is the payor of those benefits if they are awarded. (2) There were a number of procedural irre gularities that weigh against the defendant in this case: defendant misplaced plaintiffs file at least one time; defendants emphasized reports by Diamond's non-treating physicians that favored denial of benefits and deemphasized reports by Diamo nd's treating physician that suggested a contrary conclusion; defendant encouraged plaintiff to seek Social Security benefits, during which she would have had to argue and prove she was disabled. Reliance had an interest in encouraging Diamond t o obtain those benefits because, if her application were successful, it would lower the amount that Reliance would need to pay Diamond pursuant to her policy. (3) The nature of Diamond's disease makes it inherently difficult for doctors, even th ose who are actually treating her, to render a diagnosis and assess her ability to work. (4) Defendant had not conducted a physical examination ofDiamond in more than three years when it revoked her disability benefits, which renders its denial less credible. For the foregoing reasons, defendant's motion for summary judgment is denied, plaintiffs motion for summary judgment is granted, and defendant is directed to reinstate Diamond's disability benefits. (Signed by Judge Sidney H. Stein on 12/1/2009) (tve) Modified on 12/3/2009 (eef).

Date Filed

Document Text

December 1, 2009

Filing 27 OPINION:#98294 The Court has weighed the relevant factors in this case and concludes that Reliances decision to terminate Diamonds benefits was arbitrary and capricious. Plaintiff is, therefore, entitled to summary judgment on her claim for the foll owing reasons: (1) As a matter of law, Reliance has a conflict of interest since it both has the discretion to decide whether benefits will be paid, and it is the payor of those benefits if they are awarded. (2) There were a number of procedural irre gularities that weigh against the defendant in this case: defendant misplaced plaintiffs file at least one time; defendants emphasized reports by Diamond's non-treating physicians that favored denial of benefits and deemphasized reports by Diamo nd's treating physician that suggested a contrary conclusion; defendant encouraged plaintiff to seek Social Security benefits, during which she would have had to argue and prove she was disabled. Reliance had an interest in encouraging Diamond t o obtain those benefits because, if her application were successful, it would lower the amount that Reliance would need to pay Diamond pursuant to her policy. (3) The nature of Diamond's disease makes it inherently difficult for doctors, even th ose who are actually treating her, to render a diagnosis and assess her ability to work. (4) Defendant had not conducted a physical examination ofDiamond in more than three years when it revoked her disability benefits, which renders its denial less credible. For the foregoing reasons, defendant's motion for summary judgment is denied, plaintiffs motion for summary judgment is granted, and defendant is directed to reinstate Diamond's disability benefits. (Signed by Judge Sidney H. Stein on 12/1/2009) (tve) Modified on 12/3/2009 (eef).

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Plaintiff: Elizabeth Diamond
Represented By:	Raymond Nardo
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Defendant: Reliance Standard Life Insurance Company
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