ST. LOUIS – A federal court has granted a defendant's motion for summary judgment in a case involving an Alexian Health System employee who was denied short-term and long-term disability benefits by the company's claims administrator.
According to the March 14 U.S. District Court for the Eastern District of Missouri memorandum and order, the court granted defendants Ascension Health Alliance's motion for summary judgment and denied plaintiff Jacqueline Presi's motion for judgment on the administrative record or in the alternative motion for summary judgement.
The case involves the denial of Presi's short-term disability (STD) and long-term disability (LTD) benefits by Alexian Health's claims administrator Sedgwick Claims Management Services Inc. in 2015 and 2016. While employed as a unit secretary at Alexian, Presi applied for short-term and long-term disability due to a history of osteochondroma, muscle spasm, shoulder pain and an anxiety disorder. Along with her claims, Presi had submitted medical records that included notes from more than five different doctors, a nurse practitioner and medical test results.
Presi's claims were denied by the defendants, who stated Presi did not "offer any evidence to support her claim" and that she did not file the LTD claim in the required 180-day elimination period, the ruling states. Presi argued that her documentation "was sufficient to present a valid claim for LTD benefits" and that her lawsuit over denial of STD benefits was a factor in the defendant's decision, according to the ruling.
Judge Jean Hamilton agreed with the defendants and said Sedgwick "gave detailed reasons for denying plaintiff’s STD claim, clearly pointed to the basis for its decision, and declined to rely on plaintiff’s lack of objective support for her claimed disability."
The court concluded that it did not agree the defendant abused its discretion in turning down Presi's claims and that the lack of evidence "of the plaintiff’s disability is not unreasonable."