Published by The Pellegrin Firm February 5, 2020

In a recent decision, a panel of the United States Court of Appeals for the Sixth Circuit discussed the meaning of a “regular care” provision in a long-term disability policy. The case is Bruton v. American United Life Insurance Corp., No. 19-3466,__F.App’x__, 2020 WL 398539 (6^th Cir. Jan. 23, 2020). The Sixth Circuit overturned the decision of the third-party claim administrator that denied long-term disability benefits and the decision of the district court that upheld the denial.

Many long-term disability policies include the requirement that a claimant continue to seek medical treatment for his or her disabling condition in order to continue receiving benefits. Insurance companies do this because they want to incentivize claimants to undergo treatment that might help to resolve or mitigate the disabling condition and allow the claimant to return to work. The question in Mr. Bruton’s case is just how much and what kind of care is required to satisfy the requirement of regular care.

Mr. Bruton underwent consistent medical treatment for his back and leg pain, including nerve stimulation, epidurals, physical therapy, and heavy doses of opioids. However, he did not undergo each and every treatment recommended by treating doctors or the third-party administrator’s doctors.  The court held that this was not required by the policy. If a claimant believes that a treatment is too expensive (a common issue for long-term disability beneficiaries), too painful, or too risky, he or she is not necessarily obligated to undergo it to continue receiving benefits. In Mr. Bruton’s case, he refused a follow-up MRI he couldn’t afford, aquatic therapy, and treatment with a pain management doctor.

The decision is not designated for publication, and thus is not likely to be widely cited. However, it does give some guidance to claimants. People receiving or seeking long-term disability benefits often have questions about whether they must undergo all treatment suggested by insurers and their doctors. The Sixth Circuit’s decision suggests that people receiving disability insurance benefits still can exercise some degree of control over their own medical care.