The disability saga of one chronic pain patient


Factual Background

On August 6, 1997, Mr. Braddock saw his treating orthopedist, Dr. Richard Conn, who wrote in a report of that visit: “It is my medical opinion that this gentleman is suffering from his systemic rheumatologic condition to the point that he would be unable to continue to stand for any long periods of time and any squatting, crawling or climbing would be out of the question. I feel this is going to be on a permanent basis.”

On March 3, 1998 Reliastar approved Mr. Braddock’s claim for long-term disability benefits, effective February 28, 1998.

And this is where Mr. Braddock’s fun begins…

Dr. Mark Dahl reviewed Mr. Braddock’s medical records and in a report dated October 14, 1998, concluded that Mr. Braddock “should be capable of doing sedentary work.”

Dr. Huntwork completed an Independent Medical Evaluation, dated December 8, 1998, in which he generally concurred with the previous diagnoses of inflammatory arthritis and concluded that Mr. Braddock could engage in work activity of an “entirely sedentary nature involving lifting of no more than 25 pounds, freedom of movement, a flexible schedule, no prolonged sitting and no climbing, stooping, crawling, kneeling, pushing or pulling whatsoever.”

On January 6, 1999, Reliastar wrote to Dr. Conn enclosing Dr. Huntwork’s report and asking if he agreed with Dr. Huntwork’s assessment that Mr. Braddock could work in a sedentary capacity. Dr. Conn signed the letter indicating his approval on February 2, 1999 and returned it to Reliastar. Mr. Braddock was then referred to Robin Burris-Thomas, a Rehabilitation Coordinator, for a vocational assessment. On February 22, 1999, Ms. Thomas interviewed Mr. Braddock and completed a Rehabilitation Report. In her report, Ms. Thomas noted that Mr. Braddock stated that his pain was 7.5-8 on a scale of 0 to 10, and he estimated that he could sit for 30-40 minutes, stand for 20-30 minutes and drive for 15-20 minutes. On May 18, 1999, Reliastar wrote to Mr. Braddock informing him that Ms. Thomas had explored vocational alternatives that existed within his physical limitations but that based upon review of this information, “it does not appear that vocational rehabilitation services are appropriate.”

In a November 9, 1999 Medical Assessment, Dr. Conn stated that Mr. Braddock suffered from degenerative arthritis and concluded: “Pt continues to have joint pain in both knees. And multiple joint pain and tenderness. We see no resolution of this problem at this time.” And Dr. Conn noted after a September 20, 2000 visit with Mr. Braddock: “The fact that these conditions are of a chronic and permanent nature relative to his ability to get about and the gentleman continues to be markedly restricted in terms of his activities with no crawling, climbing, limited to sitting and walking tolerance.”

Plaintiff then submitted a Disability Claim Form to Hartford dated April 14, 2004 in which he stated that his activities were “very limited” and that he spent his time “either sitting, watching T.V. or reading.” Thereafter, in June 2004, Hartford referred Mr. Braddock’s claim to the Special Investigation Unit (“SIU”) for further investigation. Hartford had become suspicious that Mr. Braddock might have been misrepresenting his disability because his self-reported restrictions and limitations seemed extreme when compared to his medical records. SIU requested that HUB Enterprises conduct surveillance of Mr. Braddock.

A video was made of Mr. Braddock which, according to the November 5, 2004 summary prepared by HUB Enterprises, depicts him on the first day of surveillance standing and walking around his home in a normal manner without any restrictive movement or visible medical devices, and on the second day of surveillance, over nearly a three-hour period, driving from his house to a gas station, getting out of his car to pump gas, going into and out of the gas station, getting back into his car, driving to a store, going into and out of the store, getting back into his car, driving to a nursing home, going into and out of the nursing home twice, going to an investment and insurance company office and driving home. During this trip, Mr. Braddock was not seen wearing or using any medical devices and was seen walking in a normal manner, without any visible signs that he was in pain.

Funny, my HUB report doesn’t include any video… or if it does, it’s been covered up.

And what are pain patients supposed to do, walk around every day with our faces and expressions downcast, or in an angry expression of pain?  And just because Mr. Braddock can walk in a “normal manner,” that doesn’t mean he’s pain free.

On a July 1, 2004 Claimant Questionnaire submitted to Hartford, Mr. Braddock stated that his activities were severely limited, that he was in constant pain, that he was unable to sit or stand for any period of time and that riding in vehicles was extremely painful for him.

Please learn a lesson from Mr. Braddock, and do not specify your limitations to your insurance company.  Once you say you can sit for 30 minutes, with 10 minute breaks in between, if you are caught sitting for 31 minutes, then you’re toast.

But just because Mr. Braddock said that riding in vehicles was extremely painful, that doesn’t mean he’s going to stop doing it.  Pain patients live in pain, so EVERYTHING is painful — it’s not like the pain goes away while sitting for 30 minutes.

On September 13, 2004, Hartford wrote to Dr. Folse and told her that based on its review of Mr. Braddock’s medical records and the information provided by Dr. Folse and other doctors, it had concluded that Mr. Braddock “appears to have full-time sedentary capacity for employment. Specifically, Mr. Braddock should be capable of sitting for 8 hours per day with allowances for periodic breaks and change of position every 2 hours.” Dr. Folse was asked to either sign the letter indicating her agreement with its opinion or, if she disagreed, to provide a response supported by specific medical information. Dr. Folse signed the letter on September 23, 2004.

Man, Mr. Braddock’s doctors really screwed him.  The capability to sit for 8 hours per day, with periodic breaks and change of position every 2 hours — like that’s all there is to working every day.  Like you don’t have to spend time sitting in stressful, smog-filled traffic, or have to do anything else, really, except sit for 8 hours a day.

Mr. Braddock was interviewed in his home by Hartford Investigator Howard Spencer on September 14, 2004. At the interview, Mr. Braddock identified himself as the subject of the surveillance video and agreed that it accurately depicted his level of functionality. In his summary of the interview, Mr. Spencer noted that during the interview, Mr. Braddock remained seated for one hour and ten minutes until he was asked a question about sitting, at which point he rose and stated that he needed to walk around and stretch his legs, as well as use the restroom. Mr. Spencer also noted that Mr. Braddock walked from the carport into the living room without complaining of pain, although he did shuffle back and forth to the bathroom. Mr. Spencer noted that Mr. Braddock did not display any objective signs of pain during the interview, nor did he complain of pain.

Wasn’t the whole interview about Mr. Braddock’s complaints of pain?  Is he supposed to say “ow” every 5 minutes, or what?  Funny, my field investigator had some of the same comments about me… used some of the same language, too.  In fact, he said that I kept getting up to get cigarettes, which isn’t true, but it makes me look bad — because all smokers are bad.

During the interview, Mr. Braddock gave a continuing disability statement in which he stated that he suffers from chronic and severe back, shoulder knee and wrist/hand pain, that he cannot stand, walk or sit for extended periods of time, that he cannot lift and carry anything of significant weight, and that although he does not wear a back brace around the house, he wears it when outside his home.

Based upon Mr. Braddock’s age, work history, education, geographic location and functionality, Tiffany Dyerson, M.S., C.R.C., determined that he could perform sedentary-level work as an account executive, sales manager or consultant. Ms. Dyerson further found that these occupations “exist at a gainful wage in [Mr. Braddock’s] geographical location.”

See, all pain patients really need are sedentary-level jobs.  I mean, if you can sit, stand, or walk for any period of time, then you must be able to work, right?

On November 17, 2004, after Mr. Braddock had received notice that his benefits would be terminated, Dr. Folse wrote a letter to Hartford in which she discussed Mr. Braddock’s condition and stated that it continued to decline. Dr. Folse also stated that Mr. Braddock was currently unemployable and would eventually require surgery in the future.

Hartford stopped paying long-term disability benefits to Mr. Braddock on November 27, 2004.

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