Dr. Fantasia finds fibromyalgia Plaintiff disabled

Whaley v CNF Transportation, Inc. Long Term Disability Plan, C. A. No. 03-363 (Southern District of Ohio (Order Granting Plaintiff's Motion For Judgment On The Administrative Record (June 14, 2005))

In Whaley, Judge Thomas M. Rose found that the Defendant claims administrator abused its discretion. Dr. Fantasia, Plaintiff's chiropractor, opined that Plaintiff was disabled. That was the extent of Dr. Fantasia’s role. However, Dr. Fantasia’s name alone rates a headline.
Whaley was diagnosed with fibromyalgia. She completed a Daily Activities Questionnaire (“DAQ”) and an Employee Assessment Report (“EAR”). After completing those two forms, Ms. Whaley provided various doctor reports indicating she was disabled. The DAQ was 13 months old and the EAR was 11 months old on the date the claims administrator denied the claim.
Judge Rose found that the claims administrator abused its discretion in denying Plaintiff’s benefit claim. Judge Rose reasoned that, since the claims administrator had more current evidence from Whaley’s doctors at the time of the denial, at the very least it should have obtained updated DAQ’s and EAR’s at the time it denied Whaley’s claim.