Court Rules in Favor of Denied Disability Insurance Plaintiff

September 27, 2013, 1:30PM. By Gordon Gibb

Sacramento, CAA California woman suffering from diabetes, severe psoriasis and the loss of several toes due to amputation recently fought a previously denied disability insurance claim and scored a victory when the US District Court, Eastern District of California, upon judicial review, reversed a decision by an Administrative Law Judge (ALJ) to deny the plaintiff disability benefits. The case must return to the ALJ for further review.

According to a release by US Official News (9/7/13), plaintiff Christine Marquez sought disability benefits according to provisions entrenched in California insurance law. Marquez originally filed her application for disability benefits - which initially resulted in a denied ERISA disability claim - in 2007, stemming from disability that dated back to February 1, 2006.

Following her long-term disability-denied claim, Marquez sought a hearing before Administrative Law Judge Laura S. Havens, who subsequently issued an order denying Marquez’s disability application in March 2010. The plaintiff appealed.

According to the release, Marquez was employed as a cosmetologist from 1984 through 2007. Court records showed that Marquez’ troubles began in February 2006 when, related to her diabetes, the plaintiff required the amputation of a toe. Marquez attempted to continue working part-time in spite of the amputation, but subsequent amputations of additional toes due to her condition worsened the neuropathy in her feet, resulting in ulcers in her affected foot that subsequently became infected.

Marquez stopped working in April 2007 and sought disability benefits under California insurance law.

According to Marquez’ California ERISA-denied claim, the amputations affected both feet. Four toes required removal from her left foot, and Marquez’ big toe was amputated from her right foot. The plaintiff stated she could no longer undertake work as a cosmetologist as blood no longer properly circulates to her foot.

The plaintiff’s long-term disability-denied claim stated that Marquez requires Pristiq, Lisnopril, Glyburide, Aspirin, Metformin and Hydrocodone. The plaintiff, due to her medications, experiences dry mouth, poor concentration, dizziness, drowsiness, fatigue and nausea. She also claimed an inability to walk, requiring the use of a wheelchair. Sleep is a constant challenge, with the plaintiff averaging four hours of sleep per night.

Marquez’ treating physician testified that the plaintiff was required to avoid all exposure to vibrations, dryness and temperature extremes; avoid concentrated exposure to chemicals, dust, fumes, odors and smoke; and avoid even moderate exposure to noise and dampness.

Interestingly, Marquez’ application for disability benefits was stamped “California insurance claim denied” in spite of the fact that amputation of toes, diabetes, arthritis and psoriasis were identified as severe impairments. And in spite of the testimony of treating and consulting physicians, all of whom identified physical limitations, the ALJ noted that each physician imposed different limitations.

Thus, the ALJ deemed that Marquez could perform sedentary work and upheld the original decision of Social Security having denied disability insurance in her case.

However, the court saw it differently. “Based on the foregoing, the Court finds that the ALJ decision is not supported by substantial evidence and is therefore reversed and the case is remanded to the ALJ for further proceedings consistent with this opinion,” the Court ruled. “The Clerk of this Court is directed to enter judgment in favor of Plaintiff Christine Marquez and against Defendant Carolyn W. Colvin, Commissioner of Social Security.”

The case is CHRISTINE MARQUEZ, Plaintiff, v. CAROLYN W. COLVIN, [Acting] Commissioner of Social Security Defendant. 1:12-cv-00778 GSA.