8th Circuit Court Decision - Polich v. Prudential Life

Saw an interesting decision from the 8th Circuit Court of Appeals last week. In Polich v. Prudential Life, the circuit court upheld the district court’s ruling that the insurer was justified in denying a group LTD claim because the claimant refused to attend an independent medical exam (IME) the insurer had scheduled as part of its 2nd appeal review and also declined the insurer’s subsequent request that he provide “raw data” from his treating neuropsychologist regarding the condition that was the basis for his claim.


In this instance, the policy language allowed the insurer to deny or terminate a claim if the claimant refuses to be examined as reasonably required by the insurer or does not submit appropriate information requested by the insurer in support of the claim.

The claimant contended the request for the IME and the raw data from his treating physician were unreasonable, since the insurer should have requested all that as part of its prior review of the claim and initial appeal, especially since a medical professional the insurer consulted with on the initial claim had recommended obtaining the raw data.

The circuit court took a different view, holding that the claimant “was not required to pursue a second administrative appeal but when he continued to dispute the insurer’s conclusion and asked again for reconsideration, it surely was reasonable for Prudential to gather additional relevant information as part of its reexamination of the earlier decisions.”