Pension board rejects own examiner twice to deny officer’s disability claim

In April 2021, Lara applied for duty disability retirement benefits under the Milwaukee City Charter, which provides benefits to employees permanently and totally incapacitated as the result of an on-duty injury. Four independent medical examinations were conducted between November 2019 and April 2022. Each reached the same conclusion: Lara was not disabled as a result of the workplace injury. The explanations varied – one examiner pointed to a mood disorder, another to pre-existing psychological factors, a third to possible malingering, and a fourth to non-credible symptom reporting – but the bottom line was consistent.

The Medical Council recommended denial, and the Pension Board accepted that recommendation in July 2022.

Lara appealed through the municipal administrative review process. An independent reviewer first examined the medical evidence and reports in the record and concluded that Lara’s injuries were not a result of the fall, recommending that the denial be affirmed. Still dissatisfied, Lara requested an administrative appeal hearing. An independent hearing examiner conducted a two-day hearing, heard from multiple witnesses, and found Lara eligible for benefits. The Pension Board pushed back, returning the report for reassessment over concerns about factual errors and the examiner’s handling of the medical evidence. The examiner reviewed the record again and stood by his recommendation.

The Pension Board disagreed. In August 2023, it issued a final determination denying Lara’s claim, citing three problems with the examiner’s reports: the dismissal of multiple experts who opined that Lara was malingering, factual errors in the examiner’s findings, and the conclusory nature of both reports.

Lara challenged the denial in court, raising four arguments – that the Pension Board lacked authority to act as the final decision maker, that it missed a statutory deadline, that it improperly sent the case back for reassessment, and that its reliance on inconsistent medical reports was unreasonable.