In Knox v. United of Omaha Life Ins. Co., a federal judge in the Middle District of Georgia ordered United of Omaha (“United”) to pay disability benefits to a claimant with HIV/AIDS. Stepping into the shoes of the insurer, the judge determined that United had reached the wrong decision in denying Mr. Knox’s disability benefits.
The judge found:
- Mr. Knox’s evidence of disability to be persuasive and credible;
- United’s evidence against disability to be insufficient.
Timing is not Everything
Importantly, the judge addressed an issue of timing that often comes up in disability benefit disputes. In Knox, United admitted that Mr. Knox was disabled as of December 2016 when it received a comprehensive neuropsychological report outlining a number of physical and cognitive limitations. United argued, however, that Mr. Knox had failed to prove his disability in January of 2016, when he first filed for disability benefits. Thus, according to United, Mr. Knox had failed to meet the elimination period and was not owed benefits.
The judge was “unpersuaded, based on the record, that a degenerative disease like AIDS suddenly manifested into a disability in November 2016 but at no time prior.” He noted that some conditions, like AIDS, have intermittent symptoms that progress overall overtime. He noted that just because symptoms are intermittent does not mean a disability does not exist.
He also used the December 2016 report and United’s admission that Mr. Knox was disabled at that time to address the previous evidence United had relied on to deny benefits. When United denied Mr. Knox’s claim, it relied on the opinion of a physician who thought Mr. Knox was exaggerating his symptoms. The judge found the December 2016 report to be persuasive in determining that Mr. Knox was not exaggerating his condition.
Ultimately, the court found Mr. Knox’s evidence of disability to be consistent and that was key. The court compared the opinions of his multiple treating providers to the statements from his friends and family and found that they were credible and consistent.
United Gets a Second Chance
Unfortunately, the court’s opinion was limited. The court determined that Mr. Knox was disabled from his own occupation. Under Mr. Knox’s policy, after 24 months, he would need to prove he was disabled from any occupation. So, the court awarded benefits for 24 months, then sent the case back to United for a determination as to whether Mr. Knox met the new definition of disability.
This is a common occurrence in disability benefits litigation. In these cases, your “win” from a court may be limited.
Having an Experienced Disability Attorney Matters
Disability insurance law is complicated. If your claim for long term disability benefits was denied or being delayed by an insurance company, it is important to get legal help from a lawyer who focuses on disability law.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
Dabdoub Law Firm represents clients nationwide with:
- submitting a disability insurance claim;
- appealing a long-term disability denial;
- negotiating a lump-sum settlement; or
- filing a lawsuit against your disability insurance company.
Call today to speak with a disability insurance attorney.