Ms. Denmark’s Short-Term Disability Claim
Ms. Denmark began working at GenRad on April 2, 1973 as a Group Leader in Manufacturing Inspection. Her job involved inspecting products and overseeing other inspection personnel. In 1996, Ms. Denmark was diagnosed with fibromyalgia. Despite her illness, Ms. Denmark continued to work for as long as she was able.
In October of 2001, Ms. Denmark’s symptoms forced her out of work. She then filed a claim for short-term disability (“STD”). At first, Liberty denied her claim based on a review completed by a nurse employee and a records review completed by a paid consulting doctor.
Ms. Denmark appealed the denial of her STD benefits and included a supportive letter from her doctor. Liberty chose to send Ms. Denmark for a medical evaluation with Dr. Schur. Based on his physical examination of Ms. Denmark, Dr. Schur concluded she was disabled due to her fibromyalgia. So, Liberty awarded Ms. Denmark all of her STD benefits.
Ms. Denmark’s Long-Term Disability Claim
Ms. Denmark also filed a claim for long-term disability (“LTD”) benefits. Despite approving all of Ms. Denmark’s STD benefits, Liberty denied her claim for LTD benefits. Again, Ms. Denmark appealed Liberty’s denial of benefits and included updated medical records in support of her disability.
Liberty denied Ms. Denmark’s appeal based on the following:
1. Surveillance of Ms. Denmark showing her running errands
2. Labor Market Survey
3. Records review completed by Dr. Bomalaski in which the doctor opined Ms. Denmark was capable of full-time sedentary work
Based on the above, Liberty denied Ms. Denmark’s appeal. One of the arguments it made was that Ms. Denmark failed to provide objective evidence of disability. After her appeal was denied, Ms. Denmark filed a lawsuit against Liberty.
The Court’s Review of Ms. Denmark’s Case
Generally, claims for group disability insurance offered through one’s employment are governed by the Employee Retirement Income Security Act of 1974 (ERISA). This is a federal statute that makes it difficult for individuals to win disability lawsuits. That is because these cases are typically reviewed under an arbitrary and capricious standard of review. This means for someone, like Ms. Denmark, to win a disability lawsuit, the court must find the insurance company not only was wrong in its decision, but had absolutely no reasonable basis for its decision.
Here, the court ruled that Liberty was reasonable to rely on the opinions of three non-examining medical professionals to deny Ms. Denmark's appeal. This despite that:
1. Ms. Denmark’s appeal social security disability benefits had been approved
2. Liberty’s own examining physician, Dr. Schur, found Ms. Denmark to be disabled
Under the difficult arbitrary and capricious standard of review, the court ruled Ms. Denmark is not entitled to any LTD benefits payments.
Help from an Attorney with Expertise in Disability Insurance
Disability insurance law is complicated, especially when dealing with ERISA. Under ERISA, your appeal represents the last opportunity to introduce supportive evidence of disability. It is important you hire an experienced disability attorney to help gather the support needed for your appeal. This is especially true for conditions like fibromyalgia, which are difficult to support through objective medical evidence.
1. Our lawyers specialize in disability insurance;
2. Our lawyers have experience with UNUM, Provident, Paul Revere, Hartford, Liberty Life, Lincoln Financial, CIGNA, Reliance Standard, National Life Insurance Company, and just about every other insurance company;
3. Our lawyers have won tough disability insurance lawsuits;
4. Our lawyers have recovered millions in disability benefits for clients who were wrongly denied.
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 short-term or long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.
Call for a free consultation with a disability attorney.