A South Carolina court ruled in favor of a construction supervisor with disabilities against United of Omaha.
Brogan Adams filed for disability due to mental health issues, liver failure, and cognitive deficits. Most of his symptoms are self reported and subjective in nature. Mr. Adams’ doctor fully supported his disability and inability to work in at least his occupation as a construction supervisor.
The LTD Policy Language
United of Omaha’s LTD policy did not require the claimant to provide objective evidence of a mental disorder. Moreover, the policy was silent as to whether someone could receive LTD benefits based on self-reported symptoms. Thus, the Court considered Mr. Adams's self-reported and subjective symptoms in determining whether he was disabled.
In order to determine disability, the claimant must prove they are
“prevented from performing at least one of the Material Duties of his Regular Occupation on a part-time or full-time basis; and
Unable to generate current earnings which exceed 99% of [his] basic monthly earnings due to that same Injury or Sickness.”
The Court finds Mr. Adams Disabled
Mr. Adams was continuously treated with his doctors for mental health treatment and his doctor agreed with his reported symptoms. His treating doctor diagnosed him with attention deficit disorder, depression, anxiety, panic disorder, mild cognitive disorder and memory loss.
The Court noted that the evidence clearly supported the severity of Mr. Adams's symptoms and the symptoms prevented him from working in his occupation.
Notably, the Court found that Mr. Adams cannot complete the duties of his job including an inability to problem solve, make judgments, direct others, plan or organize, or work independently.
This case is a good example of how policy language is important. Had the Policy had an exclusion for self-reported symptoms, it may have been more difficult for Mr. Adams to prevail.
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