A Systems Support Specialist II at Coca-Cola was wrongly denied disability benefits after being injured in a car accident. After submitting countless medical documentation in support of his disability he won his lawsuit and was awarded past and future disability benefits.
How Does One Receive Benefits Under an ERISA Governed Disability Plan?
Upon becoming disabled, one usually applies for short-term disability (“STD”) benefits. The length of STD benefits can vary but for this plaintiff he received benefits for 26 weeks. After STD benefits end then one usually applies for long term disability benefits.
To qualify to receive benefits for the first 24 months one must satisfy the “own occupation” standard. This means that because of the individual’s disabling condition he / she is unable to perform the material and substantial duties of their occupation. Following the first 24 months, a change of definition applies and to continue receiving benefits the individual must be unable to work in the “any occupation” category. Traditionally, this means jobs falling with the sedentary category.
Despite Oliver’s doctors providing abundant medical evidence in support of his disability Coca-Cola claimed Oliver’s diagnoses and pain was mostly “subjective” and continued to say he could return to his job.
Can an Insurance Company Deny a Claim Based on Lack of “Objective Testing” for Pain-Related Disabilities?
No. In Oliver v. Coca Cola, the Court made it very clear that insurance companies cannot simply object to covering pain-related disabilities, like Oliver’s diagnoses of fibromyalgia and chronic pain syndrome, for lack of being able to diagnose through “objective” lab testing.
Neither Coca-Cola, nor any of their doctors disputed or denied Oliver’s diagnoses. They denied the disability claim because they felt the medical evidence submitted was simply “subjective complaints of pain without any objective data.”
The court held Coca-Cola acted unreasonably when they consistently continued to say the reported symptoms were subjective. They willingly ignored the diagnoses and countless reports from physicians who had examined Oliver and repeatedly said he was unable to work. Oliver submitted overwhelming amounts of medical evidence all supporting his disability and diagnoses, these included:
- Records of physical examinations and treatment notes from six of his treating physicians
- An MRI
- Two EMG’s
- A nerve conduction test
Yet, Coca-Cola still focused on labeling these diagnoses and his pain as “subjective” and deemed him completely functional to return to work. It is undisputed that it is difficult to quantify pain levels, however, this does not mean pain is not incapacitating.
Oliver set a solid foundation for individuals who are consistently told by insurance companies that their pain is “not enough” and “subjective.” Just because pain cannot be measured by bloodwork, does not mean it does not exist and is not impairing.
This ruling is consistent with courts not allowing insurance companies to avoid paying benefits for pain-related conditions in an effort to claim pain does not impede an individual’s ability to function.
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.
As a law firm built to focus disability insurance, all our disability lawyers spend every day working to get our clients disability benefits from insurance companies.
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:
