An Oregon attorney with post-concussion syndrome won her disability case against The Standard Insurance Company. The Standard initially approved Bethany Coleman-Fire’s long term disability claim and then terminated benefits. After unsuccessfully appealing The Standard’s claims decision, she filed a lawsuit under ERISA. An Oregon federal court found Ms. Coleman-Fire was entitled to her disability benefits.
Ms. Coleman-Fire’s Disability
Ms. Coleman-Fire was hit by a slow moving vehicle early one morning while walking her dog with her spouse. The impact threw her onto the car’s hood, causing her head to smash the windshield. She was then thrown into the air and hit her head again when she landed on the pavement. Ms. Coleman-Fire was transported by ambulance to the hospital with road rash and multiple contusions. A CT scan of her brain came back normal. She complained of nausea, headaches, dizziness and pain. Ms. Coleman-Fire was released from the hospital later the same day.
The Standard’s Claims Review
Less than a month after the accident Ms. Coleman-Fire tried to return to work part-time with the intent to return to full-time, but struggled due to her symptoms. As a result, she submitted her claim for long term disability benefits, which The Standard approved but only for a few months. Ms. Coleman-Fire then provided medical evidence supporting her disability including a neuropsychological evaluation that showed cognitive impairment, updated medical records, and opinion letters from her treating physicians. In response, The Standard determined Ms. Coleman-Fire was due additional benefits not due to her cognitive issues but due to her depression and anxiety. Ms. Coleman-Fire appealed The Standard’s decision and provided Ms. a second neuropsychological evaluation that also showed significant cognitive impairment and no primary mental health issues. The Standard had two physician consultants review the medical record who opined she could perform her occupation as an attorney and denied the appeal. She then filed a lawsuit under ERISA, the federal law that governs most disability insurance claims.
The Court’s Decision
The court reviewed the case de novo and found that Ms. Coleman-Fire could not perform her own occupation as an attorney. It determined the occupation required a great amount of mental processing, a significant amount of reading and writing, and the ability to work more than 40 hours per week. The court pointed to medical records that showed Ms. Coleman-Fire’s consistent symptoms of fatigue, lack of stamina, headaches, and cognitive impairment. The court further noted that while the record showed she had anxiety and depression, Ms. Coleman-Fire had no mental disorder before the accident and any changes post-accident in her mental condition were temporary and symptoms of her brain injury. Therefore, The Standard could not limit her long term disability benefits to a mere 24 months under the policy’s mental health limitation. The court ordered The Standard pay Ms. Coleman-Fire benefits for the entire own occupation period under the disability insurance contract absent a showing of improvement.
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 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.
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