A Federal Court found Boston Mutual Life Insurance Company wrongfully terminated long-term disability benefits for a Baltimore nurse suffering from fibromyalgia.
Ms. Kyrsztofiak was forced to stop working in late 2016 due to psoriatic arthritis and fibromyalgia. Unable to work, she submitted a claim for long-term disability benefits with Boston Mutual.
Boston Mutual initially approved Ms. Kyrsztofiak’s long-term disability benefits. Yet, just over one year later, Ms. Kyrsztofiak’s benefits were terminated. Ms. Kyrsztofiak appealed the termination of benefits. Boston Mutual denied the appeal. She then filed a lawsuit for her disability benefits.
Based on its review of the facts, the Court ruled Boston Mutual abused its discretion in terminating Ms. Kyrsztofiak’s LTD benefits.
The Court’s Review of Ms. Kyrsztofiak’s Claim
The court had a good grasp of the facts in this case and ruled in favor of Ms. Kyrsztofiak.
In terminating Ms. Kyrsztofiak’s benefits, Boston Mutual relied on the following:
- A functional capacity evaluation (“FCE”)
- A medical examination performed by Dr. Parkerson at Boston Mutual’s request
- A medical record review completed by Dr. Russel at Boston Mutual’s request
The court concluded these pieces of evidence did not support a termination of benefits. Notably, the court held Boston Mutual incorrectly pointed to a lack of objective medical evidence to terminate benefits.
The court found that the FCE confirmed Ms. Kyrsztofiak was disabled and was unclear as to how Defendant could read the FCE results otherwise. The court disagreed with Dr. Parkerson’s suggested opinion that a diagnosis of fibromyalgia can never be disabling. Similarly, the court disagreed with Dr. Russel’s conclusion that since fibromyalgia is not a condition that demonstrates physical destruction of tissue, there is no support for disability.
Contrary to Boston Mutual’s doctors opinion, the court held that fibromyalgia is “very real,” and can result in significant pain, fatigue, tenderness, stiffness, and sleep deprivation. The severity of these symptoms can interfere with a person’s ability to carry on with daily activities.
While there is no objective evidence to confirm fibromyalgia, subjective complaints of fibromyalgia and subjective responses to tests - like the tender points test - support the diagnosis. The court rejected Boston Mutual’s notion that because fibromyalgia is subjective, it cannot be disabling.
The court suggested the following type of evidence would support disability due to fibromyalgia:
- Claimant’s own description of her subjective symptoms
- Videos showing how she moved in her condition
- Treating physicians’ opinion that the pain and fatigue rendered her unable to work
Ms. Kyrsztofiak submitted this type of evidence to Boston Mutual in support of her claim. Boston Mutual ignored this evidence and instead relied on its own physicians. The court found this behavior was wrong and unreasonable and ruled in favor of Ms. Krysztofiak.
Help From a Lawyer with Experience in Disability Insurance
Has your insurance company denied your claim that you are disabled due to fibromyalgia? If so, you should consult our lawyers who specialize in disability claims with insurance companies. We have represented numerous people suffering from fibromyalgia. We will work with you to gather the appropriate evidence of disability.
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