A federal court in Georgia found the Standard Insurance Company (“the Standard”) wrongfully terminated long-term disability benefits for an Atlanta lawyer suffering from migraines. The court concluded that the former lawyer’s migraines resulted in his inability to practice law and that the Standard’s denial based on a mental health limitation was wrong.
Background
In June of 2001, Mr. Nevitt became disabled after falling down a flight of stairs. His fall led to the development of a number of symptoms, including:
- Migraines
- Cognitive impairments
- Pain in his cervical spine
- Post-concussive symptoms
- Anxiety and depression
After initially approving Mr. Nevitt’s claim for long-term disability benefits, the Standard terminated his benefits in April of 2007 claiming his benefits were limited to 24 months because anxiety and depression contributed to his disability. The long-term disability policy contained a mental health limitation, restricting benefits to 24 months for any mental disorders, including anxiety and depression.
Mr. Nevitt appealed the termination of benefits and submitted medical evidence showing that pain, migraines, and cognitive deficits resulted in his disability. The Standard denied Mr. Nevitt’s appeal. Thus, Mr. Nevitt filed a lawsuit for his long-term disability benefits in federal court.
The Court’s Review of Mr. Nevitt’s Claim
Standard of Review
Ms. Nevitt’s claim was governed by the Employee Retirement Income Security Act of 1974 (ERISA). Most claims for long-term disability benefits are governed by ERISA. This is particularly true if you receive long-term disability coverage through your employment.
Most long-term disability policies contain discretionary language. This means insurance companies, including the Standard, have discretion to determine if someone is disabled. Under ERISA, if a plan document includes discretionary language, the court will apply an arbitrary and capricious standard of review. Under this standard the court can only rule in your favor only if it finds:
- The denial of benefits was wrong; and
- The insurance company had no reasonable basis to deny benefits.
The Court’s Decision
Upon review of the medical evidence, the court found that Mr. Nevitt’s migraines alone resulted in his disability. The court noted that Mr. Nevitt had consistently complained of migraines since the date of his accident and had never been suspected for exaggeration. Furthermore, Mr. Nevitt’s doctors authored affidavits supporting Mr. Nevitt’s description of his migraines. Migraines are not classified as a mental health disorder. Thus, the court found the Standard’s decision to terminate benefits based on a mental health limitation was wrong.
The court then found the Standard’s termination of benefits was unreasonable for the following reasons:
- Mr. Nevitt provided objective and subjective evidence of disability, including at least 30 complaints of severe headache pain in the medical records.
- Mr. Nevitt’s treating physicians’ confirmed his complaints were consistent with medical literature on neck injuries.
- The Standard’s doctors glossed over Mr. Nevitt’s migraines pain and failed to directly address his treating physicians’ opinions that migraines incapacitated him for five to eight days per month.
In sum, the court found that the Standard’s termination of benefits was wrong and unreasonable. Therefore, it ruled in Mr. Nevitt’s favor.
Lawyers Specializing in Disability Insurance Claims
Because disability insurance law is complicated, it is important to get legal help from a lawyer who focuses on disability law.
As a law firm built to focus on disability insurance, our lawyers specialize in disability insurance. We spend every day working to get our clients long term disability benefits approved.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
If your claim for long term disability benefits was denied or being delayed by an insurance company, call us to speak with a disability insurance attorney.
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