Background
Ms. Heffernan was a self-described “workaholic” who spent up to sixty hours per week on the job until she began having episodes of low motivation, exhaustion, and impaired concentration. She received treatment from various doctors, including a neurologist and psychiatrist, but her health problems eventually forced her to stop working.
UNUM approved Ms. Heffernan’s short-term disability (“STD”) claim, and she was paid her full STD benefits for six months without dispute. When she applied for LTD benefits, however, UNUM denied her claim on the basis that she could perform her own occupation in an “alternative and less stressful work environment.”
The LTD Policy and UNUM’s Appeal Decision
Under the terms of the Policy, an employee is “disabled” and entitled to LTD benefits if, because of injury or sickness, she cannot perform each of the material duties of her regular occupation. For attorneys covered by the Policy, “regular occupation” meant the specialty in the practice of law that the employee was practicing just prior to the date the disability started. UNUM viewed the litigation as a specialty within the practice of law and considered Ms. Heffernan’s occupation as a “litigation attorney.”
In support of her appeal for LTD benefits, Ms. Heffernan provided UNUM with medical records, reports, and letters from four treating physicians who all agreed that she was unable to work as a litigation attorney because of her disabling conditions. UNUM’s paid physician consultant reviewed Ms. Heffernan’s file and suggested that 1) her symptoms were not severe, and 2) her complaints had more to do with the conflict between pursuing a professional career and being a mother who wishes to spend more time at home with her child.
In the end, UNUM denied the appeal because “none of Ms. Heffernan’s examining physicians have been able to offer objective evidence that she could not do her job” and the documentation “supports that Ms. Heffernan’s decision to stop working was a lifestyle choice.”
The Court’s Decision
In holding that Ms. Heffernan was entitled to LTD benefits under the Policy, the court explained that:
- There was no question that she suffered from a sickness considering that each physician who treated or examined her found that she had depression;
- UNUM’s conclusions that she could work as a litigator in a low-stress environment and had made a lifestyle choice by leaving her job were not rational in light of the evidence; and
- Therefore, UNUM’s denial was wrong, arbitrary and capricious.
The court also ordered UNUM to pay Ms. Heffernan’s attorney’s fees because it ignored the overwhelming evidence of her disability and, instead, denied her claim based on a theory that lacked a legitimate foundation.
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.
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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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- Submitting a disability insurance claim;
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