An Ohio federal court of appeals found that Reliance Standard Life Insurance Company (“Reliance”) improperly denied long-term disability benefits to an art director when it failed to consider whether her physical ailments, including Crohn’s disease, narcolepsy, and Sjogren’s syndrome, were independently disabling when considered separately from her mental heath conditions.
Background
Ms. Okuno had been working as an art director with clothing company The Limited for seven months when she developed a range of symptoms, including vertigo, extreme headaches, memory loss, and abdominal pain. She was eventually diagnosed with narcolepsy, Crohn’s disease, and Sjogren’s syndrome.
Reliance initially denied Ms. Okuno’s claim based on its finding that her disabling diagnosis was fibromyalgia, which was barred from coverage as pre-existing because she had received treatment for it during the year prior to joining her employer’s Long-Term Disability Plan. Ms. Okuno appealed that decision and provided evidence that she was disabled due to conditions distinct from fibromyalgia, that were not pre-existing.
Reliance then denied her claim again, finding that she was not totally disabled due to her Crohn’s disease, narcolepsy, or Sjogren’s syndrome. However, Reliance found that Ms. Okuno was disabled due to depression and anxiety and approved her long-term disability claim only for a one-year period under the Plan’s Mental or Nervous Disorders Limitation. Ms. Okuno then filed a lawsuit in federal court.
The Court’s Decision
Ohio’s Court of Appeals reversed the lower federal court’s ruling in favor of Reliance, finding that Reliance failed to conduct an independent assessment of whether Ms. Okuno’s physical conditions and symptoms were disabling, when considered separate and apart from her mental health conditions. Importantly, the Court of Appeals found that an insurer must consider the effects of an applicant’s physical ailments separately from a mental or nervous disorder.
The Court of Appeals also found that Reliance acted unreasonably when it: 1) failed to conduct a physical examination of Ms. Okuno and relied exclusively on paper reviews by its paid medical consultants; 2) did not hire consultants with the proper medical specialty and background in light of Ms. Okuno’s conditions; 3) failed to consult with Ms. Okuno’s treating physicians; and 4) provided shifting explanations for its decisions on Ms. Okuno’s appeals.
This opinion is significant in that it addresses a common situation we see as a disability insurance alw firm—when someone is disabled from a combination of physical and mental illnesses yet the insurers only focuses on mental health disabilities. This is likely because mental health condition typically have a limited pay period, somewhere between 12 and 24 months. So it is in the insurer’s own interest to approve disability based on mental health conditions rather than physical conditions because their liability is reduced significantly. However, it is against ERISA regulations to ignore disabling conditions such as physical conditions.
We have successfully argued that even when there is evidence of a mental health illness, an insurer must consider whether a claimant’s physical conditions are independently disabling. We use treating doctor supports, outside testing such as functional capacity evaluations, and personal statements from the claimant to confirm that the physical conditions alone prevent them from working.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
Because this law firm was created to focus on disability insurance, we have developed an expertise in this complex area of the law.
Our expertise in long-term disability claims means our clients have the backing of a law firm that has long term disability attorneys who:
1. are experts in disability claims;
2. fought all major disability insurance companies and know their tactics;
3. a track record of success;
4. won major disability lawsuits that created good law; and
5. recovered millions of dollars in disability benefits.
All our long term disability attorneys commit every day of their legal career to helping people get disability benefits from Reliance Standard, MetLife, UNUM, Prudential, Hartford, Lincoln Financial and others.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We help clients nationwide.
Call to get experienced long term disability attorneys on your side with:
• Submitting a disability insurance claim;
• Appealing a long-term disability denial;
• negotiating a lump-sum settlement; or
• Filing a lawsuit against your disability insurance company.
Call for a free consultation with a long term disability attorney.
Key Terms:
• Narcolepsy
- Crohn’s disease
- Sjogren’s syndrome.
• Reliance Standard Life Insurance Company
• Ohio
• Art Director