Last week the Court of Appeals found that Liberty Mutual failed to consider and discuss evidence of the claimant's ("Nancy") evidence of her long-term disability. Nancy worked for one employer for more than twenty years in a variety of positions including bank teller, teller supervisor, and technical-support analyst, before leaving due to health problems. After her physician diagnosed her with multiple sclerosis, Nancy applied for and received disability benefits through her employer's group Plan ("the Plan"). Three years after Nancy began receiving disability benefits, the Plan administrator terminated her benefits, stating that she no longer fit the Plan's definition of "disabled."
Social Security applications require information regarding work performed by the claimant in the past fifteen years. Most claimants are not working at the time, but this information is a critical part of the disability analysis.
In a recent decision in favor of our client, the Court of Appeals remanded and instructed the district court that it "needs to know whether depression ever disabled [our client]. If the answer is no-either because his mental condition never was disabling, or because his physical impairments disabled him independent of his mental state-then the Plan's two-year bar does not apply, ruled the Court. If the answer is yes, and our client's mental condition played a causal role in his past inability to work, "it remains essential to know whether it remains important."
A nice surprise was waiting for me upon return from vacation this morning. Our client, "Paul", received a decision from the Seventh Circuit Court of Appeals in his favor. Paul enjoys disability insurance as a fringe benefit of his job. He stopped working in June 2002 because of a hernia and back pain. The hernia was repaired surgically, but Paul did not return to work. After a psychiatrist diagnosed Paul with dysthymia and major depression, Prudential started sending him long-term disability payments. But "long-term" means two years, the Plan's limit when inability to work is caused even in part by a mental illness (which the policy defines to include depression). At the end of January 2005 Prudential ended the disability benefits, citing the two-year cap. After exhausting his administrative remedies, we filed suit on Paul's behalf under the Employee Retirement Income Security Act (ERISA).