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.”
The Court reasoned that a trier of fact might conclude that, even if depression was a contributing cause of our client’s past inability to work, any current inability to work has a physical rather than a mental cause. The policy does not say that, if two years of benefits have been provided on account of a mental condition, then no future benefits may be paid for a physical impairment: it says only that two years is the maximum period of benefits that may be justified, in whole or in part, by a mental condition. If the claimant’s limitations today are “entirely physical (or if physical problems disable him no matter what his mental state), then benefits are available under this policy”, the Court found.
The Court also identified a dispute about whether our client can work even with all of his physical and mental problems. Some physicians say yes, others no. The district court is required to make an independent decision. To do this, the Court held, the finder of fact must weigh all of the medical evidence. “Yet the district judge did not mention any of the evidence favoring the claimant (including the affidavits that should have been accepted). If a paper record contains a material dispute, a trial is essential. And at trial, we will now have the opportunity to offer our client’s medical evidence and cross-examine the physicians who produced the reports that underlie Prudential’s decision.
Once again, justice will prevail and a deserving person shall receive his long-term disability benefits.
Alan Olson writes this web-log to provide helpful information regarding long-term disability cases. He practices long-term disability law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here or for advice on specific disability benefit claims.
