The Ninth Circuit appeals court ruled that a 47-year-old California man should be awarded long-term disability payments for his extreme case of Chronic Fatigue Syndrome. The federal appeals court found the insurance company’s denial of long-term benefits was “illogical” and “implausible.” A federal district court in California ruled in favor of the insurance company, but the Ninth Circuit appeals court reversed the decision.
The employee in the case worked for American Honda Motor Company for over 20 years. The employee attended Harvard and Massachusetts Institute of Technology and the employee’s colleagues thought of him as a hard-working and intelligent man. Supervisors regarded the man as an ideal employee, and one supervisor said the employee was “one of the few people in Southern California to walk or jog to work.”
In 2003, the health of the employee was forever changed. The employee did not attend work for three days because of the flu. Upon his return, the employee’s performance had noticeably changed. Lesser duties exhausted the man and he even showed decreased intellectual capacity at work. The employee was diagnosed with Chronic Fatigue Syndrome. To diagnose the disease, doctors use few objective tests and rely mainly on symptoms the patient describes. Doctors who saw the employee said he had one of the worst cases of the disease they had seen.
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.
The employee applied for long-term disability benefits in 2005, but the insurance company case manager denied the man’s claim explaining there was a lack of objective tests to demonstrate his illness. The man’s final denial of long-term disability benefits was issued in May 2005, but the same evidence was used to grant the man Social Security Disability benefits.
The employee sued the insurance company and the case eventually went to the federal appeals court. The appeals court explained that while employees who have illnesses that are hard to objectively prove may have an “incentive to cheat” in acquiring benefits, the insurance plan can have an equal “incentive to cheat” when a claim is denied on a false statement of reason.
Source: Courthouse News Service, “Man with controversial illness can get benefits,” Tim Hull, 3/8/11