It's just in your head. That is effectively what Hartford told Ms. Miller. She had severe psychotic episodes and could not do her job. She filed a claim for long-term disability benefits under her Hartford policy. Hartford agreed she was disabled. It paid benefits under a mental nervous condition provision of the policy. However, those benefits are often limited. In this case, she would only receive benefits for two years.
Sure enough, after paying benefits for two years Hartford stopped. She challenged their decision, noting that she suffered from psychotic episodes due to an autoimmune thyroid disorder. The episodes were not a problem until the thyroid issue arose. Surely Hartford could see that? Surely it would reverse its decision?
Hartford hired its own psychiatrist who reviewed the record and talked to Ms. Miller's treating psychiatrist. Ms. Miller had no idea. Their psychiatrist noted that there was no record of treatment for any thyroid disorder since 2015. Hartford's psychiatrist agreed that Ms. Miller was disabled, but only due to a mental nervous condition. Hartford would not change its decision.
Ms. Miller filed suit and fared no better in the courts. In Miller v. Hartford Life & Accident Ins. Co., No. 19-1096, __F.3d__, 2019 WL 6834049 (8th Cir. Dec. 16, 2019), the court noted the evidence of a potential link between the thyroid disorder and Miller's psychotic episodes but noted the lack of treatment for the thyroid disorder. Ms. Miller also argued that she was not treated fairly by Hartford's psychiatrist – that she had a right to respond to his findings. The court wasn't swayed.
This scenario occurs too often. People in chronic pain or with chronic health issues often experience depression or other mental illness. That can provide an “out” for the long-term disability insurer by because those types of benefits are usually limited. Merely arguing that there was no mental health issue before the physical disorder will likely not be enough to make a difference. Building a record demonstrating the true disability is key.
ERISA, which governs most long-term disability policies, can be unfair. You need an experienced ERISA disability attorney at the first hint of trouble so that a strong, effective claim record can be constructed and pursued in court if necessary. Weak cases (weak claim records) have little chance of winning in court under ERISA. Call us or visit us online. We help people with disability claims every day. This is what we do.