How to Build a Disability Claim
Jan. 5, 2023
Recently, the United States Court of Appeals for the Sixth Circuit issued a decision finding for a disabled personal injury lawyer suffering from depression and anxiety. See Messing v. Provident Life and Accident Ins. Co., 48 F.4th 670 (6th Cir. 2022). In Messing, the attorney purchased a disability policy which he eventually sought coverage under following a prolonged hospitalization addressing his underlying mental health issues.
The insurer, Provident Life, at first granted coverage for his disability, but then later changed its position. Following a settlement, the insurer again started paying benefits under the policy only to change course once again and deny benefits, arguing that the attorney was not disabled under the policy.
Following the provisions within the policy, the personal injury attorney filed an internal appeal with Provident, hoping that the insurer would once again reverse its decision and pay benefits. This time, however, Provident upheld its denial and the lawyer filed suit in federal court.
Significantly, after the insurer made the initial denial, and before the lawyer filed the administrative appeal, the lawyer gathered additional record evidence supporting his claim. For example, the lawyer submitted a report prepared by Dr. Laura Franseen which diagnosed her patient with “Major Depressive Disorder, recurrent, minimal to mild.” That report concluded the attorney “must avoid highly stressful situations.”
In addition to relying on his doctor’s report, the lawyer submitted three affidavits from attorneys who all stated that, in their opinions, the lawyer was unable to return to work as an attorney. The lawyer provided Provident with a second medical report, this one from a Dr. Paul Callaghan, who agreed with the diagnosis of “Major Depression, recurrent.” The doctor noted that the attorney’s condition was in remission because of diligent work on the patient’s behalf, including his efforts to avoid “stressors.”
Dr. Callaghan also disagreed with the insurer’s doctor who concluded that there was no objective evidence that the attorney would not be able to return to work as an attorney. Finally, to support his administrative appeal, the attorney submitted a vocational rehabilitation evaluation in support of his disability.
Despite submitting all this evidence, Provident stood by its denial of disability and the district court upheld the insurer’s decision. On appeal, however, the appellate court reversed the district court, finding that the attorney had shown by a preponderance of the evidence that he remained unable to return to work as an attorney.
This decision serves as an excellent example of how to build a disability claim on behalf of a claimant. As the appellate court explained, when reviewing a decision to terminate disability benefits, courts are limited to “only the evidence available to the administrator at the time the final decision was made.” Here, the attorney built a solid administrative record to support his claim. Although the trial judge did not believe the record supported the lawyer’s claim, the appellate court disagreed and reversed the trial court, allowing the lawyer to prevail on his disability claim.