There is good news for claimants who bring an Long Term Disability (LTD) case against an insurance company. Recently the Second Circuit Court of Appeals came down with a ruling that gave credibility to subjective complaints with no objective findings of disability. In Miles v. Principal Life Insurance Company, an employee became disabled due to bilateral tinnitus, intractable ear and head pain, and feelings of disorientation. Miles saw an ENT specialist. The ENT specialist diagnosed him with sinusitis, sensor neural hearing loss, tinnitus, and headaches. The specialist then sent him to a neurologist. The neurologist’s report stated, “significant for tinnitus, vertigo, hearing loss, headaches, lightheadedness, and generalized weakness.”
Miles was unable to work as a result of these symptoms. He was not able to read for any length of time and could not concentrate adequately enough to complete his assigned tasks. Principal, the insurance company which denied Miles benefits under the LTD plan, sent him to their own doctor, who stated, “there are no objective findings to support impairment from a neurological perspective.” Basically, the insurance company was saying tinnitus was completely subjective and can be given no weight under their Plan and he was healthy enough to continue working.
The insurance company used the wording of the LTD plan to deny Miles his benefits. The Plan stated if you submit, “…complete and proper proof of disability, benefits would be payable.” The insurance company felt Miles did not offer enough proof of his disability, therefore he was denied. The Second Circuit concluded that Principal acted arbitrarily and capriciously when they denied Miles his benefits. The court ruled that the insurance company must evaluate the subjective complaints of the tinnitus as well as objective findings of medical impairments. They must also assign weight to the subjective complaints or provide specific reasons for its decision to discount them.
If you are disabled and your disability does not show up on an X-Ray there is now hope that you can collect the disability benefits that you deserve.