Long Term Disability Claims for Mental Illness – Unfortunate, Yet Common
Our client Mary (not her real name) suffered from an extreme case of mental illness disability triggered by work burnout. Her claim story and her symptoms are scary, as you’ll read below, for a number of reasons.
Mental illnesses like Mary’s bipolar disorder triggered by stress and burnout at work is a common cause of long term disability from working. It can be terrifying in extreme cases, and it can happen to anyone.
Disability insurance companies commonly deny these claims, but you can appeal the denial and win if done carefully.
Long Term Disability Claim Denials for Mental Illness – Shocking, but Also Common
Mary’s treating physicians told her that she was absolutely unable to work until she got better. Yet Principal Insurance Company ignored their opinions and denied her claim for disability benefits. Principal claimed that the evidence she presented was insufficient to prove her case, despite her treating psychiatrist’s unwavering opinion that she was mentally disabled and could not work.
Being used to a steady (and high) wage, Mary was scared to death about losing everything. An attorney friend recommended our office to appeal her claim denial.
Learning Mary’s Whole Story to Help Appeal the Bogus Claim Denial
We worked closely with Mary to help her build her claim carefully and systematically with new, undeniable evidence far beyond what she had presented to Principal before they denied her claim.
In helping Mary gather evidence to build her case, we needed to learn all the details of her story. As we did, we quickly realized that her story of burnout, and truly delusional bipolar disorder, was the most extreme we had ever heard. Mary simply needed to tell her story more vividly and effectively to the insurance company in her appeal.
A High Energy Executive
For years Mary was a dynamo. She loved her work as a highly paid (over $190,000 per year) Executive Director for a fast-paced medical practice. She worked really hard and kept long hours. She was highly valued by the physicians who employed her and loved by the staff she supervised.
Terrifying Delusional Thoughts and Bizarre Behavior
Mary was shocked when she was hospitalized under a PEC (Physician’s Emergency Certificate, which commits a person against their will for emergency medical treatment for up to 72 hours) by her own boss for mental health reasons. She had effectively burned out from the stress of being overworked, and her symptoms had eventually become so severe that her duties were given to other hospital directors. Essentially she was incapable of performing her job.
Her delusional symptoms were terrifying, and included “hearing voices and seeing her dead relatives.” She thought she was being constantly monitored to the extent she would not let anyone near her with a mobile phone. She thought her office was bugged and would only communicate in whispers with co-workers. She thought people were taking pictures of her through the skylight and while using the toilet. She was convinced trucks were following her, and she believed that everyone who worked on her house such as plumbers, yard and maintenance personnel were in the mafia.
Despite reassurance by her concerned physician supervisors that the ideas were false and fixed in her mind only, she couldn’t shake them. Physically she lost over 30 pounds and was afraid to be alone in her home. It was apparent that she was not getting any sleep.
Her employer, trying to help her in any way they could, discovered that Mary’s home was in foreclosure, despite having sufficient funds in her bank account to make her mortgage. Fortunately, they explained the situation to her lender and made the necessary payments to avoid foreclosure on her home.
Mary was determined to continue working, and her employer tried to help her hang on, but she began exhibiting increasingly bizarre behavior. She became extremely hyperactive, assigning staff to clean out cabinets and refrigerators at 2:00 am during an ice storm, and also fired good staff members for no reason at all.
Her physician employers finally told her she needed to take some time off based on her mental health symptoms they had observed as well as bizarre behavior reported to them by the nursing staff. They had to let her go.
How Mary Won Her Case: Vividly Presenting Her Story Effectively to Appeal the Claim Denial
With Mary’s help, we were able to speak with some of her physician supervisors and create detailed descriptions of their direct observations of Mary’s bizarre behavior, her 2:00 a.m. work mania, her irrational firing, her shared delusional thoughts, her inexplicable home foreclosure circumstances and other out-of-character events. These descriptions were made into formal signed statements. We were able to create a much more vivid detailed statement for Mary’s signature describing her symptoms. We presented this and other new overwhelming evidence that was not part of Mary’s initial denied application to Principal Insurance Company.
Thankfully, presented with undeniable new evidence in Mary’s appeal along with court opinions our case law research found where judges had awarded benefits under fact scenarios similar to our client’s case, Principal finally did the right thing. It paid her for all past due benefits as well as began paying her the $7,500 per month that was owed to her under the policy going forward.
Victims Of Disability Should Always Appeal Unfair Claim Denials
In the end, because she continued to fight, appealing the insurance company’s denial of her disability claim rather than just accepting it as the final word, Mary was able to maintain her financial security while she took some much needed time off to rest and get better with peace of mind.
Unfortunately, disability insurance companies unfairly deny legitimate claims every day. But anyone faced with an unfair claim denial should continue to fight and appeal the denial. These unfair denials can be overturned with stronger evidence, properly presented.
Mary deserved the benefits she had paid premium for over the years, and it was an honor to help such a wonderful lady overturn such an unfair claim denial.
Results may vary. Every case is different, and no outcome can be guaranteed.
