Mary (not her real name) suffered from an extreme case of mental illness triggered by work burnout. Suddenly facing alarming symptoms and financial concerns, Mary filed a claim for disability insurance coverage but her claim was denied.
This story and the related legal difficulties are important for a number of reasons. Mental illnesses like Mary’s bipolar disorder can be triggered by work-related stress and burnout and can lead to long-term disability claims. Mental illness can be terrifying in extreme cases, and anyone can experience emotional and mental distress.
Unfortunately, disability insurance companies commonly deny these claims, leaving claimants unable to work and support themselves or their families. However, if an insurance company denies your claim for disability benefits, all is not lost. You can appeal the denial and receive the benefits you deserve when you work with an experienced long-term disability lawyer like J. Price McNamara.
Mary’s treating physicians told her that she was absolutely unable to work until her disorder was controlled. When she filed a disability claim, her disability insurance carrier, Principal Insurance Company, ignored her doctors’ medical 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 she would lose everything. An attorney friend recommended our office to appeal her 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 previously presented to Principal when it denied her claim.
To help Mary gather additional evidence to support her case, we needed to learn all the details of her unique circumstances. As we did, we quickly realized that her ordeal, which started with burnout and led to truly delusional bipolar disorder, was the most extreme situation we had ever seen. We helped Mary tell her story more vividly and effectively prove her need for long-term disability in her appeal.
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 was dedicated to her work and kept long hours. She was highly valued by the physicians who employed her and loved by the staff she supervised.
Mary was shocked when she was hospitalized under a PEC (Physician’s Emergency Certificate), which commits a person into emergency medical treatment for up to 72 hours against their will. Mary’s own boss made the decision to hospitalize her 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 delegated to other hospital directors. Essentially she was incapable of performing her job.
Her delusional symptoms were horrifying and included “hearing voices and seeing her dead relatives.” She feared she was being constantly monitored, so she would not let anyone near her with a mobile phone. She thought her office was wire tapped and would only communicate in whispers with co-workers. She thought people were taking pictures of her through the skylight and while using the bathroom. She was convinced trucks were following her, and she believed that people who worked on her house, such as plumbers or yard and maintenance workers, were members of the mafia.
Despite reassurance by her concerned physician supervisors that these ideas were false and fixed in her mind, 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 sleeping well.
Her employer tried to help her in many ways. They discovered that Mary’s home was in foreclosure, despite having sufficient funds in her bank account to make her mortgage payments. 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 quality staff members for no reason at all.
Her physician employers finally decided she needed to take some time off based on the mental health symptoms they had observed as well as bizarre behavior reported to them by the nursing staff. They simply had to let her go.
With Mary’s help, we were able to speak with 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 included in formal statements signed by her employers. Together, we were able to create a much more detailed statement of Mary’s symptoms and how she was totally unable to perform her duties. We also created a vividly written statement for Mary’s signature based on her personal recollection.
Through diligent research, our legal team also located relevant court opinions where judges had awarded benefits under fact scenarios similar to Mary’s case. Then, when we presented these statements along with other new and overwhelming evidence that was not part of Mary’s initial disability application to Principal Insurance Company, the situation changed.
Thankfully, when presented with the undeniable new evidence in Mary’s appeal, Principal finally did the right thing. It paid her for all past-due benefits and awarded her $7,500 per month as allowed to her under the policy going forward.
In the end, because Mary refused to give up, our team was able to appeal the insurance company’s denial of her disability claim rather than just accepting it as the final word. Now, Mary can maintain her financial security while taking some much-needed time off to rest and recover.
Unfortunately, disability insurance companies improperly deny legitimate claims every day. If you are facing an unfair claim denial, you may have the right to appeal your denial. Many times we can overturn an unjust denial with a solid case built on strong evidence that is properly presented.
Mary deserved the benefits she had paid for with many years of premiums. It was an honor to help such a wonderful lady overturn such an unjust claim denial and find peace of mind again.
Have You Suffered an Unfair Disability Insurance Claim Denial? We’d Love to Hear Your Story and See if We Can Help You Recover the Benefits You Deserve.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded J. Price McNamara ERISA Insurance Claim Attorney, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts