You know that courts can expect a claimant to establish “objective evidence of impairment” from a physical condition.
But does this apply to claims arising out of a mental condition?
Courts can require the claimant to establish objective impairment related to a diagnosable mental condition, too.
Here’s the case of Gailey v Life Insurance Company of North America, 2016 WL 6082112 ( M.D. Penn. October 17, 2016)(Disability based on diagnosable mental condition properly denied because, among other things, Claimant presented “no objective findings” of mental impairment, and yet did present “subjective complaints” supporting the diagnosis of Major Depressive Disorder).
FACTS: Gailey was an office manager with anxiety and depression. She sought ERISA-governed disability benefits which had a 24 month limitation for mental/nervous disability, relying on a diagnosis from a Certified Nurse Practitioner. Life Insurance Company of North America (LINA) granted disability benefits while Gailey attended in-patient therapy, but denied continued benefits after release from in-patient therapy.
During Gailey’s administrative appeal, LINA had her claim reviewed by a psychiatrist who concluded Gailey had “no objective findings” of mental impairment, but did have “subjective complaints” supporting the diagnosis of Major Depressive Disorder. Mental examination findings indicated, however, Gailey was psychiatrically stable with no impairments. LINA affirmed the claim denial and Gailey filed suit.
ISSUE: Did LINA Properly Deny the Claim?
HELD: YES—Court GRANTS LINA’s Motion for Summary Judgment Dismissing the Claim.
- The “Appointment of Claim Fiduciary” agreement “gave [LINA] ‘the authority, in its discretion….’ This delegation of discretionary power is exactly what the Supreme Court contemplated….” Op. at 4. (Emphasis in original).
- Even in a case with a conflict of interest, “courts reviewing the decisions of ERISA plan administrators or fiduciaries…should apply deferential abuse of discretion review across the board and consider any conflict of interest as one of several factors in considering whether the administrator or the fiduciary abused its discretion.” Op. at 4.
- LINA “cited to a multitude of evidence that it considered in finding that Gailey was not ‘disabled’ under the Plan…” Op. at 4. This included the board-certified psychiatrist report confirming there was no objective evidence of impairment from the diagnosable mental condition.