A recent decision by the 7th U.S. Circuit Court of Appeals may have a tremendous impact on disability claims made when there is no evidence of an injury. The case, Holmstrom v. Metropolitan Life Ins. Co., was brought under the Employee Retirement Income Security Act (ERISA), and may influence courts nationwide in dealing with claims such as chronic pain or chronic fatigue.
The Holmstrom Decision
Lanette Holmstrom had a disability policy under a group insurance policy governed by ERISA. She developed pain in her right arm and was diagnosed with complex regional pain syndrome. She stopped working and filed a disability claim under her policy.
The insurance company (insurer) denied her claim because there was a "lack of objective findings to support ongoing total disability," or in other words, since her claim was based on pain and not an injury that can be observed, such as a cut, bruise, or broken bone, it was impossible to tell if she was truly disabled. Ms. Holmstrom appealed the decision and underwent many additional medical tests, as the insurer requested, including a bone scan, psychological testing and an electromyogram nerve study. Despite repeated testing, the insurance company denied her claim.
Ms. Holmstrom then sued the insurance company. She lost her case at the lower court, but appealed to the 7th U.S. Circuit Court of Appeals. The court overruled the lower court and awarded Ms. Holmstrom her disability benefits. The court concluded that there was ample evidence that her pain was "genuinely disabling."
The court also found that the insurer had acted improperly by regularly "moving the target," and ignoring all of Ms. Holmstron's tests and other medical evidence that it ordered her to undergo. These tests served no purpose, as the insurer clearly did not care about the results. The court noted that the case illustrated the difficult problems in disability claims cases brought by "people with painful conditions that do not have objectively measurable symptoms."
An Attorney Can Help
The Holmstrom case illustrates how insurance companies often fail to pay legitimate claims involving a debilitating disability, such as chronic pain, just because the condition cannot be observed or objectively measured. If you are considering filing a disability insurance claim, contact an attorney experienced in handling ERISA disability cases. A lawyer will work to help you receive the disability benefits that you deserve.
