Ms. Harrison was a claimant who worked as a customer service representative for a cash advance lender. Her duties included selling financial products to customers, providing customer service, handling money, and overseeing financial transactions. She also suffered from depression and anxiety during her time at this place of employment.
Ms. Harrison had suffered for many years from depression and anxiety even before she became gainfully employed by the cash advance lender. More recently; however, Ms. Harrison was diagnosed with Right Hemisphere Deficit Syndrome, which is basically an acquired brain injury that occurs at birth. This brain injury impaired her cognitive skills. It is important to note that even though Ms. Harrison was only recently diagnosed with this impairment, it was in existence since birth. Ms. Harrison argued that the pre-existing limitation provision should not apply to her Right Hemisphere Deficit Syndrome since she was just diagnosed with the condition.
Life Insurance Company of North America (LINA) had a provision in their policy that barred paying any claim that was “caused” or “contributed by” pre-existing conditions. LINA argued that because Ms. Harrison’s depression and anxiety were already in existence even prior to her employment with the company, that the pre-existing limitation applied to her claim, preventing her from obtaining long-term disability benefits. LINA further argued that there was no evidence at all stating that the Right Hemisphere Deficit Syndrome caused an inability for Ms. Harrison to work.
The issue, in this case, was whether Ms. Harrisons inability to work was caused by or further exacerbated by her depression & anxiety, both of which were pre-existing. The evidence in the medical record as well as Ms. Harrisons own physician’s letters stated that her depression and anxiety existed prior to the employment period, and were worsened due to the stress levels at her job. Additionally, Ms. Harrison was bullied at work which even further exacerbated both her anxiety and depression.
The appellate court upheld the lower court’s ruling, affirming that Ms. Harrison was barred from obtaining benefits because the depression and anxiety she suffered from were “but-for” causes of her disability and inability to work. The court further held that nothing in Ms. Harrisons medical records showed any worsening of her Right Hemisphere Deficit Syndrome, but the nature of her depression and anxiety existing prior and worsening during the tenure at her employer were enough to deny benefits.
If you have been denied by Life Insurance Company of North America (LINA) or any other insurer please don’t hesitate to call our office for a case evaluation. Don’t appeal on your own. We are skilled at handling long-term disability claims and are zealous advocates on behalf of our clients. Let us fight for you. Call us today at (888) 321-8131.
Here is a copy of the decision in PDF: Harrison_v_LINA
[Note: this claim was not handled by the Ortiz Law Firm. It is merely summarized here for a better understanding of how Federal Courts are handling long-term disability insurance claims.]
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Pre-Existing Conditions in Long Term Disability Claims