Harrison v. LINA – Claim Denied Based On Pre-Existing Condition Exclusion

Harrison argued that her recently diagnosed Right Hemisphere Deficit Syndrome — a congenital brain injury — shouldn’t trigger LINA’s pre-existing condition exclusion merely because she’d only just been diagnosed with it, but LINA denied her long-term disability (LTD) claim by pointing instead to her pre-existing depression and anxiety. The appellate court affirmed the denial, finding her depression and anxiety were “but-for” causes of her disability regardless of the newly diagnosed brain injury.

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 Ms. Harrison’s inability to work.

The issue, in this case, was whether Ms. Harrisons inability to work was caused by or further exacerbated by her depression and 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 Life Insurance Company of North America (LINA) or any other insurer has denied a claim for long-term disability benefits, it is imperative to consult an attorney before handling an appeal alone. Ortiz Law Firm is skilled at handling long-term disability claims and is a zealous advocate for its clients. Anyone who has been denied can contact the firm or call (888) 321-8131 for a case evaluation.

Here is a copy of the decision in PDF: Harrison v. LINA