Cigna’s Disability Denial Of Woman With Chronic Pain and Depression Reversed And Not Subject to Mental Nervous Limitation
Author: Attorney Gregory Dell
A Pennsylvania federal court ruled in favor of a claimant who continued to suffer severe debilitating neck, shoulder and upper arm pain following a cervical fusion surgical procedure. The pain sent her into depression and she became dependent on pain killers requiring her to spend time in a drug rehabilitation program. The Life Insurance Company of North America (LINA) denied her application for long term disability benefits finding that her pain was subjective and not supported by diagnostic testing. The court overruled LINA, stating “It is well established that ‘pain in itself may be debilitating.'”
The court also denied LINA’s request to remand the case for an analysis of whether the claim was barred under LINA’s drug abuse or mental illness limitations. The court sided with the plaintiff, clearly stating that when the disability causes the depression and drug abuse, the claim cannot be denied under the mental illness provision of the policy.
Although the law firm of Dell & Schaefer Chartered did not represent the claimant in this case, we believe it is important to bring this case to the attention of claimant’s who may have experienced a similar denial of their disability claim.
History of the Case
The case of Horn v. Life Insurance Company of North America, out of the U.S. District Court of the Eastern District of Pennsylvania, has a long history beginning with plaintiff Horn’s cervical fusion in May 2011. Following the operation, although the radiological studies indicated the surgery had been a success, Horn continued to suffer severe and debilitating pain in her neck, shoulders and upper arms which radiated down into her forearms and hands.
Horn’s treating physician reported she was unable to work due to her pain even though tests, such as a bone scan, MRI and nerve conduction studies (EMGs) failed to show any abnormalities. At one point, the physician noted in her medical record that her “chronic severe depression has also led to depression.”
Significant Court Rulings
This district court made two specific rulings against LINA and in Horn’s favor. It remanded for analysis of a third issue.
1. The court agreed with Horn that she satisfied her burden of presenting satisfactory evidence of her debilitating pain and was entitled to long term disability benefits. The court noted that a review of the medical record found that all of Horn’s medical providers, including a surgeon, rheumatologist, physical therapist and others, consistently reported that Horn suffered from severe disabling pain despite the fact that objective tests were unable to identify its source. The court said that, in a case like this one, the opinions of those who have “direct contact with a patient over an extended period of time” are more important than the opinions of reviewing physicians in that it allows a “more thorough examination of the patient’s credibility and true range of abilities.”
2. The district court refused LINA’s request for the case to be remanded for evaluation of whether the disability was due to Horn’s depression and addiction to prescription drugs. The court noted that it was clear, according to her medical records, that the depression and addiction to drug addiction “followed and resulted from the chronic pain that had already rendered Plaintiff disabled.”
3. After awarding Horn 24 months of disability for her inability to work in her own occupation, the court remanded for LINA to determine whether she was disabled from “any occupation” as of the date the “own occupation” benefits would be exhausted.
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