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Court Sides with PNC: A Claimant Must Provide Proof of How Condition is Disabling

Attorney Gregory DellAuthor: Attorney Gregory Dell

Herbert v. PNC Financial Services Group, Inc. and Affiliates Long-Term Disability Plan involves a plaintiff who applied for long-term disability benefits based on her chronic vertigo (dizziness) and nausea. She was treated by five different physicians who all noted she had these chronic conditions, but not one medical professional placed upon her any restrictions relevant to her employment.

Despite the plaintiff’s argument that she should not be required to present objective evidence of how her nausea and dizziness prevented her from working, the Pennsylvania federal court said she was confusing two separate arguments. There is a distinction “between requiring objective proof that the claimant has a condition with [requiring] objective proof that a condition is disabling.” Neither PNS nor the court doubted that she suffered from nausea and dizziness as she claimed. But, since the record was devoid of any evidence as to how these conditions made it impossible for her to do her job as a bank branch manager, she was not entitled to benefits.

Reports of Herbert’s Treating Physicians

Plaintiff, Kathleen Herbert, was a long-time employee of PNC Bank and was a Branch Manager II when she quit work for a surgical procedure, which is not the subject of her claim in this case. Following her surgical recovery, she suffered from chronic nausea and dizziness and subsequently applied for long-term disability benefits under the disability definition that she could no longer perform “the material or essential duties of [her] own occupations as it is normally performed in the national economy.”

In support of her claim, she submitted reports of five treating physicians: a gastroenterologist, plastic surgeon, neurologist, family practitioner and an Ear, Nose and Throat doctor. All physicians reported that Herbert complained of chronic nausea and dizziness. Four of them noted that her condition was worse when she was laying down and felt better when she was sitting up and walking. None placed any physical restrictions on her or commented that she could not return to work. One physician noted that she “should not return to work until she felt less nauseous.”

Reports of Reviewing Physicians and Occupational Analysis

PNC contracted with a physician board-certified in Psychiatry and Neurology to review her file. He attempted unsuccessfully to communicate with her treating physicians. He noted that her condition became worse when she was laying down, which would not affect her work as a branch manager. He suggested she be restricted, due to her dizziness, from climbing ladders, operating heavy machinery and similar types of activities.

PNC also conducted an Occupational Analysis to identify and classify Herbert’s job duties. It determined the job was sedentary and there was no medical evidence to support her claim that she could not perform the essential functions of her job.

Pennsylvania Court Analysis and Conclusion

In her court pleadings, Herbert claimed that she should not be required to provide “objective evidence of the etiology of her conditions.” The court agreed, but noted that is not what she was being asked to do and concluded, “The issue is not that Herbert failed to prove that she suffered from a condition or that the cause of those symptoms is unknown, but that she failed to submit proof that her condition prevented her from performing the essential functions of her job.” Since she failed to present this proof, PNC was within its right to deny her claim.



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