The U.S. Court of Appeals for the Fourth Circuit recently agreed with a federal district court in South Carolina that the Federal Express Corporation (FedEx) was blatantly wrong when it denied long-term total disability benefits to its employee who was injured on the job. The claimant, Richard Bilheimer, had been employed by FedEx for eight years when he was involved in his second on the job car wreck. He was left with major injuries and life-long medical problems, including chronic pain syndrome, degenerative and herniated discs, chronic cervical radiculitis and carpal tunnel syndrome as well as temporomandibular joint disorder (TMJ), high blood pressure and sleep apnea.
Bilheimer initially received six months of short-term disability benefits followed by 24 months of temporary long-term benefits from FedEx which administered its own disability benefits program. FedEx initially denied short term disability benefits to Bilheimer, but with the help of disability Attorneys Dell and Schaefer those benefits were paid. Total disability benefits were available to a person who was unable to “engage in any compensable employment for twenty-five hours per week.” So, when the temporary long-term benefits term expired, Bilheimer applied for total disability benefits.
As evidence to support his claim, Bilheimer presented reports from two experts, both of whom had examined him. One examining expert found Bilheimer suffered from several serious limitations in performing in the workplace. In addition to examining him, the other expert was also Bilheimer’s treating physician. Based on the examination and treatment, the doctor declared Bilheimer totally disabled, meaning he could not work at any employment even on a part-time basis for 25 hours a week.
FedEx denied the claim and the administrative appeal based on the conclusion of its peer review physicians who reviewed the medical records but never examined or observed Bilheimer. None of them even contacted the treating physicians. Even so, they concluded there was “no significant objective clinical documentation” that indicated Bilheimer could not work at “some employment” for a minimum of 25 hours a week. Bilheimer then filed a lawsuit in the District Court and the court ordered FedEx to pay him total disability benefits. FedEx continued to fight its former employee and appealed.
The Fourth Circuit agreed with the District Court and ordered FedEx to pay total disability benefits to Bilheimer. The appellate court stated that the district court correctly found the opinions of the treating physicians more persuasive than those presented by in the peer review reports.
The appellate court also expressed displeasure with FedEx in expecting Bilheimer to work at “some job” for 25 hours a week and held that nominal employment, “such as selling peanuts or pencils” does not amount to compensable employment. A person need not be “utterly helpless” in order to be considered disabled and “compensable employment” does not mean “any job at any place with any pay.”
Accordingly, the appellate court upheld the district courts finding that the weight of the evidence supported Bilheimer’s claim that he could not work at any employment for 25 hours per week. The court ordered FedEx to award Bilheimer the long term total disability benefits to which he was entitled.
If you have questions about collecting your disability benefits or need help pursuing your claim, call us at Dell & Shaefer for a free consultation.