In Zorn v. Principal Life Insurance Company, the plaintiff, a member of the National Association of Professional Insurance Agents, obtained insurance provided to the association by Principal Life Insurance Company (PLIC). The policy provided for five years of benefits for those disabled from their own occupation. After that time, the definition of disability changed and insureds were then considered disabled only if they could not perform the tasks of any job “that reasonably fits his or her background and training.”
PLIC made two arguments in its endeavor to prevent Zorn from qualifying for benefits: 1) The ERISA lawsuit was barred by the statute of limitations; and 2) If the lawsuit was not barred, Zorn was still not entitled to benefits. The Georgia court disagreed with PLIC on both issues and ordered it to pay Zorn long term disability benefits.
The Statute of Limitations
The parties agreed there was a three-year statute of limitations according to the insurance contract. The dispute was over the date that the statute began to run. PLIC argued it began to run when it first denied Zorn’s claim in November 2005. Zorn argued the statute was tolled during the pendency of his appeal and therefore, it did not begin to run until August 30, 2007. He filed his lawsuit on November 10, 2009, within the three-year period of time. Therefore, he argued it was timely. The court agreed with Zorn and noted that Eleventh Circuit cases “have determined that limitations periods are tolled until the end of an administrative review process.” The court held that Zorn’s argument was the correct one and, “Thus, the contractual limitation does not bar Zorn’s claim.”
Zorn’s Claim for Benefits
The court carefully analyzed the duties Zorn was required to perform according to his job description and the medical evidence presented to support that he suffered from interstitial cystitis. Interstitial cystitis is also called painful bladder syndrome. The condition makes patients feel like they have to urinate all the time. It is also painful, so they take pain medication that may affect their cognitive functioning.
Despite reports of two treating physicians and one independent medical examiner that Zorn indeed suffered from interstitial cystitis to a degree that he could not work at his job, PLIC relied on one independent medical examiner who opined that Zorn was not disabled. The doctor who gave this report met with Zorn on only one occasion. Additionally, he was not a specialist in Zorn’s illness. According to the court, that doctor’s “lack of expertise in interstitial cystitis makes his opinion even more conspicuous in its solitude as PLIC’s lone expert support.”
In fact, a second independent medical review concluded that Zorn was as disabled as his treating physicians claimed. In addition, the examiner supported the claim that the narcotics, which were his “only source of relief” also made him “incapable of sedentary work.” In addition, two separate employability analyses concluded that Zorn was disabled and could not work at any occupation.
Considering all the medical evidence and occupational analyses, “the Court finds by a preponderance of the evidence that Zorn was disabled within the meaning of the policy. Accordingly, the Court disagrees with and REVERSES the administrative decision.”
This case was not handled by our office, but it may be instructive to those who are dealing with insurers who are trying to dismiss a claim due to a statute of limitations clause or based on the opinion of a sole independent medical examiner. If you have any questions about disability claims, call us. One of our attorneys will provide you a free case evaluation.