Michigan Court Finds Plaintiff Eligible for Long Term Disability Benefits

In Chamness v. Liberty Life Assurance Company of Boston, plaintiff James Chamness, a board-certified pediatrician who is also a pediatric sleep specialist, applied for long term disability benefits. He claimed he suffered from both physical and mental disorders. Specifically, he was diagnosed with asthma, irritable bowel syndrome, coronary artery disease, sleep apnea and gastroesophageal reflux disease.

Plaintiff was also diagnosed with mental disorders of depression and obsessive-compulsive disorder along with a tendency for perfectionism. Dr. Dumerauf, a board-certified psychiatrist who treated Chamness for several years, stated that Chamness was limited in the “practice of medicine due to impaired concentration and fatigue.”

After having its consultants review plaintiff’s medical records, Liberty denied plaintiff’s claim stating that he was not physically or mentally impaired. Plaintiff appealed and, after exhausting his administrative remedies, filed this ERISA lawsuit.

The court agreed with Liberty that plaintiff did not qualify for long term disability benefits based on his alleged physical disabilities. But, the Michigan Federal District Court found in plaintiff’s favor and held that he was entitled to long term disability benefits due to his mental disabilities. The Court concluded, “Chamness has established that he is entitled to long term disability benefits for a mental health disability.”

Plaintiff Was Not Eligible for Long Term Disability Benefits for His Physical Disorders

Despite plaintiff’s numerous physical health issues, a review of the medical records did not support his claim for long term disability benefits. Neither of his treating physicians placed any limitations on his activity except to state that he should not drive if he was excessively sleepy. The Court concluded nowhere in the record was there any opinion supporting his claim that “he cannot perform his duties of his own occupation because of his physical ailments… Accordingly, Chamness has not established that he suffers a physical disability such that he would be entitled to long-term benefits under the Plan.”

Plaintiff is Entitled to Long Term Disability Benefits for His Mental Health Disability

Plaintiff claimed that he was disabled due to his depression and anxiety and that these psychological impairments limited his ability to concentrate and caused him to have memory problems. His long-term treating psychiatrist, Dr. Dumerauf, reported that plaintiff’s stress, health complications and medications “elevated his stress level as his work was affected.” As for limitations, Dumerauf checked a box which stated “Marked Limitations: Patient is unable to engage in stress situations or engage in interpersonal relations.”

The Court noted that there was a conflict between Dumerauf and Liberty’s consultants who reviewed the files. The Court also noted that although it was not legally required to give deference to the treating physician’s opinion, a second evaluation confirmed Dumerauf’s conclusion. A reviewing consultant hired by Liberty found plaintiff was not impaired and could return to work.

Ultimately, the court found in favor of plaintiff. Liberty relied on file reviews which, according to Sixth Circuit precedent, are “questionable” when the claim “involves a mental illness component.” In addition, at least one of Liberty’s reviewers either ignored or misstated the record. Based on the record, the Court reversed the decision of Liberty and ordered it to approve plaintiff’s claim for long term disability based on his mental health disability.

This case was not handled by our office, but we believe it can be helpful to professionals with physical and mental disorders who are struggling to have their insurers approve their claim for long term disability benefits. If you have any questions about this case, or about your own disability case, contact one of our disability attorneys at Dell & Schaefer for a free consultation.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

Leave a comment or ask us a question

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews   *****

Sheila W.

I would like to make sure that whomever Alex’s boss is knows how good he is. He was always was so kind and I felt like he would take good care of me. His opening statement to Hartford made me cry I could tell he really cared and truly reviewed my case. I can promise you that if anyone I know needs help that they use Alex. I’ll always remember him, he treated me like he was my big brother and was going to fight for me. Thank you as well Danielle you are very nice and always available.

Read 424 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us