Objective medical evidence of fibromyalgia may not always be required to prove total disability

Citation: Klimas v. Conn. Gen. Life Ins. Co., NO. 2:04-CV-05408-LDD 2005 U.S. Dist. LEXIS 18555.

Jennifer Klimas, an account executive for Sprint PCS, procured a group long-term disability policy through her employer that was funded and administered by Connecticut General Life Insurance Company (hereinafter “Connecticut General”).

In July 2002, Ms. Klimas underwent surgery to remove a fibroid on her uterus and later filed for long-term disability benefits due to experiencing ongoing abdominal pain, anxiety, fatigue and chronic pain post surgery. Approximately one year after the surgery, Ms. Klimas was diagnosed with fibromyalgia.

In April 2003, Connecticut General denied Ms. Klimas’s claim for long-term disability benefits. Ms. Klimas appealed Connecticut General’s denial by submitting an award granting Social Security disability benefits and updated medical records from her treating physicians. The newly submitted medical records reflected the following:

  1. Ms. Klimas complained of abdominal pain, constipation, nausea, fatigue and tiredness;
  2. Ms. Klimas suffers from chronic whole body pain consistent with fibromyalgia;
  3. Ms. Klimas suffers from chronic pain syndrome with uncertain etiology;
  4. Ms. Klimas suffers from chronic pain, fatigue, fibromyalgia and psychological and emotional problems; and
  5. Ms. Klimas is physically and emotionally disabled from working.

However, despite a plethora of medical evidence substantiating Ms. Klimas’s disability, Connecticut General continued to deny her claim for disability benefits. Connecticut General cited an absence of objective medical documentations substantiating that Ms. Klimas suffered from a condition that would preclude her from working.

Ms. Klimas sued Connecticut General, seeking benefits under the terms of her group disability policy. The court found that Ms. Klimas was entitled to past due, present and future long-term disability benefits according to her disability plan. Specifically, the court found that medical records from treating physicians provided ample evidence that Ms. Klimas was totally disabled within the meaning of the plan due to fibromyalgia and chronic pain syndrome symptoms, such as, fatigue, pain, nausea, and constipation. Additionally, the court found the denial failed to reference, let alone consider, the findings of the Social Security Administration, which concluded that Ms. Klimas was disabled. Furthermore, the court found that Connecticut General improperly injected into the analysis, the requirement that she produce objective medical evidence to validate her fibromyalgia and chronic pain syndrome, since the plan did not impose a “per se ruling requiring objective clinical evidence of the etiology of a claimant’s disabling condition prior to satisfying the definition of totally disabled.”

It is important to know the terms of your policy in order to be able to understand your rights and stand up to the insurance company if necessary.

Questions About Hiring Us

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.

Dell & Schaefer Client Reviews   *****

Ron D.

Dell & Schaefer immediately calmed the fears I had with the disability process. They made everything clear, concise and very easy to understand. They were extremely responsive to my questions and concerns and they always returned phone calls. All of that was important, but in the end it is the result that counts. Dell & Schaefer gave me the result I wanted so quickly, I could never recommend anyone else. They are the best out there.

***** 5 stars based on 202 reviews

Speak With An Attorney Now

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