Sales Rep Wins Reed Group LTD Insurance Appeal for PTSD

Our client was a former officer in the United States Marine Corp with combat service in both Iraq and Afghanistan, who upon retiring from the USMC began working as a medical device sales representative in an operating room setting. For two years he experienced no problems entering operating rooms as part of his occupation. However, in April of 2009, he witnessed a surgical procedure that led him to experience an extreme panic attack, which forced him to leave the operating room. He sought treatment for the panic attack and was ultimately diagnosed with Post Traumatic Stress Disorder.

Unable to perform all of the material and substantial duties of his occupation, he filed for short term disability benefits under his employer’s policy. The Reed Group, acting as the administrator of our client’s short term disability policy, approved his benefits.

In August of 2009, our client received notice from Reed Group that they were terminating his benefits, arguing his disability was “connected” to his service in the military and was therefore excluded under the policy. He contacted attorneys Stephen Jessup and Gregory Dell to assist him in filing his appeal for benefits. A review of the denial letter and his short term disability plan revealed that Reed Group was manipulating policy language in an attempt to deny benefits.

An appeal was filed, which argued that Reed Group misinterpreted policy language, and that under the policy the only conditions which would be excluded under the policy were those which were a “result” of military service. Medical records revealed there were no symptoms while our client was serving his country, nor were there any symptoms in the two years following his service and while working for his employer.

Attorneys Jessup and Dell argued that our client’s PTSD was not a “result” of his service in the military, but rather as a result of his occupation as a medical device sales rep, as he did not suffer any symptoms of, nor was he diagnosed with PTSD until well after his service in the USMC.

Upon review of the appeal, Reed Group reversed their denial an approved our client’s claim for disability benefits.