Standard’s decision to deny doctor’s disability benefits due to the 24-month mental/nervous limitation upheld

Dr. Schwob applied for long-term disability benefits in 1997 through a policy provided by her employer for a disability caused by Lyme disease. She claimed a physical disability based on the disease’s effect on her central nervous system, and argued that she could no longer perform her job as a pathlogist. Three of Dr. Schwob’s treating doctors agreed with the assessment that her Lyme disease was the cause of her disability.

A physician hired by Standard performed an independent medical exam (IME) of Dr. Schwob, and determined that there was no evidence of Lyme disease, and, rather, that Dr. Schwob was suffering from major depression and hypochondriasis. Dr. Schwob thereafter submitted additional information to support her claim. This information was reviewed by a specialist in Lyme disease, who concluded that there was little evidence of active Lyme disease.

Based on Standard’s review of Dr. Schwob’s claim, including the IME and the review by the specialist, Standard concluded in September 1999 that Dr. Schwob’s claim was mental in nature, and therefore a 24-month limitation on benefits for disability caused by mental or nervous conditions applied. Specifically, her policy stated: “LTD Benefits [are] limited to 24 months for each period of Disability caused or contributed by a Mental Disorder.” Moreover, the policy defined mental disorders as: “any mental, emotional, behavioral, psychological, personality, cognitive, mood or stress-related abnormality, disorder, disturbance, dysfunction or syndrome… includ[ing] depression and depressive disorders…” Therefore, Dr. Schwob was no longer eligible for benefits after January 2000.

Standard did allow Dr. Schwob to continue to submit records, and continued to reconsider Dr. Schwob’s claim. Standard also conducted a neuropsychological examination and had her file reviewed by a board-certified psychiatrist and neurologist. Their findings supported Standard’s original conclusion, and notified Dr. Schwob in March 2003 that its original decision to limit benefits to 24 months would be upheld.

Dr. Schwob then sued in Federal court. At trial, the court agreed with Standard’s argument that it had substantial evidence showing that Dr. Schwob’s disability was mental in nature, and therefore the denial of long-term disability benefits was appropriate. However, the court held that the majority of the evidence in the record did not support Dr. Schwob’s claim of active Lyme disease as the cause of her disability. The court did not disagree that Dr. Schwob was disabled, or whether or not her disabling condition, depression, was real, but, rather, held that Standard had fairly relied on the evidence available to it when it limited her to 24 months of benefits.

See Schwob v. Standard Ins. Co., No. 06-6155, 2007 U.S. App. LEXIS 21541 (10th Cir. Sept. 5, 2007).

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