4TH CIRCUIT LONG-TERM DISABILITY BENEFITS CASES (MARYLAND, NORTH CAROLINA, SOUTH CAROLINA, VIRGINIA, AND WEST VIRGINIA)
Definition of Disability
After the first two years of disability the claimant's disability is established if "the insured cannot perform each of the material duties of any gainful occupation for which [s]he is reasonably fitted by training, education or experience."
An employee is not considered able to work unless he or she can perform all the material duties of an occupation, which includes meeting the cognitive as well as the physical demands. The disability benefit lawyers of MyLTDbenefits.com have established that cognitive deficits and chronic pain which limit and restrict functioning, are circumstances that must be included in the long-term disability analysis.
Objective Evidence of Disability
It is clear that courts deciding long-term disability benefits cases in Maryland, North Carolina, South Carolina, Virginia, and West Virginia will closely evaluate functional capacity examination (FCE) reports for their completeness and accuracy. In a leading case the court held that the insurer abused its discretion by relying on an inconclusive and incomplete FCE in denying benefits to a claimant suffering from fibromyalgia, degenerative disc disease, and "lupus erythematosus." The FCE lasted only two and a half hours and the physical therapist's interpretation of the testing was "equivocal and tentative". Although the insurer's physician relied on the FCE as the basis for concluding the claimant could perform a sedentary occupation, the court disagreed that the FCE supported this conclusion. The court explained:
During the FCE [the claimant] exhibited pain when her flexibility and range of motion were tested. She 'gave out' before her strength could be measured. She could not walk fast enough for the physical therapist to assess her aerobic capacity, and she could only walk for four and a half minutes at 1.2 miles per hour before succumbing to hip and leg pain. The physical therapist halted the testing after only two and a half hours because it did not appear that [the claimant] could complete the tests, suggesting [the claimant]'s exertion could not be sustained for much longer than two and a half hours.
The court concluded the FCE results were entirely consistent with the claimant's evidence that her condition was so disabling as to prevent her from engaging in any occupation. Consequently, the court held the insurer unreasonably denied the claim.
The attorneys of MyLTDbenefits.com aggressively pursue long-term disability benefit cases on behalf of individuals suffering from pain disorders, spine diseases, cognitive dysfunction, and neurological conditions.
Use of Vocational Evaluation
The Dictionary of Occupational Titles (DOT) has been recognized and accepted in long-term disability cases in Maryland, North Carolina, South Carolina, Virginia, and West Virginia as reasonable authority for insurers to rely upon in evaluating disability claims.
An analysis of whether a claimant can perform a gainful occupation also requires a consideration of the age of the claimant and whether he retains transferability of skills.
Please contact us for experienced assistance with your disability claim. We pride ourselves on providing cost-effective solutions.