Objective Evidence of Disability
Long-term disability benefits decisions in Texas, Louisiana, and Mississippi are clear that in cases of pain, the claimant’s subjective reports must be considered. “[M]edical science confirms that pain can be severe and disabling even in the absence of ‘objective’ medical findings, that is, test results that demonstrate a physical condition that normally causes pain of the severity claim . . . [S]ubjective evidence can be used to demonstrate that the pain associated with that condition is disabling.”
The Impact of Partial/Residual Disability Clauses on Claims for Total Disability
Often, clients of MyLTDbenefits.com who are capable of performing some of the material duties of their occupation have nevertheless claimed total disability benefits, without regard to a partial/residual disability clause in the policy. The courts generally confront this issue in one of two ways. Courts deciding long-term disability benefits claims in Texas, Louisiana, and Mississippi read the total and residual disability benefit clauses together, reasoning this gives effect to the intent of the policy to provide for continuum of disability with the two clauses.
The reviewing court determines on a case-by-case basis whether, under particular facts, the long-term disability plan administrator abused its discretion by not obtaining the opinion of a vocational rehabilitation expert before denying the claim.
Recently, courts deciding long-term disability benefits cases in Texas, Louisiana, and Mississippi have taken a stronger view against the use of the Dictionary of Occupational Titles (DOT). For example, in one such case the insurer lacked vocational evidence establishing that a sales representative did not have to drive as specified in his job description so the court barred the insurer’s use of the DOT. The disability benefit lawyers of MyLTDbenefits.com have successfully argued that vocational consultants should not rely exclusively upon the DOT.
Mental Disabilities Defined
The symptom-based approach used by courts in Texas, Louisiana, and Mississippi to decide long-term mental disability cases focuses upon whether the manifestations of the infirmity (symptoms) would indicate the existence of a mental illness to a layperson. These courts have rejected the causes approach because every disorder ultimately has at least some physical cause.
If the policy language fails to specify whether a disability is classified as mental based on its origin or symptoms, the term is ambiguous, and the court will apply the “plain meaning” of the provision to resolve the ambiguity.
Most long-term disability policies limit benefits to a period of two years for mental illness.
Statute of Limitations
A long-term disability policy may contain a shorter limitation period than the otherwise applicable state law limitations period, and are generally upheld by the Court based on freedom of contract principles.
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