An important ERISA case

The facts of the case before the 7th Circuit Court of Appeals are fairly straight forward. The plaintiff in the case, a former television station manager, had received long term disability benefits from her insurance company for several years. However, the insurer eventually terminated her benefits claiming that her condition, osteoarthritis in both of her knees, had improved enough that she could go back to work at a desk job.

Although the plaintiff could not provide any objective medical evidence to prove that she was still disabled, she sued the insurance company alleging that her subjective pain was enough for the insurer to continue her benefits.

The 7th Circuit Court of Appeals agreed with her and ruled that an insurance company must consider a plaintiff’s subjective pain. It stated:

[E]ven if the source of pain cannot be located, it nonetheless can be real. Furthermore, here the plan ignored the evidence in the [Functional Capacity Evaluation (FCE)] that [the plaintiff's] complaints of pain were reliable. Under these circumstances, we believe it was incumbent on the plan (or the plan's consultant) to do more than just dismiss the complaints out of hand. Instead, the plan must explain why, despite evidence to the contrary in the FCE, it nevertheless finds [the plaintiff's] complaints of pain unreliable and why, if the complaints in fact are reliable, the pain [the plaintiff] is experiencing is not completely debilitating.

The holding of the case is important to anyone who is on long term disability. While most disability claims can be supported by objective medical testing and evidence, some cannot. This case may open the door for others who have been denied valid long term disability payments simply because current medical technology can’t validate their pain by objective means.