Insurers often balk at paying a disability claim for a condition that has existed for a long time before the individual stops working. It seems that people that struggle to continue working despite progressive medical impairment are not rewarded for their heroism. An interesting case was recently published in California regarding a woman suffering from pain from chronic migraines. In Leetzow v. Metro. Life Ins. Co., 2016 U.S. Dist. LEXIS 173698 (C.D. Cal. Dec. 5, 2016), the court recognized that long absences from work show that her condition worsened over time and that it is likely that she was unable to perform with reasonable continuity the substantial and material acts necessary to perform her job, leading up to her disability claim. The court found it unnecessary for Plaintiff’s condition to abruptly change on that particular day, for her to be disabled for the entirety of the elimination period.
Ms. Leetzow suffered from migraines for 20 years getting more severe, more frequent, (2-5 per week) and more resistant to treatment. Metropolitan Life challenged the viability of the claim, since there was no “objective evidence” of her crippling pain. Another roadblock to recovering disability benefits is if the impairment is based on a claim of chronic pain. The court laid the groundwork for a claim such as this. Since there are no neurological exams for migraines that are likely to be positive, claimant’s personal accounts of her migraine related pain are to be credited, “migraines are an invisible illness and there is often no objective medical evidence to confirm their existence, patients’ personal accounts are the strongest, and often only, evidence of disability in such cases”.
The frequency of medical visits to the doctor was less critical to the Court, since Ms. Leetzow stated that her disability makes it harder for her to initiate and arrange and attend doctors appointments. And she had in the past tried all reasonable treatment for her condition. The court noted,
“It is not uncommon for people with longstanding illnesses that have not responded to aggressive medical treatment to lose hope in the ability of doctors to improve their situations.” “Accordingly, a lack of doctors’ appointments during the elimination period does not mean Plaintiff was not disabled. In fact, it could mean Plaintiff was so disabled she had temporarily given up hope on doctors’ abilities to improve her illness.”
This case provides a helpful roadmap to arguing a claim based on longstanding but progressive illness.
We at Bonny G. Rafel LLC handle disability claims based on chronic illness and know what evidence to gather to improve our chances of successful appeals and litigation. Contact our firm for more information. www.disabilitycounsel.com