ERISA Disability and Life Insurance Litigation
Oral arguments from various courts of appeal across the federal circuits involving long term disability or life insurance claims governed by ERISA.
The podcast is a production of Ben Glass Law, a national long term disability and life insurance law firm headquartered in Fairfax, VA.
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ERISA Disability and Life Insurance Litigation
Former Williams and Connolly comptroller says "job was too stressful"
This podcast episode presents the oral arguments from the case of Lisa Holden, who worked at the prestigious law firm Williams & Connolly, LLP. As an aspiring or practicing lawyer, especially with an interest in ERISA long-term disability claims, you'll find this case not only intriguing but also highly educational.
Background:
Lisa Holden, an employee with Williams & Connolly from 1997 to 2015, ascended from assistant controller to Deputy Director of Finance. During her tenure, she was responsible for critical financial functions, including overseeing pension plans and managing the firm's tax reporting. However, behind the façade of professional success lay a troubling workplace environment. Holden reported experiencing chronic stress due to excessive work hours and understaffing. More distressingly, she endured what she describes as years of bullying, abuse, and even sexual harassment, creating a toxic work atmosphere.
Why Listen:
This oral argument recording provides a deep dive into the complexities surrounding ERISA long-term disability claims, particularly in high-stress professional environments. As Holden's case unfolds, listeners will gain insights into:
The challenges of proving mental and emotional distress in long-term disability claims under ERISA.
The nuances of employer-employee dynamics in high-pressure job roles.
The legal intricacies of handling claims involving workplace stress and harassment.
Holden's situation, unfortunately, is not unique in the professional world, making this case a crucial study for anyone dealing with or interested in employment law, particularly in the realm of mental health and workplace well-being.
Educational Value:
This episode is an excellent resource for law students and legal professionals seeking to understand the real-world application of ERISA statutes in long-term disability claims. It also offers a rare glimpse into the intersection of employment law and mental health, an increasingly relevant topic in today's work environments.
Tune in to this episode for a detailed exploration of a complex and compelling ERISA disability claim, a must-listen for anyone passionate about employment law and employee rights.
These public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.
By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike.
If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.
This case strikes me as a little unusual in that your client's narrative of what happened to her and the source of her problems turns out to be, in the hands of the physicians upon which O'Nam relied, an important factor. You can't dispute the fact that whenever she communicated with professionals about what happened to her, it was all about the specifics of her situation at Williams and Conley correct.
Speaker 2:Welcome to the podcast. This podcast is brought to you by Ben Glass Law, a personal injury and long-term disability law firm with headquarters in Fairfax, virginia. Listening to oral arguments is one of the best ways to both learn and stay abreast of the substantive and procedural aspects of practicing law. By putting these public domain recordings into the form of a podcast, ben Glass Law has made it easy for the public to access these recordings. All commentary that is not part of the actual court proceedings is that of the show's sponsor.
Speaker 4:In this Arisa-governed long-term disability insurance case, the overarching issue is whether Ms Holden is merely prevented from performing her own job for her specific employer due to workplace stressors and interpersonal conflicts unique to that work site, or if she suffered a mental illness preventing her from performing that occupation for any employer in the national economy. Her own psychiatrist, dr Fisher, repeatedly and consistently opined that, due to the cognitive and interpersonal impact of anxiety and depression, she could not perform the complicated accounting tasks necessary to her position as a director of finance for any employer.
Speaker 3:Council. What is the strongest piece of evidence in the record that Holden was unable to not just to work for Williamson County but at any other similar position in the economy?
Speaker 4:I would point to two separate things. Your Honor, first of all, is going to be again, as I mentioned, the consistent opinions given by her treating psychiatrist, dr Fisher. Below. There was a suggestion that Dr Fisher did not offer that opinion until after Unum had already denied the case on that grounds, in fact even back during Talk about his consistent opinion.
Speaker 3:but while his opinions may have been consistent, there were inconsistent opinions between other treating psychiatrists or psychiatrists Is that correct.
Speaker 4:Respectfully, your Honor, and this is actually going to be one of the first points that I was going to address.
Speaker 3:Okay.
Speaker 4:Is that we raised two main issues Firstly, unum's reliance on non-examining physicians and secondly, a handful of procedural errors. But before reaching those issues, I would first note that the origin of Ms Holden's illness, that it became in response to workplace conflict, is not in dispute. I concede it, her own physicians concede it, dr Fisher even said so. But that, your Honor, is not technically a relevant issue, in that the policy does not exclude coverage for workplace injuries. There are certainly some policies of this type that do exclude coverage for workplace injuries, and if you had a workers' comp injury, then it's simply not covered under the policy. That's a perfectly acceptable policy to draft, but this policy doesn't do that. On the contrary, it actually offsets benefits for something that someone receives in workers' comp, implicitly indicating that workplace injuries are covered by the policy.
Speaker 4:And so the issue is not whether her mental condition originated with workplace trauma. The question is whether or not that trauma is. The effects of that trauma are sufficient and pervasive enough that they would prevent work in any occupation sorry, in her occupation as a whole, rather than simply her employer. And so we should be looking, and I will concede that several doctors in addition to Dr Fisher did state that that was where her problems began, but I do not believe that any of her physicians stated that meant that she could do the occupation for a different employer. Dr Fisher affirmatively stated that she could not. The employer itself during the short term disability period actually described her as having workplace issues that went way beyond normal workplace issues but sounding more pervasive than simply.
Speaker 1:Our standard of review here is very deferential, correct?
Speaker 4:Yes, it is subject to the arbitrary and capricious standard of review.
Speaker 1:There's plenty of evidence in this record to support you know conclusion about this correct. Your argument is essentially that Unum had to credit her treating psychiatrists psychologists as opposed to others who examined her right.
Speaker 4:I would say that the argument is at least subtly different than that this court has-.
Speaker 1:I'm having a little bit of trouble appreciating the subtlety, so perhaps you could help me.
Speaker 4:This court has long held that. The first of all, the Supreme Court held that there is no treating physician rule in Orissa cases. On the other hand, this court has long held that whether or not the insurance company is relying on a doctor who actually examined the patient versus a doctor who merely performed a file review is a relevant factor into whether or not the insurance company abused its discretion. That holding goes back to 2005,. I believe the court also indicated various factors that can make it more relevant that the insurance company is relying primarily on non-examining sources, A key one being where the insurance company is purporting to judge the severity of an individual's subjective symptoms without the benefit of examination. And lastly, that brings us back to the very nature of psychiatric impairments. Psychiatric impairments are not subject to verification by X-ray or MRI or blood test. The very nature of psychiatry is that it depends upon interaction between patient and doctor, making it particularly necessary to have an examination to properly evaluate a psychiatric case.
Speaker 1:This case strikes me as a little unusual in that your client's narrative of what happened to her and the source of her problems turns out to be, in the hands of the physicians upon which O'Nam relied, an important factor. You can't dispute the fact that whenever she communicated with professionals about what happened to her, it was all about the specifics of her situation at Williams and Conley correct.
Speaker 4:That is absolutely correct, your Honor. We do not in any way dispute that her situation resulted from mental trauma within the workplace.
Speaker 1:What does it? Come and tell her that, if you tell us that if you remove the cause of the trauma, that she might flourish in a different environment.
Speaker 4:Actually, I absolutely 100% would agree that logic is something that informs the case. But in fact, after she left work and was no longer around that workplace, she didn't get better. Instead, she worsened to the point that there was an inpatient hospitalization for paranoid ideation about what was about her employer. If we take her.
Speaker 1:It doesn't discount that that happened. There's something, though, which my memory is fuzzy on right now. There's something about the date at which that occurred and the policies. Coverage isn't there.
Speaker 4:Yes, your Honor, that is correct. That hospitalization occurred some seven months after long-term disability benefits were supposed to begin and obviously, if seven months after my client alleged disability she got run over by a bus, I cannot allege that she was disabled the whole time because of injuries from being run over by the bus.
Speaker 4:You make it retroactive by virtue of the, that's how you think of it, based upon Judge Gibbons' own logic, as she raised, if my client is just affected by her own individual workplace, we would expect that during that seven month period she would be getting better, not worse. I would also add and this is part of the procedural errors that were raised in the brief is that Unum's ultimate conclusion that oh okay, maybe she is disabled, but that disability didn't happen until shortly prior to that hospitalization. That's a subtly different rationale than the original rationale.
Speaker 5:I guess I think you're. That's a good argument, but it's much different than a traumatic injury that we know would have long standing effect. This one you can't show as easily correct. But I'm looking at the doctor's testimony, two things. The doctor's testimony I don't know if as a chorus kind of thing, because we have doctor after doctor that we heard that this emanated for something other than the situational issue. I'm sorry. The main point I wanna make is that where there is discounting of some opinions in the face of an arbitrary and capricious standard of review, courts may approve. Where there's discounting of some doctor's opinions without you can still account for the favorable one and nevertheless get approved by discounting the ones that are unfavorable.
Speaker 4:I certainly follow you there, your Honor. In response, firstly, I would again point out that the large number of cases finding it improper to rely upon non-examining psychological sources, and but getting back to the question of does that hospitalization represent a new worsening?
Speaker 5:Records review. You have cases that say a records review in the mental health area cannot be given any credence.
Speaker 4:It is. The court has never found it to be a per se rule but again, starting with the Smith case back in 2006, I believe, this court found that it was particularly relevant that there was reliance on non-examiners with respect to the evaluating of subjective symptoms and that there's a large string site in the brief of cases that, finding it particularly that logic particularly appropriate when dealing with psychiatric conditions which necessarily depend upon the interaction between psychiatrist and patient to figure out what is going on.
Speaker 1:You're a battle time.
Speaker 6:Parks. May it please the court, robert Parsley with Miller Martin for Appellee Unim. I would like to make three points about why this court should affirm the judgment. First, unim reasonably concluded that Ms Holden was not disabled from working for employers other than Williamson Connolly. Secondly, it was not an abusive discretion to do a file-only review in this case. Third, there were no procedural irregularities. First, on a factual note, the record shows that Ms Holden did improve, in fact after she left Williamson Connolly. That's shown in Dr Fisher's records. It's also shown in the records of Dr Bernad.
Speaker 5:So how do you reconcile that with her eventual hospitalization?
Speaker 6:Her hospitalization and then Worson, that's right Her hospitalization a year later, in August of 2016. So it was a full year after she left Williamson Connolly involved, as the medical records state, acute onset of new symptoms. There was a brand new diagnosis at that time.
Speaker 1:Wasn't there some indication? That medication that she had been prescribed for. The original issues had actually led to this later episode. I don't know if that proved to be true.
Speaker 6:No, I don't get that from the record, your Honor. She was on a low dose antidepressant and receiving counts. I don't know why I thought that, but she had changed medications at one point. I can say the triggering event for the August hospitalization number one she reported she'd only been sleeping for one to two hours or night for several weeks. That can cause psychosis. I would think she had mania, bipolar disorder, paranoia, delusional thinking. None of those diagnoses were present at any time before August 2016. What she was diagnosed with before August 2016 was depression and anxiety. Those are two separate diagnoses. She was put on high dosage lithium in August 2016, which she'd not been on before, and what we had was a generalized anxiety and depression which is not inconsistent with being able to work. Let me say this, your Honor, Judge Donald, I have two questions for you.
Speaker 3:Yes, your Honor, In the course of coming to the determination to deny benefits, did UNAM or were they required to make any credibility determinations an aid of that ultimate determination? They did not.
Speaker 2:Your Honor, OK, so that's question one this podcast is brought to you by Ben Glass-Law, a national leader in long-term disability insurance claims. We help doctors, lawyers, entrepreneurs, ceos and other C-suite executives get paid for their long-term disability benefits. Visit us at benglasslawcom or give us a call at 703-591-9829.
Speaker 3:Ok, so here is our case and the second one is was there an obligation, on whose burden was it to show that Ms Holden could perform this work in some other area other than, even though she couldn't do it, at Williams and Conley? Whose burden was that to show?
Speaker 6:Ms Holden had the burden to show that she could not perform her duties for any employer in the national economy. She failed to meet that burden. She failed to meet it. Okay, thank you.
Speaker 1:I think that the reason I thought medications could be involved was because the final report notes that her manic symptoms could be due to medications prescribed since August of 2015. Okay, I didn't dream that.
Speaker 6:Okay that there was no determination one way or another in the file review on that particular point, your Honor and the other reason for that. I'm not trying to say that there was a causal relation.
Speaker 1:I just wanted to verify for myself that I had not imagined that.
Speaker 6:You did not, your Honor.
Speaker 5:I could have told you she did not imagine that.
Speaker 6:Okay, you did not, but the coverage had lapsed by August 2016. For a new condition there was no coverage. There was not a detailed review of that situation. One reason that Unum's decision here was reasonable is that it relied on five treating physicians who had all directly interviewed and seen and diagnosed Ms Holden. You had Dr Fisher. He's the only physician in this case out of nine physicians, who said she could not work. He's the only physician who said she had post-traumatic distress disorder.
Speaker 6:That was discredited by Dr Ralph. In fact, when it comes to the issue of an independent medical exam, she in fact had the functional equivalent of that when her own attorneys, after her initial denial her own attorney and Dr Fisher said we want you to go see a neuropsychologist and get fully checked out. And she was fully examined by a neuropsychologist who ran a battery of neurological tests which came out 99% normal, who evaluated her from a psychological and psychosocial perspective. Dr Ralph did not find she was disabled from working. That's her own physician and I think Unum reasonably relied on Dr Ralph who said she doesn't have PTSD.
Speaker 6:Reasonably relied on Dr Bernad, who is another neurologist who Dr Holden had seen in person, ran a battery of tests, had another counselor, dr Bradford, who suggested that she could work as long as she had a supportive environment. And Dr Ralph, followed by the file review of Dr Brown, suggested that the source of the problems had more to do with her personality, coping style, kind of a rigidity in being able to get along with other people, than any kind of disabling mental condition. It was reasonable and that's all had to be here is reasonable. It doesn't have to be the best decision, it just has to be a reasonable decision. For Unum to say we're crediting four providers who saw Ms Holden in person, diagnosed her, treated her over Dr Fisher, whose own opinions changed over time and were inconsistent from one point to another. He really came across as an advocate for her.
Speaker 5:Patient changes over time. What's that? Of course, the patient Patient's condition changes over time.
Speaker 6:A patient changes over time, but Dr Fisher said in his letter in 2016, after Ms Holden was denied benefits, he said she's been on a downward course since January. Yet Dr Bernad, who saw her in February of 2016, said she's getting better and her only complaint is she's having trouble sleeping. Dr Fisher ignored that. Dr Fisher ignored in his own records that she was improving.
Speaker 5:In the following report. That's right.
Speaker 6:He really comes across as advocating more than providing truly objective medical testimony.
Speaker 1:Well, that was certainly Unum. Could have thought he had become an advocate.
Speaker 6:That's right. That's how he came across and the first vocational assessment ever done was by Dr Fisher. It was after she had first been denied and it was conclusory. All he did was list the list of tasks from the vocational report and said she can't do these. Of course he himself had recorded when he was seeing her back in October, november of 2015. There's no delusion, no mania, no paranoia. She's cognitively intact, memories intact. She's just depressed, and that not only shows that the August 2016 hospitalization was a brand new set of diagnoses and symptoms, but it shows that his opinion about her vocational disability is really inconsistent with what he was perceiving all along in his treatment of.
Speaker 6:Now I would like to make a point, a legal point, about independent medical exams In this circuit. There is no bright line requirement that a file-only review is per se, invalid. It's merely a factor to consider. That is the case even when the disability alleged disability is psychological or mental. There's no bright line rule that an IME must be done. Now I would like to point out a case that did not make it into the briefing, and it's a case that I have mentioned to opposing counsel just for the court to consider, where this court affirmed in a mental disability case without an IME having been done. Now, they didn't really brief that issue, but I didn't want to bring it to the court's attention. Caster 728 Fed, appendix 457. So the court might want to take a look at that case when it is working on the opinion here. But I would say that this case, the facts of this case, are perfect to set a precedent showing that an IME is not necessarily required for mental disability.
Speaker 1:The reason that it was reasonable why would we want to do that in this case? This is not a case in which a file review is set against an independent medical exam.
Speaker 6:That's right, it's not. But. I think, the proposition here is just reinforcing the fact that the question of an IME is always a factor. There's no bright line requirement Because here, either way, it depends on the facts of the individual case, and so it's possible to have a reasonable denial of benefits for a mental disability case where there was a file-only review. That's possible, and that's because here Dr Ralph Ms Holden's own physician, did a whole person assessment. That's the functional equivalent of an IME, and so Unum had the benefit of that to rely on.
Speaker 5:Who pointed her to Dr Ralph, was it?
Speaker 6:Fisher and the employer? It was Dr Fisher and Ms Holden's attorney. I see it was after she was first denied, not the employer. Not the employer, it was after she was first denied. They said, okay, let's go get a full IME. Now, another reason that Dr Fisher was viewed as unreliable is because he had the benefit of Dr Ralph's analysis and really didn't engage with it because it didn't support his opinion.
Speaker 1:Part of this. There's reference to the per pursuit of a lawsuit against Williams and Connolly. Yes, that's used by the doctors in various ways. It has nothing to do with the resolution of this case, but did she ultimately file suit and what happened?
Speaker 6:We referenced that case in the brief. She did file suit. She drafted a quite sophisticated pro se complaint involving breach of fiduciary duty claim. Where's?
Speaker 5:Williams and Connolly.
Speaker 6:Against Williams and Connolly and Unum in the DC district court and then that case was recently voluntarily dismissed. I remember that now. Yes, I remember, but Unum found it significant that Dr Fisher said she can't function in a goal directed way to do her job as a financial employee and yet she researched and drafted her own, sophisticated, for a pro se person, and filed it. So that shows some goal directed activity and that's just one of multiple facts that we're taking into account.
Speaker 5:You're not obliged to use all your time Just saying.
Speaker 6:Thank you. I will just say that the procedural irregularities are not irregularities. We've briefed that fully. Thank you for your time and would ask the court to affirm the judgment.
Speaker 4:Mr Wilson, briefly in my three minutes, I would like to start out by pointing out that, while counsel finds inconsistencies in Dr Fisher's statements, as early as October of 2015, dr Fisher was very clear that Ms Holden could not perform her occupation due to emotional disturbance. And one thing that I would ask if we're asking, if the question is to be whether or not Unum's decision is reasonable, why was Dr Fisher's opinion a good and valid opinion for awarding short-term disability benefits, which happened to come out of the employer's pocket, and not good for approving the same question on long-term disability benefits?
Speaker 1:I don't think there's much inference to be drawn from that, because certainly by the time the decision was made with respect to long-term benefits, there was a very different record of not just one expert opinion but various others that were not a basis for the short-term disability decision.
Speaker 4:Isn't that correct. While there is more evidence, I agree, your Honor, the fact remains that any suggestion that Dr Fisher only cooked up his idea that Ms Holden couldn't perform her occupation entirely until after he made its decision is simply not true.
Speaker 1:I don't think that was exactly the suggestion.
Speaker 3:If I could ask a related question, and that is is the standard for making the decision as to short-term disability benefits and long-term? Is it the same standard or are there different standards that are used for making that determination, irrespective of the pockets that the money comes out of?
Speaker 4:It is my understanding that they were the same standard, your Honor, because in fact you can see Dr Fisher was first asked by Unum during the short-term disability period whether this was about her own job versus her own occupation. So Unum was looking at that question even back then and just quickly. With respect to the procedural irregularity of the change subtle change in reason for denial between initially you're not disabled at all. Secondly, you might be disabled but only as of the hospitalization. Plaintiff never got a chance to address that because that was first raised in the final denial. Under the new ERISA claims regulations, unum would have been required to provide us with its final peer review report so we could address that prior to the decision. Those regulations don't apply but this court's decision in WENR finding that it's improper to change the reasons for your decision between initial and final denials do apply. Plaintiff never had the opportunity to talk to get a clearer statement from the treating physician about how that hospitalization may reflect and relate back to an earlier time period. Thank you.
Speaker 1:We appreciate your argument. We'll consider the case carefully. If you all vacate the council table, we'll get started with the cleanup. Thank you, your.
Speaker 2:Honor. The proceeding has been a production of Ben Glass Law, a Fairfax, virginia-based personal injury and long-term disability law firm. For a free evaluation of your claim, visit us at benglaslawcom or call us at 703-591-9829.