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Home > Blog > Blog > Long Term Disability > District Court Finds Reliance Standard Erred in Denying Plaintiff’s Long-Term Disability Claim Due to The Effects of Long-COVID

District Court Finds Reliance Standard Erred in Denying Plaintiff’s Long-Term Disability Claim Due to The Effects of Long-COVID

In Cogdell v. Reliance Standard Life Insurance Company, No. 1:23-CV-01343 (AJT/JFA), _F.Supp.3d_, 2024 WL 4182589 (E.D. Va. Sept. 11, 2024), on cross-motions for judgment pursuant to FRCP Rule 52, Virginia Eastern District Judge Anthony J. Trenga granted judgment in favor of Plaintiff and against Reliance Standard Life Insurance Company finding that Plaintiff demonstrated by a preponderance of the evidence that she was totally disabled as of the date Plaintiff stopped working.

Plaintiff, a graduate of MIT and the University of Pennsylvania, was employed as the Principal Business Process Engineer at MITRE since 2009. Plaintiff’s material responsibilities at the time of her claimed loss were (1) managing “critical” client relationships; (2) leading project teams to apply business process engineering including improvement methods “to help solve complex [client] problems”; (3) developing new opportunities with clients around intelligent process automation; (4) mentoring and developing staff “in the application of … frameworks in the enterprise transformation space”; and (5) advancing MITRE’s knowledge of research programs and thought leadership. Following an infection of the COVID-19 virus in July 2021, Plaintiff developed and suffered from the effects of long-COVID with symptoms including intense fatigue, shortness of breath, dizziness, and sporadic headaches. Plaintiff went out on leave following the July 2021 infection, gradually progressing to part-time work a year later, when in July 2022 she suffered from a second COVID-19 infection forcing her to cease all work, and pursue treatment with various specialists (cardiology, pulmonology, neuropsychology) in an effort to identify a discrete cause of her symptoms, which now included tachycardia. Plaintiff submitted a claim for LTD benefits. Reliance denied Plaintiff’s claim after review by a nurse consultant who relied on the fact that Plaintiff could sit, stand, walk, and drive for 1-3 hours, and able to do simple grasping, pushing/pulling and fine manipulation of both upper extremities, as a basis for her conclusion that Plaintiff was not disabled. The nurse consultant did not make any particular findings with respect to the material duties of Plaintiff’s occupation. Plaintiff appealed on August 15, 2023. In response, Reliance obtained two peer reviews, which it did not send to Plaintiff until October 25, 2023, over 70 days after her appeal had been submitted. Plaintiff, believing Reliance to have violated ERISA regulations by not having issued a decision within 45 days, filed the instant action on October 3, 2023.

As a procedural matter, the Court rejected Reliance’s challenge to the 45-day period imposed by the Department of Labor that it exceeded the grant of authority delegated by the Secretary and therefore should not destroy the deference afforded to Reliance’s decision. The Court found Reliance’s challenge was untimely as it was only first raised in oral argument, and it failed to follow the established procedure for challenging federal regulations, which is a suit against the Department of Labor. Notwithstanding the procedural issues, the court found the challenge also failed on the merits. It noted that the federal regulation merely set a time limit for claim exhaustion and did not mandate or direct the courts to apply a particular standard of review. And as a majority of courts reasoned, setting time limits for administrative claim exhaustion is appropriate for a “full and fair review,” otherwise plan administrators would have no incentive to expeditiously review appeals, leaving claimants in limbo without judicial recourse. With regard to Plaintiff’s appeal, the Court found that that an independent medical review without more is not a “special circumstance” that would make a 45-day extension appropriate. It concluded that Reliance had exceeded the time limit for rendering its appellate decision and thus a de novo standard of review was appropriate. It also rejected Reliance’s efforts to include the peer reviews in the administrative record.

Turning to the facts of the case, the Court found that Plaintiff satisfied the proof of loss criteria as outlined in the LTD policy, by providing documentation that her treating physicians repeatedly determined that her symptoms were likely related to long-COVID, and medical studies about long-COVID and the difficulties in diagnosing it definitively. Research has shown that long COVID is difficult to diagnose and assess using traditional diagnostic tests, and that there is significant skepticism about false claims because the most common symptoms are “trouble concentrating” and fatigue. A recent workplace assessment report noted that “[s]ome providers report feeling hard-pressed to make a diagnosis, as some symptoms are perceived as subjective.” The Court reasoned that the absence of a clinical diagnosis relating to long-COVID should not preclude eligible persons such as Plaintiff from being designated as Totally Disabled when their self-reported symptoms, observed and documented by physicians, indicate an inability to complete the material tasks of their job. The Court found there was no basis on which to think that Plaintiff’s subjective complaints reflected malingering in any respect. Her subjective complaints, and their associated effects upon her ability to perform the material duties of her job, were consistently reported throughout her disability and were in sharp contrast to her documented high-level of functioning before contracting COVID-19.

If Reliance your insurer has denied or otherwise limited your disability insurance claim, contact us for assistance.

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*Please note that this blog is a summary of a reported legal decision and does not constitute legal advice. This blog has not been updated to note any subsequent change in status, including whether a decision is reconsidered or vacated. The case above was handled by other law firms, but if you have questions about how the developing law impacts your ERISA benefit claim, the attorneys at Roberts Disability Law, P.C. may be able to advise you so please contact us.

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