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First Circuit Upholds Ruling Despite Video Evidence

Published:  January 31, 2018

The First Circuit Court of Appeals has upheld an important ruling regarding disability benefits awarded to a woman with a range of possible conditions.  The United States District Court ruled for the Plaintiff, a former employee who had sued for coverage under her employer’s long term disability insurance coverage.  The First Circuit upheld the lower court’s ruling that the employee was entitled to long term disability benefits even though her exact medical condition was unknown. Testimony from medical professionals established that the woman did not have a specific diagnosis; however, they believed she suffered from either fibromyalgia, reflex sympathetic dystrophy, or complex regional pain syndrome, or possibly a combination of all three. All diseases involve complex and potentially debilitating pain with no known cause.

The Defendant insurance company presented video evidence that showed the Plaintiff moving freely and apparently pain free. The insurance company buttressed this video evidence with the Plaintiff’s history of at times exaggerating her condition, or as the judge put it “selective reporting of her worst-case experiences.” The judge however, found that the employee was unable to work and ruled that she was entitled to long term disability (LTD) benefits.  The insurance company then appealed, and the First Circuit Court of Appeals agreed with the trial judge.

Employers need to be aware of this case as it could mean a change in interpretation of the term disability in LTD policies. Such a change could impact premiums charged by insurance companies for LTD coverage.

If you have questions about the topics listed here, or any other Labor and Employment Law matters, please contact the attorneys at Royal, P.C. 

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