by Steve Fields | June 27th, 2022
May 24, 2022 – U.S. Court of Appeals – 11th Circuit – Citation Pending
Nunnelly was a mechanic at Honeywell before his disability claim started. He participated in and was covered by a Long Term Disability policy that was issued and insured by Life Insurance Company of America (LINA, also known as Cigna and now New York Life). Nunnelly stopped working January 18, 2017. The Long Term Disability policy required him to be disabled for 26 weeks before benefits would begin. That time period is known as the “elimination period,” which is common in Long Term Disability policies.
Nunnelly first applied for Short Term Disability benefits and then applied for Long Term Disability benefits later in 2017, in November. LINA asked for documentation to substantiate the claim, showing disability from January through July 2017 and beyond the elimination period. Nunnelly identified one provider, a psychiatrist. The psychiatrist treated Nunnelly from March 2017 to June 2017. The psychiatrist provided a statement later on in February of 2018 supporting Nunnelly’s disability claim, but they had not evaluated Nunnelly since June 2017.
LINA identified two other providers that Nunnelly had treated with – a pain management specialist and a neurologist. The pain management specialist did not identify any work restrictions or limitations for Nunnelly. The neurologist had last evaluated Nunnelly in March of 2017 and had opined that Nunelly could return to work with restrictions on June 1, 2017.
LINA hired two doctors to review the medical information. One determined that Nunnelly had no restrictions. The other determined that Nunnelly had some limitations, but he had not been treated after June 5, 2017, so they could not comment on his functionality after that date. LINA denied the claim on the grounds that Nunnelly had not been disabled throughout and beyond the elimination period. Nunnelly appealed, but LINA upheld the denial.
The Court of Appeals upheld LINA’s denial of the claim. The only medical support for limitations beyond June 5, 2017 was from the psychiatrist in February of 2018, but they had not evaluated Nunnelly since June of 2017.
Nunnelly also requested to have his Social Security Disability (SSD) award considered by LINA, but that decision was not made until 16 months after LINA issued its final decision. The Court of Appeals determined that the district court properly declined to remand the claim to consider the SSD award. Courts routinely do not allow additional information beyond the administrative record to be considered, making the pre-lawsuit submission even more important.
Nunnelly faced an all too common situation for claimants and their disability claims. Many doctors are either reluctant or unwilling to get involved in disability claims when it matters most. The timing of medical support for disability claims can play an important factor in the success of a claim. Working with an experienced Long Term Disability attorney can help you overcome this common obstacle that many individuals face while trying to navigate the disability claim process.
