In a recent decision, a federal district court in Kentucky found that United of Omaha erred in denying short-term disability (“STD”) and long-term disability (“LTD”) benefits to a worker disabled by Parkinson’s disease, chronic pain, and disk degeneration.

According to the STD policy, a “disability” is defined as an “injury or sickness,” which prevents the insured from doing “at least one of the material duties of your regular job.” The LTD definition of disability is largely identical with the additional provision that “after a monthly benefit has been paid for 2 years, disability and disabled mean you are unable to perform all of the material duties of any gainful occupation.” Disability is determined relative to the ability or inability to work, but it is not determined by having an available suitable position with the policyholder.

In support of her STD claim, the plaintiff provided attending physician statements showing she suffers from Parkinson’s disease and cerebellar herniation. One doctor also listed secondary conditions including headaches, chronic pain, and cervical disc degeneration. The human resources department of the plaintiff’s employer wrote a letter stating that the plaintiff’s condition was such that she was unable to perform the essential functions listed on her job description. However, insurance company doctors questioned the Parkinson’s diagnosis.

The court found there was an overreliance on the file reviews done by the insurance company’s doctors. The insurance company failed to explain why these opinions held more weight than the opinions of the doctors that actually examined the plaintiff. The court’s opinion was also significantly impacted by the insurance company initially granting the plaintiff’s STD benefits for the period of January 4, 2018, to May 7, 2018, stating that the plaintiff had a diagnosis of secondary Parkinson’s tremors. The insurer did not note an improvement; instead, it relied on the subsequent interpretations of the files by their doctors, which the Court already questioned.

For the above reasons, the Court granted the plaintiff’s motion for judgement. The court ordered STD benefits to be back paid from May 8, 2018, through the exhaustion of the policy on July 4, 2018. The court ordered long-term disability benefits to be back paid for the twenty-four-month period of July 5, 2018, to July 5, 2020, with remand for the defendant to determine whether the plaintiff remains eligible for LTD benefits after July 5, 2020. The case is Withers v. United of Omaha Life Insurance Company, No. 1:19-CV-00108, 2021 WL 1062551 (W.D. KY March 19, 2021).