O’Ryan Law Firm, on behalf of Plaintiff, Melissa B., recently settled a lawsuit against American United Life Insurance Company (“AUL”) for the termination of Melissa’s disability insurance benefits after she was diagnosed with cardiomyopathy and congestive heart failure.
Melissa was a teacher with a local public school system and was forced to stop teaching when, shortly after giving birth to her son, she was found to have cardiomyopathy with reduced ejection fraction and chronic systolic congestive heart failure, confirmed by numerous echocardiograms, cardiac MRIs, and other testing procedures. After she was diagnosed with cardiomyopathy, Melissa began suffering from extreme fatigue, shortness of breath, and chest pain. Her cardiologist notified her employer that Melissa had severely reduced left-ventricular systolic function left her at an increased risk for mortality and precluded her from engaging in even light level activities on a full-time basis. Melissa’s treating physicians ordered her off work indefinitely, and AUL awarded her disability benefits under the policy beginning January 1, 2014.
Melissa was awarded Social Security Disability Benefits in September 2015, based on the Social Security Administration’s finding that she had been totally disabled since May 1, 2014.
Although Melissa experienced some slight improvement over the next two years, her primary cardiologist concluded that she was capable of no more than 2-4 hours of sedentary work per day and was unlikely to ever improve sufficiently to return to work in any capacity. He also noted that Melissa was being considered for a possible defibrillator implantation. Melissa also saw an additional cardiologist and heart failure/transplant specialist, who agreed that Melissa’s condition was never expected to improve significantly, and also supported the suggestion of a defibrillator implantation.
On May 1, 2017, AUL terminated Melissa’s benefits after a review by Dr. William Jaffee, who agreed with Melissa’s diagnoses but nonetheless concluded that she suffered only from minimal functional impairment and was not precluded from engaging in any gainful occupation. Dr. Jaffe’s review relied in part on his account of a phone conversation with Melissa’s cardiologist in which her cardiologist allegedly stated that Melissa had mild to moderate impairment and was capable of performing a sedentary occupation and ambulating on a flat level. However, Melissa’s cardiologist later clarified in an email that:
“I made it clear to [Dr. Jaffe] that I did not think [Melissa] was able to work a job that involved any physical activity. I also made it clear to him that her symptoms have not improved in the past year. I’m guessing because she is so young, they are not wanting to give her disability. They are blaming me but they are actually the ones denying her. I specifically told them I supported her application for disability.”
Despite the cardiologist’s clarification that Melissa was in fact disabled, AUL refused to reinstate Melissa’s benefits.
Melissa hired O’Ryan Law Firm to help her recover the benefits owed to her by AUL. On June 1, 2017, we filed suit against AUL in the Marion Superior Court on Melissa’s behalf. After several months of litigation, AUL agreed to settle Melissa’s claim. If you are disabled and have been denied benefits under your disability insurance policy, please contact O’Ryan Law Firm to discuss your rights under your policy and the law.