Importance of Regularly Attending Doctor Appointments to Support Your Long-Term Disability Claim

Employees in Chicago and the rest of Illinois with claims for long-term disability insurance benefits rarely read the insurance policies or certificates of insurance outlining the benefits under the employer-sponsored plan. Benefit highlights distributed by the employer describing the benefits almost never discuss a key provision of the coverage: the requirement you be under the Regular Care of a Physician. How this clause is defined varies from policy to policy, but essentially it requires you be consistently getting treatment for your disabling condition. The purpose of such requirements in long-term disability policies has been described as to confirm the claimant is actually disabled, not malingering, and to prevent fraudulent claims. Heller v. Equitable Life Assurance Soc’y of U.S., 833 F.2d 1253, 1257 (7^th Cir. 1987). A recent case demonstrates the pitfalls of not attending follow-up appointments recommended by your doctors.

In Slaughter v. Hartford Life & Accident Insurance Co., No. 22-cv-5787, 2024 WL 3251371 (N.D. Ill. July 1, 2024), Slaughter was a cybersecurity systems engineer at Boeing, and in August 2020 went to the Emergency Room with complaints of chest pain and shortness of breath. He had an ejection fraction of 8%, resulting in very severe left systolic dysfunction. After undergoing surgery, Slaughter submitted a claim for long-term disability benefits to Boeing’s insurer, Hartford. Hartford denied the claim, contending Slaughter could perform sedentary work, which was required of his occupation. After Slaughter unsuccessfully appealed, he sued Hartford under ERISA § 502(a).

The United States District Court for the Northern District of Illinois ruled against Slaughter. As a threshold matter, it determined, under de novo review, that Slaughter failed to establish he was under the Regular Care of a Physician, as required by the policy. The court noted it was Slaughter’s burden to prove he met all the policy’s terms and conditions, citing Halley v. Aetna Life Insurance Co., 141 F. Supp. 3d 855, 865 (N.D. Ill. 2015). The court explained there was no evidence Slaughter received any care from his cardiologist beyond January 2021, despite that office visit note instructing Slaughter to follow-up in six weeks, and scheduling the next appointment in March 2021. Slaughter submitted an affidavit attesting he continued his treatment with the doctor, but failed to submit the updated medical records. The court ruled it would not rely on such “self-report evidence,” citing Canter v. AT&T Umbrella Benefit Plan No. 3, 33 F.4^th 949, 957 (7^th Cir. 2022). Accordingly, the court ruled Slaughter was not entitled to any long-term disability benefits under the group insurance policy.

If you have a claim for long-term disability benefits call an experienced ERISA long-term disability lawyer today.