Is Repetitive Trauma a Sickness or Injury Under Your Long-Term Disability Policy?

Most employees in Chicago have long-term disability coverage through their employers. Most policies draw no distinction between benefits for an illness versus an injury, but some provide enhanced benefits for injuries instead of illnesses. Some such policies will expressly limit the enhanced “injury” benefits to those resulting from an accidental injury, but some do not distinguish the type of injury. So how are disabilities caused by repetitive trauma treated under these policies. A recent case dissected this issue.

In Stein v. Paul Revere Life Insurance Co., No. 21-3546, 2023 WL 2539004 (E.D. Pa. Mar. 16, 2023), Stein worked for over 30 years as an interventional radiologist. He spent most of his working years wearing a heavy lead vest to protect himself from the radiation. He began seeking treatment in 2011 for back pains and spinal problems, and by 2018 he had to stop working and claim long-term disability. Paul Revere approved the claim, but characterized the disability as due to illness. The distinction was material because the policy paid only 10% of the original benefit for sickness disabilities lasting over 30 months. But disabilities due to injury paid the full benefit for life. Stein appealed the characterization, and subsequently sued under ERISA § 502(a).

The United States District Court for the Eastern District of Pennsylvania granted judgment in Stein’s favor. It held Stein’s disability was caused by years of wearing the heavy lead vest, and was thus a repetitive trauma injury. It held Paul Revere’s interpretation of “injury” was “fundamentally flawed” in that it excluded repetitive trauma injuries, though the policy had no such exclusion. Though the court ruled in Dr. Stein’s favor, it denied his request for attorney’s fees.

If you have a question about repetitive trauma injuries under your long-term disability policy, speak to a knowledgeable ERISA long-term disability lawyer today.