Employees in Chicago receiving long-term disability benefits often mistakenly believe they are entitled to continued disability benefits until retirement age automatically. Instead, policies contain “Proof of Loss” provisions, both for initial approval and for continued benefits. You must show continued proof of loss for continued benefits. Since the Covid-19 pandemic began, many patients opted for telemedicine appointments with their doctors. While this may be a convenient way to see your doctor, it can create problems for continued proof of loss under a long-term disability policy because the doctor has not physically examined you. A recent case highlighted the difficulty telemedicine appointments can cause in proving ongoing disability.
In Masevice v. Life Insurance Co. of North America, No. 1:22CV223, 2023 WL 2534042 (N.D. Ohio Mar. 16, 2023), Masevice worked as a marketing manager at Accenture, LLP. She suffered from migraine headaches that worsened in 2017, and also was diagnosed with postural orthostatic tachycardia syndrome (POTS), dizziness, fatigue, shortness of breach and brain fog. Masevice stopped working in January 2018, and LINA approved her claim for long-term disability commencing in July that year under the policy’s own occupation definition. In 2020, LINA began its review to determine if Masevice met the policy’s “any occupation” definition of disability. It requested an Independent Medical Examination (IME) since Masevice had not been seen physically by any of her doctors since September 2019. Masevice repeatedly declined to attend an in-person IME, and insisted on a virtual IME, which LINA advised was not available. After multiple failed attempts to schedule the IME, LINA proceeded to review the claim and terminated benefits. After unsuccessfully appealing, Masevice sued under ERISA § 502(a).
The United States District Court for the Northern District of Ohio held de novo review applied to the dispute because the policy was issued in Illinois and subject to Illinois’ ban on discretionary clauses. The court determined Masevice could not demonstrate her disability by a preponderance of the evidence because she had not been seen by any of her providers since 2019, and she declined to attend the in-person IME. Rather than grant either party judgment, the court remanded the matter to LINA with instructions that Plaintiff attend an IME.
If you have a long-term disability claim and have questions about whether to schedule virtual appointments with your doctors, call a skilled ERISA long-term disability lawyer today.