Sixth Circuit overturns local judge; acknowledges that software engineer was wrongfully denied long-term disability by insurer
On February 3, a disabled software engineer finally received his ERISA long-term disability benefits due in 2006 from Lucent Technologises and CIGNA, the plan insurer and administrator. The Sixth Circuit opinion in Javery v. Lucent Technologies, et al., explains that Javery applied for the one-year supplemental LTD benefit that followed his six-month short-term disabililty benefits which were recognized by the employer. The insurer, Connecticut General, or CIGNA as it is commonly known, denied the one year benefit, ruling that Javery was capable of performing the demands of his job. Javery appealed multiple times, each time providing additional medical substantiation, however, CIGNA ruled that he had not proved a disability that continued for that calendar year.
Javery filed a federal lawsuit under the Employee Retirement Income Security Act and thoroughly documented both his degenerative spinal condition, his resulting depressive disorder, and the debilitating effects of his multiple pain medications. He also documented the nature of his job involving consistent high functioning intellectual demands and long hours before the computer solving co-workers' software issues. The trial judge deferred to the medical opinions of CIGNA's medical staff, despite the fact that they had not examined Javery, had not investigated his actual work demands, and were employed by the entity whose wallet would be invaded to pay benefits.
On Javery's appeal, the federal appellate court concluded that the trial judge had improperly deferred to CIGNA's IME doctors' conclusions regarding disability. It pointed out that under the federal law applicable to this ERISA policy, the Court was required to make an independent determination of disability. Noting several defects in CIGNA's IME doctors' opinions, it adopted the reasoning and opinion of Javery's three threating doctors (including the doctor who hospitalized him for 12 days) and recognized that he was disabled from his job in 2006.
CIGNA had also suggested that Javery should be "estopped" from collecting disability, because he had not documented his disability claim on his 2008 bankruptcy application. The Court noted that under state law, the bankruptcy court would not take custody of any disability benefit award, and that Javery had documented his claim to the bankruptcy attorney who decided against including it in the bankruptcy application. Under these circumstances, there was no dishonesty by Javery, no motive for him to "hide" his disability claim, and no basis for CIGNA's estoppel argument.