Appeal Victory in a Mental Health Claim
Principal Reverses Wrongful Denial
Our client Mary (not her real name) suffered from an extreme case of mental illness disability triggered by work burnout. Her symptoms and experiences were frightening, and her story is an example of how quickly severe stress can escalate. Mental illnesses like Mary’s bipolar disorder, triggered by workplace burnout, are a common cause of long-term disability. They can be terrifying in extreme cases, and they can happen to anyone. Mary’s treating physicians told her that she was absolutely unable to work until she got better. Principal Insurance Company ignored those opinions and denied her claim, stating that her evidence was insufficient, despite her psychiatrist’s unwavering conclusion that she was mentally disabled and could not work. Mary was used to a steady, high wage and was scared about losing everything. An attorney friend recommended our office to appeal her denial. We worked closely with Mary to build her claim with new, undeniable evidence that went far beyond what she had initially submitted to Principal. As we gathered her records and learned the details of her situation, we realized that her burnout and bipolar symptoms were among the most extreme we had encountered. She simply needed help describing her condition more vividly and effectively. A High-Energy Executive For years, Mary was a dynamo. She loved her work as a highly paid (over $190,000 per year) executive director for a fast-paced medical practice. She worked hard and kept long hours. She was highly valued by the physicians who employed her and loved by the staff she supervised. Every part of her life changed when she was hospitalized under a PEC (Physician’s Emergency Certificate) for emergency treatment. Burnout and overwork had pushed her into a severe delusional state. Her symptoms included hearing voices, seeing deceased relatives, believing people were monitoring her, refusing to be near mobile phones, whispering at work, thinking her office was bugged, and assuming people were taking photos of her from skylights and even while she used the bathroom.
She also believed trucks were following her and that workers around her home were in the mafia. She lost more than 30 pounds, was unable to sleep, and became afraid to be alone. Her employer discovered that her home had slipped into foreclosure, despite having sufficient funds available, and stepped in to help resolve it with the lender. Mary was determined to continue working, and her employer tried to help her hang on, but she began exhibiting increasingly bizarre behavior. She became extremely hyperactive, assigning staff to clean out cabinets and refrigerators at 2 a.m. during an ice storm, and also fired good staff members for no apparent reason. Her physician supervisors eventually told her she needed to take time off and later had to let her go. Winning Her Appeal With Mary’s help, we interviewed several of her physician supervisors and prepared detailed statements describing her behavior, her 2 a.m. work mania, her shared delusions, her foreclosure issues, and other events. We also drafted a stronger, more vivid statement for Mary and assembled overwhelming new evidence that had not been part of her original application. Presented with this evidence, along with relevant court opinions from similar cases, Principal finally reversed its earlier denial. It paid all past- due benefits and began paying Mary the $7,500 per month she was owed under the policy. Why Appeals Matter By fighting the denial instead of accepting it, Mary was able to maintain her financial security and focus on recovering. Unfortunately, disability insurers unfairly deny legitimate claims every day. But these denials can be overturned with stronger evidence, properly presented.
Mary deserved the benefits she had paid for, and it was an honor to help such a wonderful lady overturn such an unfair claim denial.
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