Get more! Sign up for PLANSPONSOR newsletters.
Disability Payment For Mental Illness Reasonable
Maritza Burgie was on her way to work when the planes crashed into the two World Trade Center towers. She worked in one of the towers as a benefits specialist for Euro Brokers Inc.
She was thrown from the building by the first explosion,
witnessed a woman crushed to death by falling debris and a
later explosion threw Burgie to the floor of a subway
terminal – all of which she claimed caused her mental and
physical injuries that required her to stay home from work.
She claimed she was forced to return to work in November
2001 – before she was clinically ready – and then had a
nervous breakdown “from the stress of the attacks and
her return to work.”
Burgie filed for extended medical leave under the Family
and Medical Leave Act (FMLA) and disability benefits after
she was diagnosed by a physician as suffering from
“anxiety, post traumatic stress disorder and other
sequelae,” and was therefore unable to perform her
job, according to the opinion.
In March 2002, she received a letter that she would be
terminated because she failed to return phone calls,
contact the office or advise on her expected return date;
however, Burgie claims she and her husband maintained
continuous contact with Euro Brokers.
In September of 2002, Burgie filed a claim for benefits
from First Unum Life Insurance Co, but her company did not
supply the paperwork needed to process the claim. The claim
was terminated by Unum in October 2002 and remained closed
after she missed the 30-day deadline to request for it to
be reopened.
It was only after Burgie sued Unum in February 2005 that
the plan administrator obtained the required paperwork and
calculated that the maximum disability benefits she was
entitled to for mental disability was $6,390.
Burgie claimed that the calculations were incorrect and that she was entitled to more than two years of disability benefits.
According to the opinion by U.S. District Judge Charles Sifton, Unum’s policy spells out that mental illnesses have a limited pay period of 24 months. “Where the written plan documents confer upon a plan administrator the discretionary authority to determine eligibility for benefits or to construe the terms of a plan, a court confronted with such a claim should not disturb the administrator’s ultimate conclusion unless it is ‘arbitrary and capricious.” he writes.
In its opinion, the court said the calculations were correct and that because the diagnosis for Burgie of depression and post-traumatic stress disorder met the American Psychiatric Association’s requirements for mental illness, Unum’s assessment was not arbitrary and capricious.
However, Burgie argued that her illness was also physical, but provided no documentation.
The case is Burgie v. Euro Brokers Inc., U.S. District Court of the Eastern District of New York , No. CV-05-0968, January 26, 2007.
You Might Also Like:
EEOC Says 74-Year-Old Worker Forced to Retire After Medical Leave
EEOC Wellness Program Rule Lawsuit Decided in Favor of AARP
The district court had previously ruled against the plaintiffs’ motion for a preliminary injunction, finding AARP did not prove irreparable...
EEOC, Orion Reach Agreement on Wellness Program Challenge
« FL Firm Offers Pension 'Roadmap' to Model Future Strategies