A federal district court recently overturned Northwestern Mutual's denial of own occupation disability insurance benefits to an attorney with congestive heart failure unable to handle stress. The case Mustain-Wood v. Northwestern Mututal Life Insurance Company involved a family law attorney and partner at his own law firm who experienced congestive heart failure requiring major surgery and cardiac rehabilitation. 938 F.Supp. 2d 1081 (D. Co. 2013). Mustain-Wood became unable to practice as an attorney in part because of the high stress environment it required.
Mustain-Wood attempted to return to work as quickly as possible in a limited capacity, but unfortunately the effects of congestive heart failure prevented him from working. His doctor issued a report which explained, Mustain-Wood "has tried to return to work in a relatively low stress position as a mediator at his practice on Tuesdays and Fridays, but even with those interactions, he has experienced undue chest discomfort, tightness and some anxiety."
Mustain-Wood submitted a disability claim under his group insurance policy to Northwestern Mutual. However, Northwestern Mutual denied his claim finding that he was not disabled for the 90-day elimination period and thus was not eligible for benefits. Mustain-Wood submitted an appeal to Northwestern as required under ERISA, but Northwestern upheld the denial of benefits and a lawsuit was necessary. The Court's review of Northwestern's denial of disability benefits to Mustain-Wood included the following analysis in determining that Northwestern's denial of benefits was arbitrary and capricious and "not lying anywhere 'on the continuum of reasonableness'":
. . . I disagree with [Northwestern's] conclusion for several reasons.
First, the practice of law, whether civil or criminal, requires: (1) a high degree of cognitive ability and function; (2) precise analytical skills; (3) the ability to clearly and succinctly communicate arguments and ideas orally and in writing; and (4) the ability to effectively handle multiple tasks simultaneously. Most important, an attorney must have the ability to cope with rising levels of stress and anxiety that vary on an hourly basis. An attorney, regardless of what he or she practices, who suffers congestive heart failure is not likely to be able to resume the full gamut of his or her duties within 90 days of congestive heart failure. The duties and stressors of an attorney require him or her to operate at optimum levels of efficiency. Save the rare the occasion, this is not possible within 90 days of congestive heart failure.
Id. at 1088. The Court also explained in overturning Northwestern Mutual's wrongful denial of benefits that:
[Northwestern] proposed that Mustain-Wood chose not [to] return to work as [a] family law practitioner, and he could have chosen to practice law in another area because he was qualified to do so as a "general practitioner." I disagree. While attorneys are not allowed to say they "specialize" in certain areas of law, the reality is that the majority of attorneys practice within a narrow field of the law. This serves several practical purposes; the most important being that by practicing in a narrow field of law, an attorney hones his or her knowledge of the subject matter over years of practice such that he or she is competent in that field and can effectively litigate claims on that subject matter when presented with diverse and complicated sets of fact patterns. With that said, it is counterintuitive to hold that an attorney such as Mustain-Wood, who has practiced family law in his entire legal career, could immediately switch to and successfully practice in another area of the law without serious malpractice concerns. However, this is the precise argument presented [by Northwestern] . . . . To believe Northwestern's argument, I would have to disregard: (1) the inherent difficulties involved with the practice of law; and (2) Mustain-Wood's physical condition after heart surgery. I will not do so. Id. at 1088-89.
At DI Law Group our experienced disability insurance and ERISA attorneys have handled several cases involving professionals who were no longer able to perform the duties of their regular occupation because of heart failure or other medical conditions which caused them to be restricted from exposure to high levels of stress. If you are faced with filing a claim with your disability insurance company, or have been denied disability insurance benefits, contact one of our experienced attorneys today for a complimentary consultation about your options. Let us deal with them for you.