In a recent case, Kennedy v. The Lilly Extended Disability Plan, No. 16-2314, __F.3d__, 2017 WL 2178091 (7th Cir. May 18, 2017), the Seventh Circuit Court, overturned a disability insurance benefit denial of a claimant with fibromyalgia. The claimant in the Kennedy case was the executive director of Lilly’s human resources department, earning a monthly salary of $25,011. Kennedy was diagnosed with fibromyalgia and was suffering from its severe symptoms. Ultimately, she was unable to continue to work and filed a claim for disability benefits under Lilly’s self-funded ERISA governed disability plan. Originally, Kennedy’s claim was approved and she received benefits for over three years. However, the plan required Kennedy to undergo a physical evaluation over 100 miles from her home by a physician it hired. The “examination” lasted a mere five-minutes. The plan also hired a rheumatologist to conduct a records review of Kennedy’s medical information, who falsely alleged that the American
College of Rheumatology does not consider fibromyalgia to be disabling on an extended basis. Based on the opinions of these two physicians, the plan terminated Kennedy’s benefits.
Kennedy’s treating doctors unanimously opined that due to fibromyalgia, Kennedy was disabled. After exhausting her administrative appeals, Kennedy was able to file suit against the plan. The
district court granted summary judgment in favor of Kennedy. She was awarded past-due benefits and interest in the amount of $537,843.81. The plan appealed the decision to the Seventh Circuit Court of Appeals
The Seventh Circuit affirmed the district court’s decision in favor of Kennedy, providing “There used to be considerable skepticism that fibromyalgia was a real disease. No more.” In so doing, the Court rejected the assertion that the American
College of Rheumatology does not consider fibromyalgia to be a long-term disabling condition.
The Seventh Circuit also commented that if Kennedy suffered flare ups of fibromyalgia even one to two days per month, Kennedy would not be able to work a regular schedule. The Court also found it relevant that “By cutting off Kennedy’s benefits the company has saved itself about $2.5 million. Big as Lilly is, that’s not a trivial loss.” There was one dissenting opinion by Judge Manion, who asserted that the record contained sufficient evidence to uphold the plan’s decision and alleged that “most people with fibromyalgia can work.”