A former CFO who has anxiety and depression following a traumatic brain injury from a car accident in 2007 is eligible for long-term disability benefits, a federal judge ruled.
Although Prudential Insurance Co. of America had argued that the former CFO suffers from mental illness that is unrelated to the trauma, which means that his disability benefits would be limited to two years, U.S. District Judge Joel Slomsky of the Eastern District of Pennsylvania was unconvinced by the doctors’ testimony that the company provided.
“Generally, the doctors who treated him found that he suffered a traumatic brain injury that caused his neuropsychological symptoms, while the doctors commissioned by Prudential to review the file — who did not treat the plaintiff — generally disagreed with the treating physicians, and reached medical conclusions that were favorable to Prudential,” Slomsky said in White v. Prudential.
He later concluded, “Although plaintiff’s disability may be due in part to mental illness, the mental illness was caused by a traumatic brain injury endured in the automobile accident, and therefore is not subject to the 24-month limitation in the plan.”
James White, who had earned $255,000 a year as the chief operating officer, chief financial officer and the director of risk management at Holt Oversight and Logistical Technologies, got into a severe car accident in the spring of 2007. As he was driving a sport utility vehicle on Interstate 95 with his family, he was struck by another car, which flipped his vehicle several times before it rested on its roof on the median, according to the opinion.
White told paramedics and emergency-room workers that he hadn’t hit his head or lost consciousness, but his son’s testimony and later reports from several doctors indicate otherwise, Slomsky said. James White Jr. pulled his siblings and cousin from the car while his parents were unresponsive in the front seats, according to the opinion.
Regarding White’s initial denial of a head injury, Slomsky said, “Although this is a relevant fact, its importance is outweighed by his later complaints of headaches, tinnitus, memory loss, lack of concentration, and word-finding difficulties, and his doctors’ diagnoses of post-concussion syndrome and head trauma.”
A week after the accident White lost his job — the reason isn’t clear from the record — Slomsky said, and he was offered a job as a COO at a Holt subsidiary. He declined.
After White had run through his sick and vacation time in the fall of 2007, he applied for disability benefits from Prudential, which denied his claim, starting a years-long dispute over his entitlements.
At one point in 2009, Prudential overturned its denial and granted White disability benefits based on additional submissions from him, but later that year notified him that “it had ‘questions about the etiology of the cognitive impairments,’” according to the opinion, and told him that the 24-month limit for mental-illness benefits would apply.
Slomsky was unconvinced by Prudential’s argument that White hadn’t met his burden in proving that he couldn’t work because of his diminished mental capacity.
Referring to Prudential’s finding that White was eligible for benefits because of his disability and then finding that they were subject to the mental-illness limit, Slomsky said, “Prudential’s decision was not based on a finding that plaintiff was not disabled. Rather, its decision was based on a finding that he was disabled, but his disability was due to mental illness — specifically, depression and anxiety — and therefore limited to 24 months of benefits.
“Upon review of the medical evidence in the administrative record — the same medical evidence Prudential reviewed when it determined that plaintiff was disabled due to cognitive deficits — it is abundantly clear, as Prudential conceded, that plaintiff suffers from disabling depression and anxiety.”
That record puts White squarely within the plan’s definition of disabled, Slomsky held. The first condition, according to the plan, is being unable to perform your regular job duties. White, who used to be responsible for complex transactions and important decisions, can no longer concentrate enough to carry out those duties and is plagued with anxiety and depression, according to the opinion.
The second condition that qualifies a beneficiary of the plan for disability is a loss of 20 percent or more in monthly income, which White has clearly lost, according to the opinion.
Having found that White qualified for disability benefits within the terms of the plan, Slomsky turned to the contentious issue of whether the 24-month limit on benefits for mental illness should apply.
He looked to the Eastern District of Pennsylvania’s 2010 opinion in Morgan v. Prudential, which held that “where a mental condition is a sequelae or component of a physical disease or condition, a mental-illness limitation will not apply,” according to the opinion.
So, Slomsky said, “it matters not whether plaintiff suffers from depression and anxiety as a result of the accident — the pertinent question is whether his depression and anxiety are sequelae or components of a physical disease or condition caused by the accident. If the depression and anxiety stem from a physical disease or condition, the 24-month limitation will not apply. This analysis advances the congressional objectives of ERISA.”
He explained that ERISA was meant to protect beneficiaries.
After a lengthy discussion of White’s treating physicians and Prudential’s doctors’ reports, Slomsky found that White’s mental disabilities were a result of the brain trauma he suffered in the accident. Slomsky noted that three different doctors who treated White had diagnosed him with post-concussion syndrome.
“Although plaintiff’s disability may be due in part to mental illness, the mental illness was caused by a traumatic brain injury endured in the automobile accident, and therefore is not subject to the 24-month limitation in the plan,” Slomsky said,
John Leonard of Leonard, Sciolla, Hutchison, Leonard & Tinari in Philadelphia represented White and said that his client was pleased. However, Leonard said, he was frustrated with Prudential since it wouldn’t address the issue earlier.
“It was doubly frustrating to have to go to federal court,” Leonard said.
Jaclyn DiLascio Malyk of d’Arcambal Ousley & Cuyler Burk in Parsippany, N.J., referred questions to Robert DeFillippo, spokesman for Prudential, who declined to comment.
(Copies of the 33-page opinion in White v. Prudential, PICS No. 12-2168, are available from The Legal Intelligencer. Please call the Pennsylvania Instant Case Service at 800-276-PICS to order or for information.) •