ERISA-governed group long-term disability claims are frequently litigated in both the Eastern and Southern districts of New York. To make a successful claim under a group long-term disability plan, an employee generally has to provide proof that an injury or sickness prevents her from performing either her own occupation or any occupation for which she is reasonably suited. In the end, the proof in every long-term disability claim boils down to "subjective complaints." For example, while cancer can be "objectively" proven, its disabling sequelae, pain and fatigue, are entirely subjective. Although an X-ray can verify a spinal fracture and an MRI can often verify a herniated disk, the disabling pain and numbness flowing from them cannot be objectively confirmed, only clinically correlated. Quite simply then, all disability claims require claimants to explain how sickness or injury subjectively disables them in order to establish a valid claim in the first instance.
The U.S. Court of Appeals for the Second Circuit's recent decision in Miles v. Principal Life Insurance1 recognized this reality and in so doing, set forth proper procedural parameters to guide claimants, fiduciaries, and district courts through the proof-of-disability process. Thus, the success or failure of nearly all Employee Retirement Income Security Act-governed long-term disability claims depends on how a long-term disability claim administrator (typically an insurance company) weighs and evaluates a disabled individual's subjective complaints.
