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Compliance April 1, 2005
Judge Rules Cardiac Patient's Fear of Dying Made Heart Woes Worse
April 1, 2005 (PLANSPONSOR.com) - A Bear Stearns
senior managing director suffering from heart disease and
extreme anxiety over additional cardiac problems is not
entitled to continuing long-term disability (LTD) benefits
beyond mid-2003, a federal judge has ruled.
Reported by Fred Schneyer
>Senior US District Judge Charles Haight Jr. of the US District Court for the Southern District of New York ruled that LTD coverage provider MetLife should have provided 27 additional months of coverage to plaintiff James Sheehan beyond March 2001 when he was cut off after six years of coverage, BNA reported. According to Haight’s ruling, payments to Sheehan had started in February 1995 after he had suffered a heart attack and that the insurance company halted the payments after deciding that Sheehan was no longer totally disabled.
>Haight found that Sheehan’s situation was not covered by the Bear Stearns LTD plan because the plan limited benefits to two years for a condition that was contributed to by a psychiatric condition.
>According to Haight, the terms in the plan certificate trumped the terms in the SPD governing the effects of a psychiatric condition on a disabling condition. The certificate provided that no monthly benefits would be paid after two years if the participant’s total disability in any way resulted from, or was caused or contributed to by a mental or nervous disorder.
>The court concluded that Sheehan’s fear of suffering additional heart problems was a “mental or nervous disorder” as described in the plan certificate and that Sheehan’s cardiac condition was not totally disabling after June 2003. Haight ruled that Sheehan’s disabling concerns stemmed from his cardiac neurosis, which in turn exacerbated his physical symptoms
>The case is Sheehan v. Metropolitan Life Insurance Co., S.D.N.Y., No. 01 Civ. 9182 (CSH), 3/15/05).