LTD Plan's Demand of Objective Proof of Migraines is not Wrong

The court said it could be argued that the plan’s decision to terminate Sharon Creel’s benefits was unfair, because it is almost impossible to have objective medical evidence that substantiates the severity of her migraines. However, it pointed out the terms of Wachovia Corp.’s plan require that participants submit evidence in support of claims for disability benefits in a form satisfactory to the plan administrator and that the administrator can require objective medical evidence.

Creel argued that the plan administrator cannot require objective medical evidence of her disability, because it is an inherently subjective condition, but the court disagreed based on the terms of the plan. The court said determining if a plan was unfair was not one of its functions.

Additionally, according to the court’s opinion, it was not wrong for the plan administrator to credit the opinions of doctors it hired to review the case over the opinions of Creel’s own doctors. The doctors hired to review Creel’s case noted that none of her doctors had observed her during one of her migraines despite reporting they occurred as frequently as 10 days out of the month. The plan’s hired physicians concluded “there is not objective information available on laboratory testing or by history that these headaches are an organic process, but rather by history would be most consistent with depression, stress, and anxiety.”

The plan had a condition that LTD benefits for mental illness would be stopped after 24 months.

Creel worked as a Group Product Manager at Wachovia until July 15, 2002, when she was hospitalized for an attack, in which she complained of chest pain and partial paralysis of one side of her body. She applied for short-term disability benefits, and she received them for the maximum period under the STD plan. At that time, her primary care physician stated that Creel’s primary diagnosis was major depression, with a secondary diagnosis of anxiety and migraine headaches.

Creel submitted a claim for LTD benefits, which was approved effective January 13, 2003. After 24 months, the plan notified her that her benefits would be discontinued unless she offered proof she was unable to work in any occupation due to her disability. After several appeals to continue benefits were denied by the plan administrator, Creel filed suit.

The case is Creel v. Wachovia Corp., M.D. Fla., No. 8:07-cv-248-T-24 MAP, 2/25/08.