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Page 9 of 12
Claimant, an investment banker, became disabled with clinical depression and attention deficit disorder. He continued working for over a year, but his condition deteriorated and he began experiencing anxiety, exhaustion, dysphasia and impaired concentration. His treating doctor recommended in-patient treatment and prescribed a host of medications including Lexapro, Trazodone, Levothyroxine and Phentermine, He was fired for non-performance, sued his employer for wrongful termination and filed a disability claim with his long term disability carrier.
His policy defined Totally Disabled for the first two years on claim as the inability to perform the duties of his own occupation. After two years the definition changed to the inability to perform the duties of ANY occupation for which he was qualified by reason of the insured's education, training or experience.
The insurer initially denied his claim saying that there was insufficient evidence of clinical depression and that there was no proof that the claimant could no longer perform his job duties. Following a detailed demand letter setting forth the basis for the disability claim the insurer reversed its decision, paid back benefits and made a $60,000 offer to buyout the policy. The low buyout was in part justified by the insurer on the basis that the insured could perform other occupations for which he was qualified, besides investment banking.
The $60,000 offer was countered by a buy out demand of $149,381, which was the present value of the future benefits reduced to present value. This demand was based on the contention that the claimant would not be able to perform any occupation in the future.
Settled for $149,381
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