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Court Rejects Reliance on Mental/Nervous Disorders Limitation; Awards Attorneys’ Fees to ERISA Claimant

Blogs, Erisa

In a 66-page decision discussing a claim for long-term disability arising out of Chronic Fatigue Syndrome, the court in Perryman v. Provident Life and Accident Ins. Co., No. CV-01-0927-PHX-PGR, (D. Ariz. Feb. 18, 2010), rejected the insurer’s reliance on the mental/nervous disorders limitation as an independent ground for denial of coverage. First, the court noted that insurer had not raised the issue in its written denial letter. Second, the court interpreted such an exclusion as inapplicable where the mental/nervous disorder was secondary to concluded that there was ample evidence of an objective physical impairment. Finally, the court concluded that the evidence reflected that the claimant’s depression-related symptoms were secondary to her CFS.

The court also had noted the consistency of the CFS diagnosis as part of the objective evidence of the condition, and, based on the evidence of impairment as well as the sporadic nature of CFS, rejected the insurer’s surveillance evidence. The court awarded the claimant her attorneys’ fees and costs pursuant to 29 U.S.C. 1132(g)(1). The matter had been pending in the District Court since 2001.