In Cline v. Aetna Life Insurance Co., a North Carolina District court overturns a denial of own occupation benefits to Mr. Cline, who was employed as a commercial pilot for NetJets. Mr. Cline suffered from lumbar stenosis and other musculoskeletal impairments which caused him to file for disability in 2014. Unfortunately, Aetna denied the claim under the own occupation definition of disability finding that Mr. Cline’s impairments were not severe enough to preclude him from working as a pilot.

Mr. Cline appealed and submitted evidence establishing that although his condition did not preclude FFA medical flight certification, several treating physicians, including the flight surgeon who had examined him, found him unable to meet several job requirements such as: climbing on wings; running while carrying or pulling a suitcase or kitbags; leg control expecting 150 lbs. of force; bending the body downward and forward by bending leg and spine. One treating physician deemed Mr. Cline unable to safely fly at all.

In reviewing the evidence, the court acknowledged the policy required consideration of a pilot’s duties as that job is performed in the national economy but concluded that Aetna’s decision was not reasonable in that it was not the product of a reasoned principled process, was not supported by substantial evidence, was undermined by the inherent conflict of interest existing within the defendant, and ultimately constituted an abuse of discretion.

Interestingly, the court found the “primary fallacy in Defendant’s analysis” was in its failure to consider subjective evidence. According to the court “subjective evidence is not only relevant, but may be sufficient in itself to support the claim.” The court cited several cases where courts reviewed similar claims that relied heavily on subjective evidence. Where the policy contained no provision precluding the claimant from relying on his subjective complaints as part of his evidence of disability, the carrier cannot reasonably deny the claim because of such reliance.

It is important to note that the court was impressed by the consistency in Mr. Cline’s complaints of leg weakness and in the absence of any challenge to his credibility. Also, the court was troubled by Aetna’s apparent disregard of the issue of safety as it relates to a pilot’s duties.

When claims rely heavily on a claimant’s subjective complaints consistency and credibility are key. Had Mr. Cline’s credibility been brought into question the outcome would have been quite different.

This case was not handled by our office, but we think it can be beneficial to those struggling to obtain long-term disability benefits. If you have any questions about your own disability claim, contact one of our attorneys at Dell & Schaefer for a free case evaluation.