Whether fibromyalgia was a real disease used to be subject of skepticism, but "no more" as the U.S. Court of Appeals observed in Kennedy v. Eli Lilly, where it ruled that disability insurance benefits must be paid due to Kennedy's fibromyalgia.
Cathleen Kennedy had an impressive career with Eli Lilly, rising to become its executive director of its human resources division and having an annual salary in excess of $300,000. But in 2008 she was forced to quit working due to fibromyalgia. She received disability insurance benefits for 3 1/2 years, before they were cut off. Eli Lilly's plan, which it both funded and administered, defined "disability" as any condition that rendered an individual unable "to engage, for renumeration or profit, in any occupation commensurate with the Employee's education, training, and experience." This is an employee-friendly definition of "disability", because rather than linking disability to being unable to perform "any" type of job or occupation, it hinges eligibility on the individual being unable to perform "any" type of job or occcupation "commensurate" with the employee's job history and expertise. For a high level employee like Kennedy, this is important.
The Court characterized Eli Lilly's evidence as a "hodge-podge" and took to task a Dr. Schriber in Dayton, Ohio: "Lilly sent Kennedy to be examined by a Dr. Schriber in Dayton, Ohio, more than 100 miles from Kennedy's home in Indianapolis. The doctor conducted a physical exam of her that lasted all of five minutes. He testified that the 'American College of Rheumatology does not consider fibromyalgia to be disabiling on a long-term basis.' That, as we know from our earlier quotation from the ACR is false[.]"
The Court also noted Lilly's conflict of interest:
Another questionable aspect of Lilly's case is the company's conflict of interest, by reason of its being both the initial adjudicator of an employee's benefits claim (via Lilly's Employee Benefits Committee) and the payor of those benefits. By cutting off Kennedy's benefits the company has saved itself about $2.5 million. Big as Lilly is, that's not a trivial loss.
The Court upheld the district court's ruling that Kennedy was entitled to receive the disability insurance benefits.
Lexington, Kentucky disability benefits lawyer Robert Abell represents individuals and employees on their claims for disability insurance benefits; contact him at 859-254-7076.
