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DarrasLaw wins a Principal Financial appeal for a Vice-President of Operations at a supply chain.

The case involves a vice president of operations and supply chain who had purchased an individual disability insurance policy from Principal Financial rather than receiving coverage through his employer. His high-level logistics position involved overseeing operations and the movement of supplies. He eventually became unable to continue working because of severe anxiety, along with migraines and cognitive difficulties. However, when he initially filed his disability claim, he had relatively little medical documentation supporting the severity of his condition. He was primarily treating with a primary care physician, had only recently begun seeing a therapist, and was not yet receiving regular psychiatric treatment.

Principal conducted an extensive review that included a phone interview, an in-person field interview, two medical reviews, and a detailed vocational assessment. The company ultimately denied the claim, concluding there was insufficient treatment history and medical evidence showing that his conditions were severe enough to prevent him from performing his occupation. Principal’s denial letter was approximately 18 pages and outlined its medical, vocational, and investigative findings. The central problem was not necessarily that the client’s symptoms had only recently developed, but that there was little contemporaneous medical documentation showing how long he had been struggling or how severely his anxiety and cognitive problems affected his ability to work.

Attorney Stephen Jessup developed an appeal focused on providing objective evidence to support the client’s largely subjective mental health and cognitive complaints. Key components of the appeal included:

• Arranging a comprehensive neuropsychological evaluation to assess the client’s cognitive functioning. Although the testing did not establish a neurological basis for a neurocognitive disorder, it identified deficits involving memory, executive functioning, processing speed, and other areas, with a pattern consistent with severe anxiety.
• Obtaining attending physician statements and additional support from the client’s primary care physician, who supported his inability to perform his occupation.
• Working with the client’s therapist to complete behavioral health questionnaires and provide additional statements documenting his symptoms and functional limitations.
• Addressing the relatively recent treatment history by asking providers to evaluate, based on their training, treatment, and experience with the client, whether his symptoms were likely present before he formally began treatment.
• Connecting the documented cognitive and psychological limitations to the substantial demands of his executive-level operations and supply chain position.

The appeal involved considerable back-and-forth with Principal, including requests for additional information and another phone interview with the client. Principal continued to raise concerns about whether he was receiving appropriate specialist care and whether the intensity of his treatment matched the reported severity of his condition. However, Principal’s extensive vocational analysis ultimately helped establish the significant demands of his specific occupation. Because the individual policy used an own-occupation definition of disability, the issue was whether he could perform his particular executive position—not simply whether he retained the ability to perform some type of work.

Principal ultimately accepted liability and approved the client’s