California PTSD Sufferer Denied Disability Insurance

February 9, 2014, 8:00AM. By Gordon Gibb

Sacramento, CAIn spite of California Insurance Law and other federal statutes that dictate a constituent’s right to pursue disability insurance as required, most applicants will tell you that in the majority of cases an application for disability is routinely denied, and sometimes stamped denied ERISA disability a second time on appeal.

Some disability applicants take their cases to an appellate court, as one California resident did recently. Her long-term disability denied claim, which was ultimately rejected by the court, appears in fact to be a complicated case that could be subject to various interpretations as to the suitability of a disability claim, and the need for such. In the end, however, the court upheld the findings of the administrative law judge (ALJ) who initially ruled on the case, denying the plaintiff disability benefits.

The case was heard in US District Court for the Eastern District of California. According to court documents, plaintiff Shirley Larson initially filed her claim for disability benefits July 9, 2009 - alleging disability commencing April 15 of that year. Both of Larson’s applications, for disability insurance benefits and Social Security Insurance benefits, were initially denied, and subsequently turned down upon reconsideration.

Larson’s California ERISA-denied claim was then heard before an administrative law judge on September 6, 2011. In a decision released about six weeks later, the ALJ determined on October 28 that Larson was, in the view of the ALJ, not disabled under various sections of the Social Security Act.

Following the decision of the ALJ, Larson took her long-term disability denied claim to court and sued for benefits.

Court heard that Larson, in her mid-30s, suffers from post-traumatic stress disorder (PTSD), bipolar disorder and substance abuse in early remission. The substances involved were identified as alcohol, and use of methamphetamine (meth) and heroine. At the time of the hearing, she was living in a tent in her mother’s backyard. Larson had last worked as a cashier at a chain convenience store for about a year, ending in 2009. Court heard she was fired from that job after her boyfriend showed up at the premises and caused a scene. The circumstances leading up to that fracas were not discussed. Larson reported to the doctor tasked with undertaking a psychiatric consultative examination, that she was a teen mom at 16 but lost her baby to SIDS at nine months. She also said the baby’s father committed suicide shortly after the baby’s death. Larson reported that she witnessed abuse toward her mother by her stepfather, and that she herself had suffered abuse by her ex-boyfriend. The plaintiff told the consulting psychiatrist that she rarely left the house, and only did so when accompanied by her mother. Her chief complaint was PTSD based upon the foregoing.

The doctor summarized that Larson presented a long history of exposure to domestic violence as well as being a victim of abuse. The expert concluded that Larson would require further psychiatric evaluation and treatment to stabilize symptoms that affect daily activities by being secluded in her own home due to constant fear. “This can also affect her capacity to relate to coworkers, difficulty concentrating, and the public in general,” wrote Dr. Ornella Addonizio. “Her attendance will be affected as well. She has difficulty concentrating which will affect her capacity to understand, carry out, and remember simple instructions. She cannot manage her own funds.”

In the end, the ALJ in the initial hearing gave Dr. Addonizio’s opinion limited weight. A second State Agency consultant brought in to evaluate the plaintiff in light of her denied disability insurance claim determined that the plaintiff suffered from chronic anxiety and from a substance addiction disorder, and that she has inflexible and maladaptive personality traits that cause either significant impairment in social or occupational functioning, or subjective distress. He opined that Larson could understand, remember and carry out simple and some detailed but not complex instructions; can sustain concentration, persistence, and pace for simple tasks only; can get along with others but not work effectively with the public; and can adapt to the stress and changes of a simple work environment.

However, the ALJ gave that portion of the opinion limited weight as well, noting that although the plaintiff “has social limitations, which would limit her contact with others, the record supports that she can deal with people on a limited basis and that it is not completely prohibited.”

In the end, the ALJ determined that while Larson did not have the capacity to perform any past relevant work, there were employment opportunities in significant numbers in the national economy that the claimant could perform.

The court found no error in the ALJ’s opinion, and therefore denied Larson the disability benefits she sought, and her pursuit of California insurance claim help was for naught.

The California insurance claim denied case was Shirley Larson, Plaintiff v. Carolyn W. Colvin, Acting Commissioner of Social Security, Defendant. Case No. 2:12-cv-2100 AC, US District Court for the Eastern District of California.