CHICAGO (CN) - A man who was working on the 61st floor of the South Tower of the World Trade Center on Sept. 11, 2001 has sued his insurance company, which denied him disability payments for post-traumatic stress disorder.
The South Tower was the second one hit, 17 minutes after the North Tower.
Thomas J. Jones sued Standard Insurance Co., in Federal Court.
When the first hijacked plane crashed into the North Tower, Jones says, he joined the evacuation process.
"As he was escaping down the stairs, plaintiff was confronted by the chaotic scene with individuals crying and people in extreme fear," the complaint states. "Plaintiff was still in the building when the second South Tower was hit. As his descent continued, plaintiff grew increasingly anxious and he believes he eventually went into shock, was afraid for his life and witnessed horrifying events after exiting the building.
"As a result of plaintiff's exposure to the traumatic events of September, 11, 2011, he developed Post Traumatic Stress Disorder," the complaint states.
Two independent doctors diagnosed Jones with PTSD.
"Dr. Capriotti's notes show that plaintiff suffered from: recurrent intrusive thoughts about the event while awake and distressing dreams related to the event; an avoidant/numbing behavior including decreased interest and participation in activities and feeling detached from others emotionally; hyper arousal including difficulty falling and staying asleep, difficulty with concentrating, hypervigilance, and an exaggerated startled response," according to the complaint.
Capriotti also noted that Jones "experienced symptoms for over a decade and that the symptomatology clearly impacted plaintiff's occupational abilities."
Jones was working for Morgan Stanley Dean Witter when the planes hit. In March 2011, he says, he lost his job with DS Waters of America because his PTSD made him unable to work. He was earning $4,597 a month. He has not worked since then.
He filed a disability claim with Minnesota Mutual Life Insurance Company, with whom he had had a disability policy since 1991. "Standard Insurance Company acquired the individual disability business of Minnesota Mutual Life Insurance Company in 2000, which included plaintiff's disability policy," according to the complaint. Jones says he is eligible for monthly benefits of $5,849 if his disability is verified.
However, in July 2011, Dr. Reff, a doctor compensated by the insurer, found that Jones "did not suffer from Post Traumatic Stress Disorder based on the alleged lack of identifying Criterion C (avoidant/numbing) symptoms; even though not all symptoms of all criteria are required to formulate the diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR)," according to the complaint.
Jones says Dr. Reff "wrongfully minimized plaintiff's symptoms."
On September 1, 2011, Minnesota Mutual denied Jones disability benefits.
Its denial letter stated that "the IME [independent medical examiner] physician concluded that Mr. Jones does not manifest clinical evidence that substantiates significant limitation of daily functioning: including job related functioning, as a consequence of a severely impairing psychiatric condition. It was the IME physician's opinion that Mr. Jones does demonstrate evidence of a psychiatric condition, however, the condition is not causing impairment."
Jones says the insurer "has persisted in a plainly unreasonable interpretation of its policy."
"The definition of disability provided in the policy clearly defines disability as being under the 'regular, reasonable and customary care of a physician' and being 'unable to engage in your regular occupation' or 'earning not more than 85% of your prior average earned income.' The defendant chooses to ignore the definition of disability as spelled out in the policy," Jones says.
He seeks punitive damages for breach of contract, bad faith and consumer fraud.
He is represented by William C. North, of Downers Grove.
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