This ERISA case, decided in 2008, is a case dealing with the arbitrary and capricious standard for reviewing the decisions of the plan administrator.
The Plaintiff/Insured began receiving long term disability benefits in 1990 due to debilitating osteoarthritis in both knees. In 2005, the plan terminated her benefits and the claimant filed this action. The district court concluded that the plan’s decision was not arbitrary and capricious and granted summary judgment in its favor. On review, the Plaintiff argued that a different standard of review was required after a decision in the Glenn case by the Supreme Court. However, the Court rejected that argument, finding that the arbitrary and capricious standard was still applicable with any conflict of interest taken into account as a factor. While the Court rejected the Plaintiff’s argument that previous payment of benefits and a decision at odds with an opinion of a treating physician created a presumption that the termination decision was arbitrary and capricious, it did agree with the Plaintiff that the long term disability plan failed to consider the Plaintiff’s complete medical history and then rejected, without explanation, important aspects of the Functional Capacity Evaluation. As a result, the plan acted in an arbitrary and capricious manner in terminating benefits and a remand was necessary.
Here, the Court found no merit in the Plaintiff’s main argument, but did find that the lower court erred in the arbitrary and capricious determination. This case is a good example of the importance of exhausting all appeals before giving up on a case.
If you need assistance navigating your claim for short term or long term disability benefits under ERISA, or it is time to sue the insurance company, please do not hesitate to give Cody Allison & Associates, PLLC a call (844) LTD-CODY, (615) 234-6000. or send us an e-mail Cody@codyallison.com. We provide representation nationwide and have successfully sued all the major insurance companies in many states. Our headquarters are located in Nashville, Tennessee. We offer a free consultation and would love to speak with you.