This ERISA case, decided in 2017, is a case dealing with the Defendant failing to make a record for the case.
The Plaintiff/Insured was hired by the Defendant and rose rapidly, eventually becoming an executive director in the human resources division. However, after working at the company for over three decades, she was forced to quit because of disabling symptoms of fibromyalgia. She made an initial claim for long term disability benefits which was granted. Three and a half years later, these benefits were terminated. She brought suit. At trial, the Defendant based it’s denial on evidence presented by a number of doctors. However, the Court found that this evidence was a hodge-podge and was not consistent. However, the Court also found that even if this evidence was not deficient, the Defendant failed to indicate what job or kind of job, and on what level, the Plaintiff would be capable of performing if it was permitted to cancel her benefit. Further, the Court found that the evidence submitted by the Plaintiff’s treating rheumatologist demonstrated that the Plaintiff had flare-ups of her condition periodically and that the Plaintiff would not be able to work any sort of regular schedule because of this. The Court found that the Defendant did not demonstrate that this doctor’s opinion was incorrect. Therefore, the judgment of the lower court, granting the Plaintiff back due and ongoing long term disability benefits was affirmed.
If the employer wants to deny the benefits under ERISA, it better have its ducks in a row. Here, the employer did not. It is clear from the opinion that the employer presented a sloppy case, and the denial of benefits was arbitrary and capricious. The Court didn’t let it stand and the employee was justly compensated.
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.