In a challenge to the denial of benefits, the district court properly awarded ERISA benefits on the basis that the Plaintiff proved partial disability. According to the express terms of the long term disability plan, partial disability was the equivalent to total disability, and the Plaintiff was totally disabled with the relevant period. Because the Plaintiff proved partial disability, the plan administrator acted unreasonably in denying her benefits. The Court affirmed the lower court’s judgment determining that the Plaintiff was entitled to benefits, and the amount of benefits owed.
As we have said over and over in this blog, the policy controls. Here, the plan allowed the Plaintiff to merely prove partial disability to be considered totally disabled. The Court enforced this provision, as it should have.
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.