In this 2010 case, the Appellant Plan Administrator appealed from the U.S. District Court, which held that the Administrator abused its discretion in denying appellee employee’s application for long term disability benefits and ordered the Administrator to pay the Employee disability benefits and to pay the Employee’s attorney’s fees. The Administrator appealed.
The court agreed that the Administrator abused its discretion in denying the employee’s application for long term disability benefits under ERISA. The Administrator’s sole reason for denying the Employee’s application was that she had not shown her disability to be “permanent.” To reach that conclusion, the administrator interpreted doctors’ letters as suggesting that the Employee’s restrictions were not permanent, focusing on the use of the term “indefinite.” However, the court ruled that the intended meaning of “indefinitely” — that the restrictions were permanent — was clear from the context of the letters that the employee’s attorney and the doctors exchanged. The court found no abuse of discretion in the district court’s decision to award attorney’s fees. The Administrator relied on a hypertechnical reading of the medical evidence and ignored the doctors’ attempts to clarify their opinions. Additionally, there was evidence that the Administrator attempted to frustrate the Employee’s ability to move the claims process forward.
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.