In this 2006 case, the claimant sought review of a decision in which defendant, a pension committee, terminated the claimant’s long-term disability benefits. Those benefits had issued under a plan governed by ERISA. The claimant moved for summary judgment, and the committee moved for final judgment based on review of the administrative record. The claimant also moved for an award of attorney’s fees.
The claimant, who had severe asthma, received benefits under the “own occupation” plan’s definition of disability, but her benefits were discontinued under the “any occupation” definition that started when the “own occupation” period ended because the committee determined that the claimant could perform sedentary work. The Court held that the committee acted arbitrarily and capriciously in terminating benefits. The claimant’s treating physician had consistently opined that the claimant’s asthma rendered her incapable of sedentary work. However, the committee’s reviewing physicians ignored the opinion of the treating physician, took his comments out of context, and mischaracterized verbal statements that the treating physician had made. The committee then relied on the opinions of its reviewing physicians, who had not examined the claimant, to find that she could perform sedentary work. The unreasonableness of the committee’s decision was underscored by the fact that it granted benefits under the more rigorous “own occupation” standard and terminated benefits under the less rigorous “any occupation” standard despite the lack of any noticeable improvement in the claimant’s condition.
The Court granted the claimant’s motion for summary judgment, denied the committee’s motion for final judgment based on review of the administrative record, reversed the committee’s decision and remanded the case to the committee for reinstatement of the claimant’s benefits. The claimant’s request for attorneys’ fees would be considered upon the filing of a formal motion therefor.
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.