In this 2008 ERISA case, the Plaintiff former employee filed suit against defendant long-term disability plan pursuant to ERISA to recover long-term disability benefits allegedly due him under a plan sponsored by the parent company of his former employer.
The court found that the insurance company was clearly mistaken in its assertion that no physician opined that the employee’s mental faculties were in any way deficient or impaired. The court reasoned that every attending physician’s statement submitted by the employee’s treating physician indicated either that the employee had a major psychiatric impairment in several areas or that he had a moderate impairment in occupational functioning. Furthermore, the medical records showed that the employee was taking Xanax at least by July 2001 and that he was still taking Xanax on June 28, 2006, which was the date of what appeared to be the latest medical record in the file. The insurance company argued that the employee waived this issue because he did not assert it in his administrative appeal. The court found that the employee had not waived any argument and that the insurance company should have considered whether he had a psychiatric impairment. The court reasoned that the insurance company did not advise the employee of any deficiency in his letter or request that he specify the issues that he wanted considered.
The decision of the insurance company determining that the employee was no longer eligible for long-term disability benefits was reversed, and the claim was remanded for further proceedings. The insurance company must consider not only the employee’s chronic obstructive pulmonary disease but also other impairments noted in the employee’s claimant statements and in the medical records contained in the administrative record.
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.