In this 2023 ERISA case, the Plaintiff, an attorney, began working for a law firm which had a long term disability policy through the Defendant insurance company. The Plaintiff had a history of back and lower leg pain problems beginning in 2008 resulting from a herniated disc. At the time he suffered this injury, the Plaintiff was a second year law student. He had several surgeries to try to correct the problem, but in September, 2016, he was involved in an automobile collision which aggravated his condition. In April, 2018, Plaintiff took a leave of absence from his job because of his condition. During this time, he sought medical treatment and physical therapy. He returned to work on July 9, 2018. After this return, he continued to get steroid injections and was eventually referred for a neurological consultation by his treating physician. The steroid injections stopped working and the Plaintiff had continual pain and nausea from his medications. He took a second leave of absence on February 19, 2019 and did not return to work. He continued to get treatment, including a spinal stimulator. He met with several surgeons about the possibility of a second surgery and finally had an extra-pedicular decompression surgery. After little success, he had another lumbar spine surgery and more physical therapy, which did not help. He continued to seek medical treatment.
Meanwhile, the Defendant had one of its Designated Medical Officers review the Plaintiff’s records to see if he was capable of performing Sedentary Work duties. The Defendant determined that the Plaintiff was capable of performing this work. The Defendant terminated the Plaintiff’s long-term disability benefits. The Plaintiff appealed this termination. The Plaintiff submitted additional proof of his inability to work and the Defendant reviewed this proof, but continued to deny benefits.
The Court in this case examined the proof on both sides, and found the Defendant’s arguments to be unpersuasive. In a lengthy opinion, the Court went through every one of the arguments and found that the Plaintiff had established that he was disabled under the plan. The Court concluded that the Plaintiff is entitled to reinstatement and an award of past-due benefits from the date of his termination until present. However, the Court makes it clear that the Defendant can continue to re-evaluate the Plaintiff for improvement.
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.