In this 2008 ERISA case, the Plaintiff insured brought an acation against the Defendant plan administrator pursuant to ERISA, seeking reinstatement of long-term disability benefits. Before the Court were the administrator’s motion for judgment on the administrative record and the insured’s motion for summary judgment
After the insured had shoulder surgery, she did not return to her job as a sales person. The insured sought long-term disability benefits based primarily on her multiple sclerosis (MS). The administrator approved the insured’s claim and assisted the insured in obtaining Social Security Disability benefits. The administrator subsequently terminated the insured’s long-term disability benefits, finding that there was no change in the insured’s MS when she stopped working, that the insured’s MS had stabilized, and that the insured was able to return to work once she recovered from her surgery. The court held that the administrator’s determination that the insured was no longer disabled was arbitrary. The administrator refused to consider evidence showing that before the insured stopped working, she regularly fell and had difficulty walking and using stairs. That the insured’s MS was stable during chemotherapy did not control a determination concerning the insured’s condition non months after the treatment had ended. The administrator did not rationally address how the insured would be able to perform a job that requir3ed significant travel while carrying presentation materials.
Holding that the insured was entitled to reinstatement of her long-term disability benefits and an award of attorney’s fees, the court denied the administrator’s motion for judgment on the administrative record and granted the insured’s motion for summary judgment.
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.