Mongeluzo v. Baxter Travenol Long Term Disability Benefit Plan

In this 1995 case, Plaintiff brought action based on a denial of his claim for long-term disability benefits pursuant to the Employee Retirement Income Security Act, 29 U.S.C.S. § 1132(a). The district court granted summary judgment in favor of defendants. On appeal, plaintiff argued that the district court improperly excluded the new medical evidence of chronic fatigue syndrome in its de novo review. The court reversed and remanded the decision. The court held that new evidence was to be considered under certain circumstances to enable the full exercise of informed and independent judgment. The court concluded that the evidence regarding chronic fatigue syndrome had to be considered on remand as one possible explanation for the disability that plaintiff experienced. The court reasoned that consideration of that explanation was part of the determination of whether physical symptoms were in whole or in part a cause of plaintiff’s disability such that benefits had to be paid. It was an additional explanation, it was not a new claim.

Outcome: The court reversed and remanded the decision of the district court and held that the new evidence should have been considered to enable the full exercise of informed and independent 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.