Douglas Brown v. Covestro LLC Welfare Benefits Plan

• 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.

Douglas Brown (“Appellant”) worked for Covestro, LLC (“Employer”) who provided him with long-term disability insurance through Standard Insurance Company (“Appellee”). Appellant stopped working in June 2019 due to back pain and applied for long-term disability benefits (“LTD”) in December 2019. The initial claim was approved March 2020. Appellee terminated Appellant’s benefits in June 2021 and Appellant appealed to Appellee’s ERISA Review Committee (“Committee”) that upheld the denial. Appellant filed a lawsuit in District Court challenging the Committee’s determination. The District Court granted Appellee’s motion for summary judgment and denied Appellant’s motion finding that the Committee did not commit a severe procedural violation when it failed to disclose a supplemental report to Appellant. Appellant appealed arguing that the District Court should have applied a de novo standard of review. “[w]here a plan administrator possesses discretionary authority to determine eligibility for benefits … we review the administrator’s decision under an abuse of discretion standard.” Bergamatto v. Bd. of Trs., 933 F.3d 257, 263–64 (3d Cir. 2019). The court sometimes applied de novo review if a claims administrator possesses discretionary authority but did not exercise that discretion, such as when the administrator provides no reason for the denial. See Gritzer v. CBS, Inc., 275 F.3d 291, 295–96 (3d Cir. 2002). “[a]lthough the Supreme Court has never suggested that the standard of review applied to ERISA administrators’ benefits determination should change because of procedural irregularities … [s]ome circuits substitute de novo review for deferential review only when the plan administrator committed severe procedural violations.” James v. Int’l Painters & Allied Trades Indus. Pension Plan, 738 F.3d 282, 283 (D.C. Cir. 2013). The court applied an abuse of discretion standard and granted summary judgment in favor of Appellee finding that the record contained ample evidence establishing that Appellant was not totally disabled and that Committee’s procedural errors did not rise to the level of a severe procedural violation. Credit to Saul Ewing, LLP.