by Cody AllisonArmani v. Northwestern Mut. Live Ins. Co.
In this 2016 case, where an employee challenged the denial of long-term disability benefits under the Employee Retirement Income Security Act and the district court found that he failed to show that he was disabled from “all occupations” after July 18, 2013, remand was warranted because an employee who could not sit for more than four hours in an eight-hour workday could not perform “sedentary” work that required “sitting most of the time,” and the district court erred in concluding that he had not established that he was unable to perform the four positions the insurance company had identified based on his functional capacity as of April 18, 2013, despite the fact that all four positions were classified as “sedentary,” and despite undisputed evidence that, as of that date, he was unable to sit for more than four hours a day.
Outcome: Judgment vacated in part and case remanded.
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.
by Cody AllisonMitchell v. CB Richard Ellis Long Term Disability Plan
In this 2009 case, an employee challenged a plan administrator’s denial of long-term disability benefits under the Employee Retirement Income Security Act of 1974, 29 U.S.C.S. § 1001 et seq., the administrator abused its discretion because he was receiving appropriate treatment and was unable to earn 80% of his pre-disability earnings during the elimination period and the next 24 months, and was impaired in his capacity to work, despite working full-time hours; [2]-The policy contained no exclusion or preclusion of coverage where the date of onset of disability occurred before the effective date of the plan; [3]-Because the administrator failed to raise a compulsory counterclaim requesting that the district court determine the respective rights and responsibilities between the administrator and the prior administrator, the district court did not err by declining to reach the issue.
Outcome: Judgment Affirmed.
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.
by Cody AllisonLelu v. Hartford Live & Accident Ins. Co.
In this 2009 case, the employer was the plan sponsor and plan administrator of an ERISA long-term disability benefits plan. The insurance company was the claims administrator of the plan. The insured sought to depose a nurse who worked for the employer. The nurse was responsible for processing doctors’ notes for the employer’s employees who received sick pay and short-term illness benefits. The employer’s short-term illness program was not administered by the insurance company. The insurance company opposed the discovery because the nurse would not provide information regarding or participate in its decision to deny the insured long-term disability benefits. The court found that the insured had not shown that there was something in the administrative record or other evidence that established that the insurance company was aware of information in the possession of the employer that it should have considered in making its decision on the claim for long-term disability benefits. Absent such a showing, discovery from the nurse or others regarding the employer’s short-term illness and/or salary continuation program decisions was not appropriate.
Outcome: The motion for a protective order was granted.
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.
by Cody AllisonChapman v. Choicecare Long Island Term Disability Plan
In this 2002 case, due to a mental disability, the claimant submitted a long term disability benefits application to an insurance company that was under contract with the plan to pay the plan’s benefits. The insurance company denied the claimant’s claim as untimely filed and informed the claimant that a written request for review of a claims denial had to be sent within 60 days of the receipt of the notice of denial. The claimant’s attorney’s letter asking for review was 10 days late, and the insurance company denied the appeal. The appellate court found that the plan itself was a proper defendant in the action and the plan could be held liable in its own name for a money judgment under 29 U.S.C.S. § 1132(a)(1)(B). The difficulties that the claimant’s counsel encountered because of the claimant’s inability to participate in her representation due to her mental illness, and the brevity of the 10 day delay provided a basis for finding that counsel acted with due diligence. Thus, on remand, the proof proffered by the claimant’s counsel was sufficient to warrant an evidentiary hearing as to whether the claimant’s mental illness impaired counsel’s efforts to file a timely request for review.
Outcome: The judgment of the district court was vacated and the case was remanded to the district court for further proceedings to address the issue of whether the 60-day time limit was enforceable given that such limitation was not mentioned in either the policy or the plan’s summary plan description.
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.
by Cody AllisonGibbs v. CIGNA Corp.
In this 2006 case, the district court held that $ 150,000 in “guaranteed” “minimum compensation” paid to the executrix’s husband was not a salary under his long-term disability plan and, therefore, should not have been included in the calculation of his disability benefits. The court held that the administrator’s decision was subject to a de novo standard of review, and that there were genuine issues of material fact surrounding whether the husband received a salary, prior to becoming disabled, that should have been included in the calculation of his disability benefits. The court held that, because the husband’s benefits had vested, the summary plan description in effect at the time the benefits vested governed for purposes of determining the standard of review. An amendment to the summary plan description granting discretionary authority to the plan administrator did not apply to the husband’s claim because his right to disability benefits vested prior to defendants’ amendment of the plan. The district court erred in disregarding defendants’ admission that the husband was not a so-called “CFA Associate” under the plan. There were material issues of fact concerning whether he received a “salary.”
Outcome: The court vacated the judgment and remanded to allow the district court to determine whether the $150,000 in “guaranteed” “minimum compensation” was intended by the parties to be a salary or a draw on future commissions earned.
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.
by Cody AllisonGeiger v. Zurich Am. Ins. Co.
In this 2023 case, an insurer did not abuse its discretion in denying long-term disability (LTD) benefits to plaintiff under ERISA, as considering the Booth factors and the standard of review, the insurer’s interpretation of plaintiff’s employer’s LTD plan’s terms, purpose and goals was reasonable; the insurer did not abuse its discretion by not obtaining additional vocational evidence, as neither the plan nor case law affirmatively required it to have done so; [2]-Plaintiff’s claim that the insurer failed to consider how the amount of stress involved in his job might impact his cardiac conditions was improper, as the plan defined “disabled” as the inability to perform the material and substantial duties of one’s regular occupation due solely to sickness or injury, and nowhere in the records did any physician opine that plaintiff could not perform the duties of his job because of stress.
Outcome: Judgment affirmed.
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.
by Cody AllisonMongeluzo 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.
by Cody AllisonBlair v. Alcatel-Lucent Long Term Disability Plan
In this 2017 case, where an ERISA claims administrator terminated a recipient’s long-term disability benefits, substantial evidence supported the decision, including that treatment notes reflected continued improvement in her anxiety and depression, and nothing in the record demonstrated that the medications themselves prevented her from working. The administrator was not required to personally examine her because the plan did not require a personal examination, even if the disability was mental illness. The administrator was not judicially estopped from arguing the recipient was not disabled because that position was inconsistent with the position it took when it required her to apply for SSA benefits, paid for her SSA representation, and benefitted from her receiving those benefits, because the ERISA standard for disability benefits was different than that for SSA benefits.
Judgment affirmed.
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.
by Cody AllisonMarantz v. Permanente Med. Group, Inc. Long Term Disability Plan
In this 2012 ERISA case, the claimant, who was a doctor, underwent surgery for a herniated disc and degenerative disc disease, but she stopped working full time and obtained part-time work because the surgery did not eliminate her pain. As part of its investigation to determine whether the claimant satisfied the policy’s requirements, the administrator conducted an investigation, which included several days of surveillance video showing the claimant engaging in activities such as group exercise classes and lifting heavy items into her car after working at her part-time job; the administrator also conducted a functional capacity evaluation and obtained a medical professional review of the case. On appeal, the court agreed with the district court that the claimant did not show that she was entitled to benefits under the policy. In particular, the court found that the surveillance video was properly considered because it demonstrated an inconsistency between the claimant’s allegations and her actual or demonstrated abilities. The functional capacity evaluation, medical evidence, and medical professional review also supported the benefits determination and demonstrated that there was no violation of ERISA.
Judgment affirmed.
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.
by Cody AllisonPerez-Jones v. Liberty Life Assur. Co.
In this 2016 ERISA case, the Plaintiff sought reinstatement of her long term disability benefits after she had “knowingly and voluntarily” waived her right to these benefits pursuant to a severance agreement and acceptance of a severance package. At the time she signed this agreement, the Plaintiff was no longer receiving long term disability benefits and the court determined that she no longer had any claim to these benefits and had no ERISA claim to waive. The Court determined that the Plaintiff was no longer a “participant” or a “covered person” within the plan, as she no longer worked there.
Judgment affirmed.
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.