by Cody AllisonSnapper v. Unum Life Ins. Co. of Am.
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.
by Cody AllisonMacnaughton v. Paul Revere Ins. Co.
In this 2023 ERISA case, the Plaintiff, a doctor, commenced this action against the Defendant insurer to recover unpaid benefits after an adverse benefits determination on her employer-sponsored long-term disability claim. In a previous Order, this Court remanded the claim to ensure a “full and fair review” of the Plaintiff’s appeal of the adverse decision. After remand, the defendants denied the Plaintiff’s claim a second time and both parties moved for summary judgment.
The Plaintiff is a radiologist. Part of her job is to read and examine radiographic images. The Plaintiff gave birth to twins and soon began having difficulty seeing out of her left eye. She was eventually diagnosed with nerve damage in that eye. The Defendants initially paid for the Plaintiff’s long-term disability and the Plaintiff continued to work part-time as a supervisor but not in diagnosis. Eventually, the Defendants had an IME conducted on the Plaintiff and that physician’s opinion was that the Plaintiff’s vision problems were correctable. Therefore, the Defendants terminated the Plaintiff’s benefits. Plaintiff had another physician submit a report saying that the Plaintiff’s vision problem was uncorrectable. The Defendants had another IME physician review all the records, who concluded that the Plaintiff was able to work because the condition had largely corrected itself and that her job did not require her to have two healthy eyes and depth perception. Therefore, the Defendants continued to deny benefits.
The Court notes on the summary judgment that the Defendants’ physician went through the Plaintiff’s physician’s reports point by point and rebutted each point, but the Plaintiff’s physician did not do that to the Defendants’ physician’s report. The Court concluded that the Defendant was then allowed to rely upon their physician’s report and that such reliance was not arbitrary and capricious and did not violate the standard. Therefore, the Court granted the Defendant’s Motion for Summary Judgment and denied the Plaintiff’s claim.
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 AllisonPearson v. Group Long Term Disability Plan for Employees of Tyco Int’l (US), Inc.
In this 2008 ERISA case, the Plaintiff former employee filed suit against defendant long-term disability plan pursuant to ERISA to recover long-term disability benefits allegedly due him under a plan sponsored by the parent company of his former employer.
The court found that the insurance company was clearly mistaken in its assertion that no physician opined that the employee’s mental faculties were in any way deficient or impaired. The court reasoned that every attending physician’s statement submitted by the employee’s treating physician indicated either that the employee had a major psychiatric impairment in several areas or that he had a moderate impairment in occupational functioning. Furthermore, the medical records showed that the employee was taking Xanax at least by July 2001 and that he was still taking Xanax on June 28, 2006, which was the date of what appeared to be the latest medical record in the file. The insurance company argued that the employee waived this issue because he did not assert it in his administrative appeal. The court found that the employee had not waived any argument and that the insurance company should have considered whether he had a psychiatric impairment. The court reasoned that the insurance company did not advise the employee of any deficiency in his letter or request that he specify the issues that he wanted considered.
The decision of the insurance company determining that the employee was no longer eligible for long-term disability benefits was reversed, and the claim was remanded for further proceedings. The insurance company must consider not only the employee’s chronic obstructive pulmonary disease but also other impairments noted in the employee’s claimant statements and in the medical records contained in the administrative record.
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 AllisonAvenoso v. Reliance Std. Life Ins. Co.
In this 2021 ERISA case, the district court’s entry of summary judgment in favor of claimant was affirmed because, while the court adjudicated the parties’ summary judgment motions as if it were ruling in a bench trial, whether the district court’s decision survived de novo review of its legal determinations and clear-error review of its factual findings turned on whether it clearly erred in finding the claimant lacked sedentary-work capacity, on the record before it, the appellate court could not say the district court’s finding the claimant lacked sedentary-work capacity was clearly erroneous, and it had to disregard as harmless the district court’s error in adjudicating the parties’ motions for summary judgment as if it were ruling in a bench trial. The judgment of the lower court was 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 AllisonRoehr v. Sun Life Assur. Co.
In this 2021 ERISA case, the Court found that the district court did not err by evaluating the claimant’s claims under the well-known abuse of discretion standard. The court had consistently rejected the notion that the mere presence of a potential conflict of interest is sufficient to warrant a less deferential standard, and here, the plan administrator actively sought to reduce any potential conflict of interest or bias by consulting with two independent physicians who reviewed the claimant’s medical records.
The plan administrator relied on virtually the same medical records for a decade and pointed to no information available to it that altered in some significant way its previous decision to pay benefits. There was not substantial evidence in the joint administrative record to support the plan administrator’s termination decision.
The court reversed the district court’s grant of the plan administrator’s motion for judgment on the record. The court remanded to the district court with directions to order the reinstatement of benefits.
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 AllisonYates v. Symetra Life Ins. Co.
In this 2023 ERISA case, a participant in an employee benefit plan governed by ERISA was not required to exhaust administrative remedies before challenging a denial of benefits in court when the written plan documents made no mention of any review process or administrative remedies that could be exhausted.
The plain language of the administrator’s intentionally self-inflicted injury exclusion did not apply to unintended injuries like the participant’s husband’s heroin overdose. The administrator’s denial of the participant’s claim for accidental death benefits based on that exclusion was erroneous. Judgment of the lower court was 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 AllisonAvenoso v. Reliance Std. Life Ins. Co.
In this 2021 ERISA case, the district court’s entry of summary judgment in favor of the claimant was affirmed because, while the court adjudicated the parties’ summary judgment motions as if it were ruling in a bench trial, whether the district court’s decision survived de novo review of its legal determinations and clear-error review of its factual findings turned on whether it clearly erred in finding the claimant lacked sedentary-work capacity, on the record before it, the appellate court could not say the district court’s finding the claimant lacked sedentary-work capacity was clearly erroneous, and it had to disregard as harmless the district court’s error adjudicating the parties’ motions for summary judgment as if it were ruling in a bench trial. The judgment of the lower court was 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 AllisonNewport v. Prudential Ins. Co. of Am.
In this 2004 ERISA case, the Appellant employee brought a suit in the United States District Court for the Eastern District of Michigan, Southern Division, against appellee benefit plan administrator afte rthe plan terminated the long term disability benefits, which the employee received under a benefit plan goverened by ERISA.
The employee claimed that the administrator did not give enough weight to her treating physicians’ opinions that she should not work. The appellate court could not conclude that the administrator acted arbitrarily and capriciously when it terminated the employee’s benefits. The treating surgeon’s opinion that the employee could not work in one letter contradicted his work restrictions in which he restricted her only in ways consistent with sedentary work. Moreover, he did not apply the definition of “disabled” as defined by the plan. The other physician did not apply the plan’s standard for “disabled.” She simply supported the Social Security Administration’s determination. ERISA plan administrators were not bound by SSA findings of disability because the SSA had to use the treating physician rule while ERISA plan administrators did not. Rather than disregarding the surgeon’s opinion entirely, the administrator submitted his opinion of the employee’s work restrictions to its vocational rehabilitation counselor. Using the restrictions issued by the surgeon, the counselor determined sedentary jobs were suitable for the employee considering her physical restrictions.
The plan administrator’s termination of the employee’s benefits was affirmed and the case was dismissed.
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 ERISA case, an ERISA claims administrator terminated a recipient’s long term disability benefits. The Court determined that substantial evidence supported the decision, including that treatment notes reflected continued improvement in the recipient’s anxiety and depression, and nothing in the record demonstrated that the medications she was using prevented her from working. The administrator was not required to personally examine the recipient because the plan did not require a personal examination, even if the disability was a mental illness. The administrator was not judicially estopped from arguing that the recipient was not disabled because that position was inconsistent with the position it took when it required her to apply for Social Security benefits, because the ERISA standard for disability benefits was different than that for SSA benefits. Therefore, the lower court’s judgment is 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 AllisonLynecker v. Johnson & Johnson Pension Comm.
In this 2006 ERISA case, the Plaintiff/claimant sought a review of a decision in which the defendant, a pension committee, terminated the claimant’s long term disability benefits. Those benefits had issued under a plan governed by ERISA. The Plaintiff moved for summary judgment, and the committee moved for final judgment based on review of the administrative record. The Plaintiff also moved for an award of attorney’s fees.
The Plaintiff, who had severe asthma, received benefits under the “own occupation” plan’s definition of disability, but her benefits were discontinued under the “any occupation” definition that started when the “own occupation” period ended because the committee determined that the claimant could perform sedentary work. the court held that the committee acted arbitrarily and capriciously in terminating benefits. The claimant’s treating physician had consistently opined that the claimant’s’ asthma rendered her incapable of sedentary work. However, the committee’s reviewing physicians ignored the opinion of the treating physician, took his comments out of context, and mischaracterized verbal statements that the treating physician had made. The committee then relied on the opinions of its reviewing physicians, who had not examined the claimant, to find that she could perform sedentary work. The unreasonableness of the committee’s decision was underscored by the fact that it granted benefits under the more rigorous “own occupation” standard and terminated benefits under the less rigorous “any occupation” standard despite the lack of any noticeable improvement in the claimant’s condition.
The court granted the claimant’s motion for summary judgment, denied the committee’s motion for final judgment based on review of the administrative record, reversed the committee’s decision, and remanded the case to the committee for reinstatement of the claimant’s benefits. The court also indicated that it would consider the claimant’s request for attorney’s fees upon the filing of a formal motion therefor.
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.