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.
by Cody AllisonDonachie v. Liberty Life Assur. Co.
In this 2014 ERISA case, a claimaint suffering from anxiety due to the noise from a prosthetic valve with each beat of his heart after surgery that replaced his aortic valve, was erroneously denied long term disability benefits because the plan administrator ignored substantial evidence for the claimant’s treating physicians that he was incapable of pe3rforming his current occupation, while failing to offer any reliable contrary evidence.
In denying the claimaint’s attorneys’ fees, the district court abused its discretion because it inadequately addressed two important fee factors and erred in considering the absence of bad faith on the part of the administrator as the most salient fee factor; fees should have been awarded since they furthered the policy interest in vindicating the rights secured by ERISA.
The lower court’s decision was affirmed in part and vacated and remanded in part.
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 AllisonMcQuillin v. Hartford Life & Accident Ins. Co.
In this 2022 case, the question is whether the beneficiary of the plan timely brought suit in federal court – whether or not he had exhausted his plan remedies. The lower court determined that he had not exhausted his remedies and dismissed his suit, from which the beneficiary appealed. The beneficiary argued that the remedies should have been deemed exhausted because the insurer, in violation of the applicable ERISA regulation, failed to provide a final decision on his benefits within 45 days of the administrative appeal. The Court notes that the appropriate ERISA statute requires that the insurer “strictly adhere” to the 45 day window in which to render its decision, absent extraordinary circumstances. Here, there were no extraordinary circumstances as contemplated by the statute, so the insurer did not strictly comply with the 45 day deadline, and the beneficiary’s remedies were exhausted, and he timely filed suit. Therefore, the lower court is reversed and the suit is reinstated.
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 AllisonLyncker v. Johnson & Johnson Pension Comm.
In this 2006 case, the claimant sought review of a decision in which defendant, a pension committee, terminated the claimant’s long-term disability benefits. Those benefits had issued under a plan governed by ERISA. The claimant moved for summary judgment, and the committee moved for final judgment based on review of the administrative record. The claimant also moved for an award of attorney’s fees.
The claimant, 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 claimant’s request for attorneys’ fees would be considered 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.
by Cody AllisonRote v. Titan Tire Corp.
In this 2010 case, the Appellant Plan Administrator appealed from the U.S. District Court, which held that the Administrator abused its discretion in denying appellee employee’s application for long term disability benefits and ordered the Administrator to pay the Employee disability benefits and to pay the Employee’s attorney’s fees. The Administrator appealed.
The court agreed that the Administrator abused its discretion in denying the employee’s application for long term disability benefits under ERISA. The Administrator’s sole reason for denying the Employee’s application was that she had not shown her disability to be “permanent.” To reach that conclusion, the administrator interpreted doctors’ letters as suggesting that the Employee’s restrictions were not permanent, focusing on the use of the term “indefinite.” However, the court ruled that the intended meaning of “indefinitely” — that the restrictions were permanent — was clear from the context of the letters that the employee’s attorney and the doctors exchanged. The court found no abuse of discretion in the district court’s decision to award attorney’s fees. The Administrator relied on a hypertechnical reading of the medical evidence and ignored the doctors’ attempts to clarify their opinions. Additionally, there was evidence that the Administrator attempted to frustrate the Employee’s ability to move the claims process forward.
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.