When you are making a claim for long-term disability through your company’s insurance plan, you will be dealing with the ERISA law.  Below is an article which explains the history and purpose of this law.  This article will help you become more familiar with the areas of the law you are navigating.  However, these laws are often confusing.  If you need help making your long-term disability claim, call us.  We are ready to help you! Our law firm fights on behalf of individuals to obtain their long-term disability benefits. If you believe you have been wrongfully denie ..read more

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 identifie ..read more

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 da ..read more

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 ..read more

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 defen ..read more

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, b ..read more

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 condit ..read more

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. T ..read more

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 ..read more

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 ther ..read more