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Happy Memorial Day!  Hope you all are reading today’s newsletter from the comfort of your lawn chair sipping mimosas.  No matter what you have on the agenda, please take a moment to honor and remember everyone who has died serving in the American armed forces.

Today’s notable decision is Gorbacheva v. Abbott Laboratories Extended Disability Plan, et al., No. 5:14-CV-02524-EJD, 2018 WL 2387852 (N.D. Cal. May 25, 2018), where the court grants in part Plaintiff’s motion for attorneys’ fees and denies Defendants’ request for attorneys’ fees, even though Defendants were ultimately successful on the merits of the underlying long-term disability dispute. 
Continue Reading Court Awards Six Figures in Attorneys’ Fees to Claimant Who Achieved a Remand of Long-Term Disability Claim that was Ultimately Denied

The Sixth Circuit is back in the news.  This week’s notable decision is Clemons v. Norton Healthcare Inc. Ret. Plan, No. 16-5063, __F.3d__, 2018 WL 2142640 (6th Cir. May 10, 2018), an upset to the Plaintiff-Retirees who had prevailed on behalf of a certified class at the district court on their claim for underpaid pension benefits.  This lengthy opinion is succinctly summarized by the Court as follows:

This appeal is the latest installment in an ERISA litigation saga that has spanned almost ten years. At the risk of oversimplifying their case, the Plaintiff–Retirees claim that Defendant Norton Healthcare, Inc. Retirement Plan (“Norton”) underpaid them under the terms of the plan. The district court found that the plan was unambiguous in the Retirees’ favor. We agree with the district court on most issues.
Continue Reading Sixth Circuit Holds that Contra Proferentum and Firestone Deference Are Incompatible on Issues of ERISA Plan Interpretation

I love it when I can report a righteous outcome in an ERISA disability case.  I remember when I first read the district court decision in Wagner v. Am. United Life Ins. Co., 2017 WL 4099216 (S.D. Ohio Sept. 15, 2017), I said to myself “are you kidding me?!”  As I previously reported, Wagner was rendered paraplegic in a motorcycle accident as a teenager and went to school and worked for much of his adult life.  In his fifties, he was involved in another motorcycle accident and broke his right femur. 

He stopped working and received long term disability benefits after that time but American United Life Insurance Company (“AUL”), a la its claims administrator, Disability Reinsurance Management Services (“DRMS”), terminated his claim in reliance on surveillance video showing Wagner active and not in pain as well as medical reviewers’ opinions of non-disability.  This happened on month 34 of his claim, just two months before a change in the policy’s definition of disability was to take place.  On de novo review, the district court found in favor of AUL.  The court determined that despite Wagner’s subjective complaints, the surveillance video showed a different reality.  The district court also rejected Wagner’s argument that AUL must prove that he can do the thinking required for his job.
Continue Reading Sixth Circuit Reverses Denial of Long Term Disability Benefits to Claimant with Paraplegia