Disability Benefit Claims

Subscribe to Disability Benefit Claims via RSS

Good morning, ERISA Watchers!  This has been an extraordinary week to say the least.  I’m currently writing this from under a “shelter-in-place” order in San Francisco.  While there is a lot going on in the world, there wasn’t a lot of excitement in the courts when it came to ERISA decisions this past week.  So, I chose to highlight two plaintiff-friendly decisions from district courts, one decided under de novo review and the other under the arbitrary and capricious standard.

The first case is Szabo v. Hartford Life and Accident Ins. Co., No. 18-CV-06258 (N.D. Ill. March 10, 2020). Plaintiff Szabo became disabled after he collapsed at work from syncope, orthostatic hypertension, and vertigo.  He applied for long-term disability (“LTD”) benefits from Hartford, and Hartford approved and paid his claim for two years before terminating them.  After an unsuccessful appeal, Szabo filed suit.  In the lawsuit, the main disputes were factual. The parties agreed Plaintiff suffered from syncope. They disagreed on (1) the frequency and severity of Plaintiff’s symptoms; (2) whether and to what extent Plaintiff needed to lie down to mitigate his symptoms; and (3) whether Plaintiff’s symptoms prevented him from working a sedentary job. 
Continue Reading District Courts Rule Against Hartford and Aetna in Long-Term Disability Disputes

This week’s notable decision is Dorris v. Unum Life Ins. Co. of Am., No. 19-1701, __F.3d__, 2020 WL 524726 (7th Cir. Feb. 3, 2020), in which the Seventh Circuit stridently announced, “[a]t least in this circuit, ERISA de novo review requires no review at all, but an independent decision.” It then made clear the plaintiff bears the burden of proving she is entitled to benefits, not that the plan administrator erred. 

For Stephanie Dorris, the former president of Beans Plus, Inc., this failure to recognize her burden was determinative. Her disability provider, Unum, had paid benefits for over 12 years – the last ten of which were under the “any occupation” standard. Unum then terminated Dorris’ benefits claiming she was able to return to work at her own occupation. Dorris fought hard to prove that Unum’s explanation for its decision was wrong. She convinced the district court that it was, largely because the occupation demanded long hours and constant mental acuity – job duties that aggravated her Lyme disease symptoms.
Continue Reading In Seventh Circuit, de novo ERISA Cases Are Reviewed Just Like a Breach of Contract Case

This week’s notable decision is Kaviani, D.M.D. v. Reliance Standard Life Insurance Company, No. 19-11798, __F.App’x__, 2020 WL 506551 (11th Cir. Jan. 31, 2020), where the Eleventh Circuit characterized Reliance Standard’s long-term disability (“LTD”) determination as ignoring “uncontradicted record evidence of disability.”  Though this is an unpublished decision, it provides a good road map of arguments for disability claimants who suffer from progressive conditions causing pain and who have attempted to continue working despite the pain.  The decision also arguably reflects a softened arbitrary and capricious standard in the Eleventh Circuit.
Continue Reading Eleventh Circuit Affirms Judgment against Reliance Standard in Favor of Dentist in Long-Term Disability Dispute