LTD: Standard of Review

Generally, an ERISA LTD decision will be reviewed de novo unless the plan documents grant the claim fiduciary discretionary authority to construe the policy terms to decide eligibility for benefits.  Marantz v. Permanente Med. Grp., Inc. Long Term Disability Plan, 687 F.3d 320, 327 (7th Cir. 2012).

Chronic Pain

Clint Cooper, a staff writer for the Chattanooga Times Free Press, published a very good article on Chronic Pain in today’s paper.  If your chronic pain keeps you from working, feel free to contact Patrick Cruise at The Hamilton Firm for a free consultation. You may be entitled to disability benefits.

LTD Offset for Receipt of RRA benefits

In Duckworth v. Allianz Life Ins. Co. of N. Am., 2013 U.S.App. Lexis 2132 (11th Cir. Jan. 30, 2013), the long term disability insurance policy provided for an “offset” of disability benefits received by the claimant from the Social Security Administration “or any similar . . . act.” The District Court ruled the provision was ambiguous as applied to the claimant’s receipt of disability benefits under the Railroad Retirement Act (RRA). The 11th Circuit reversed the District Court and held that the RRA is substantially similar to the SSA, and thus, the offset provision was applicable.

If you need help with your long term disability case, click here.

Equitable Tolling and ERISA

In Turbville v. Metro. Life Ins. Co., 2012 U.S. Dist. LEXIS 153969 (N.D. Alabama, 10/26/2012), the District Court held: It is ‘simply illogical’ not to toll the limitations period when requiring administrative exhaustion, for otherwise, a cause of action could accrue and be immediately subject to dismissal.” Jeffries, 169 F. Supp. 2d at 1383 (quoting Mitchell, 1997 U.S. Dist. LEXIS 7323, at *5). Therefore, the statute of limitations was tolled while plaintiff exhausted her administrative remedies.”

How does an LTD Carrier Recover an Overpayment?

Can a long term disability carrier bring suit against a claimant to recover an overpayment through ERISA?  The answer to this question has been the subject of many cases, with conflicting results.  The normal fact pattern that brings about this situation is as follows:  The claimant applies for and receives long term disability benefits.  Thereafter, the claimant receives Social Security disability benefits.  Most, if not all, long term disability (LTD) plans have a provision for offsetting the LTD benefits by the amount of Social Security disability benefits the claimant receives.  In other words, once that claimant receives Social Security disability benefits in a lump sum amount for past due benefits, the LTD carrier has an overpayment claim.  The issue is how the LTD carrier can collect the overpayment.  Obviously, the LTD carrier will ask the claimant to pay back the overpayment.  Often, the claimant will comply. If the claimant does not comply and the carrier is still paying LTD benefits, the carrier will normally stop paying monthly LTD benefits until such time as the overpayment is recovered. Basically, the carrier credits the amount owed against the overpayment balance.  Some carriers have tried other approaches, such as bringing suit under ERISA or bringing a counterclaim for reimbursement under ERISA if the claimant brings suit to challenge a decision of the carrier.  In one relatively recent case, the Court held that because the carrier could not specifically identify whether or not the claimant still had the overpayment proceeds in her possession, the LTD carrier could not recover the overpayment directly from the claimant, but instead, could withhold benefits to collect to the overpayment.  Epolito v. Prudential Ins. Co. of Am., 737 F. Supp. 2d 1364, 2010 U.S. Dist. LEXIS 91010 (M.D. Fla. 2010).

Disability Social Security Substitute Policy

Disability Social Security Substitute Policy benefits are usually sold as private insurance to individuals. Generally, the Policy will provide a monthly benefit for a certain number of years. Like many disability policies, the individual must be “disabled” as defined in the policy.  These policies add an additional requirement that the individual not be entitled to Social Security benefits. The Policy may also require that the individual not elect to receive retirement benefits from Social Security.
If you need help with your private disability claim and want to talk with an attorney, feel free to call my office. Click here for contact information.

ERISA/LTD Discovery

Consult the following cases with regard to the nature and extent of discovery in ERISA/LTD actions:
1. Metropolitan Life Ins. Co. v. Glenn, 128 S.Ct. 2343 (2008)
2. Firestone Tire & Rubber Co. v. Bruch Systems, Inc., 489 U.S. 101, 115 (1989)
3. Wilkins v. Baptist Healthcare Systems, Inc., 150 F.3d 609 (6th Cir. 1998)
4. Cerrito v. Liberty Life Ass. Co. of Boston (209 F.R.D. 663 (M.D. Fla. 2002)
5. 179 F.Supp.2d 1100 (D.Neb. 2001)
6. 167 F.Supp.2d 846 (E.D.Pa. 2001)
7. Gooden v. Provident, 250 F.3d 329 (5th Cir. 2001)
8. 5 F.Supp.2d 1172 (D.Kan. 1998)
9. Johnson v. Conn. Gen. Life Ins. Co., 324 F.App’x 459 (6th Cir. 2009)
10. 271 F.R.D. 584 (E.D.Tenn. 2011)
11. 746 F.Supp.2d 860 (E.D. Mich. 2010)
12. Calvert v. Firstar Fin., Inc., 409 F.3d 286 (6th Cir. 2005)
13. 581 F.Supp.2d 911 (E.D.Tenn. 9/22/2008)
14. Kalish v. Liberty Mutual, 419 F.3d 501 (6th Cir. 2005)