The Firm handles claims for short term disability benefits under employer provided disability plans and programs in the Chicago area and in the rest of Illinois. Employer provided short term disability plans may or may not be governed by ERISA, often depending on the method of funding. Whether or not the plan is covered by ERISA dramatically alters the process by which you claim the benefits and appeal any denial. Under ERISA, the plan adheres to complex regulations regarding the claim and appeal process, dictating how the plan notifies you of a claim denial, strict time frames in which the plan must issue that notification, and how long you have to administratively appeal such a denial before your right to litigate the claim has been forfeited.
Many claims for short term disability will eventually lead to reviews of claims for benefits under a long term disability plan. Often employers self fund short term disability benefits, but utilize the insurer from whom it purchases long term disability insurance to review claims for short term disability. This can result in two recurring problems. The insurer may readily approve your claim for short term disability, while the employer is paying the benefit, and then turn around and deny your claim for long term disability benefits, which are paid by the insurer. Alternatively, the insurer may recognize your claim as one likely to lead to long term disability and promptly deny it at the short term disability stage. Either one often has a single objective in mind: to avoid paying you long term disability.
Ferrin v. Aetna Life Ins. Co., 336 F. Supp. 3d 910 (N.D. Ill. Sept. 28, 2018) (holding insurance policy’s grant of discretionary authority is void under Texas law due to certificate being issued after effective date of regulation, and policy renewing after effective date, and holding Plaintiff was disabled from Any Reasonable Occupation where treating doctors certify she can sit at the occasional level, and insurer’s consultants opine Plaintiff can sit frequently, as weighing all evidence together would make capacity likely at low end of frequent range at best).
Sadowski v. Tuckpointers Local 52 Health & Welfare Trust, 281 F. Supp. 3d 710 (N.D. Ill. Dec. 20, 2017) (holding plan was arbitrary and capricious in denying medical benefits for removal of spinal cord stimulator following a fall down the stairs and infection where plan argued the expenses were caused by the same injury as the car accident necessitating implantation of the stimulator years earlier)
Tassone v. United of Omaha Life Ins. Co., 264 F. Supp. 3d 867 (N.D. Ill. Aug. 30, 2017) (awarding client long term disability benefits denied by United of Omaha despite insurer’s doctor opining there was no objective evidence of functional impairment)
Suson v. PNC Fin. Servs. Grp., Inc., No. 15-CV-10817, 2017 WL 3234809 (N.D. Ill. July 31, 2017) (holding Liberty Mutual’s denial of client’s long term disability benefits was arbitrary and capricious where Liberty Mutual disregarded client’s carpal tunnel syndrome and relied on a vocational opinion to which client never had an opportunity to address before litigation)