Source: https://www.whiteman-law.com/disability-insurance-benefits/
Timestamp: 2019-04-21 12:22:05+00:00

Document:
Mr. Whiteman specializes in cases involving claims for disability insurance and other employee benefits. These cases typically involve application of a federal law, the Employee Retirement Income Security Act of 1974, known by the acronym ERISA, and are usually resolved through the benefit plan’s appeal process or federal court. Mr. Whiteman has helped hundreds of individuals with their claims for short-term and long-term disability insurance benefits.
Fortier v. Principal Life Insurance Company, 666 F.3d 231 (4th Cir. 2012).
This case involved a dispute about the meaning of convoluted plan provisions that described how the disability benefit of an owner-employee was to be calculated. The Fourth Circuit Court of Appeals affirmed the ruling of the District Court and upheld Principal’s interpretation of its plan as a reasonable exercise of its discretionary authority to interpret plan terms. Judge Floyd dissented.
DuPerry v. Life Ins. Co. of North America, 632 F.3d 860 (4th Cir. 2011).
The Fourth Circuit upheld the rulings by the district court in all respects. The court ruled that the insurer abused its discretion by denying Ms. DuPerry’s claim that she was disabled from her chronic diseases, which included rheumatoid arthritis, osteoarthritis, and fibromyalgia.
Leone v. Tyco Electronics Corp., Case No. 09-1821, 2011 WL 96540 (4th Cir. Jan. 12, 2011).
In this case, the Fourth Circuit Court of Appeals upheld the ruling of the district court that, under North Carolina law, Tyco Electronics did not breach the terms of its short-term disability policy by refusing to pay the employee salary continuation benefits..
Williams v. Metropolitan Life Insurance Co., 609 F.3d 622 (4th Cir. 2010).
The Court of Appeals agreed with the district court that Ms. Williams was entitled to benefits. The undisputed evidence showed that, despite numerous corrective surgeries, Ms. Williams’ hand and wrist impairments continued to significantly impede her ability to type on a computer.
Gorski v. ITT Long Term Disability Plan for Salaried Employees, 314 Fed.Appx. 540, 2008 WL 4790117 (4th Cir. 2008).
In this case, the Fourth Circuit reversed the decision of the district court in favor of the plan and the plan administrator, MetLife. The evidence clearly demonstrated that the claimant’s surgical hardware had dislodged and was irritating nerve tissue surrounding the hardware, causing the claimant substantial back pain and other problems that prevented her from working.
Guthrie v. National Rural Electric Cooperative Association Long-Term Disability Plan, 509 F.3d 644 (4th Cir. 2007).
The Fourth Circuit reversed the district court’s ruling in favor of the defendant’s ERISA disability plan. The plan hired two pulmonologists to consider whether the claimant was disabled from asthma, a condition which the claimant’s own physician conceded did not prevent her from working. The reviewing pulmonologists failed to consider whether the claimant was disabled by a combination of her other health conditions, including anxiety and depression, skin lesions and arthritis.
Nyce v. Liberty Life Assurance Company of Boston, Case No. 5:11-CV-594-BO (E.D.N.C. Nov. 28, 2012).
The court ruled that the plaintiff was entitled to benefits. The court focused on the reports of two consulting physicians retained by Liberty Life to review the plaintiff’s claims. Both reports were found to be contrary to the medical evidence.
Reininger v. Azdel, Inc. Retirement Plan, 768 F.Supp.2d 825, (W.D.N.C. 2011).
The plaintiff alleged that the defendant, a pension plan, wrongfully reduced his pension benefit retroactively to the date of the plaintiff’s retirement. The district court dismissed plaintiff’s claim for breach of fiduciary duty.
DuPerry v. Life Insurance Company of North America, Case No. 5:08-CV-344-FL (E.D.N.C. Dec. 23, 2009).
The district court’s ruling in favor of Ms. DuPerry was later affirmed on all contested points by the Fourth Circuit Court of Appeals. See above.
Ward v. Life Ins. Co. of North America, Case No. 1:08CV675, 2009 WL 2740202 (M.D.N.C. August 26, 2009).
The plaintiff had a history of degenerative disc disease. The district court ruled that the insurer had the duty to consider the plaintiff’s “voluntary” second-level appeal and ordered the insurer to provide a full and fair review in accordance with 29 U.S.C. § 1133.
Pinario v. The Prudential Life Insurance Company of America, Case No. 4:08-CV-161-F (E.D.N.C. July 23, 2009).
The plaintiff suffered from chronic fatigue syndrome and fibromyalgia, which limited her to half-time work in her position as an administrative assistant. The district court ruled that the employer’s disability insurance policy failed to reserve discretionary authority to Prudential, the claims administrator, citing Woods v. Prudential Insurance Co. of America, 528 F.3d 320 (4th Cir. 2008) and other cases. The court then reviewed the evidence under the de novo standard of review and found that the plaintiff was entitled to benefits.
Allen v. Metropolitan Life Insurance Co., Case No. 4:06-CV-175-H (E.D.N.C. March 31, 2008).
The plaintiff ceased working for IBM in 2001 after she was exposed to toxic mold following a flood at her workplace. The plaintiff’s physicians differed as to whether the cause of her disability was a physical or mental illness. However, all of the treating physicians and one of MetLife’s reviewing physicians agreed that the plaintiff actually suffered from the symptoms she claimed. The district court held that the plaintiff had satisfied her burden of submitting evidence that she was disabled.
Thornton v. Metropolitan Life Insurance Company, Case No. 5:05-CV-827-H(3) (E.D.N.C. June 13, 2007).
The district court, having granted the plaintiff’s motion for summary judgment, concluded that she was also entitled to an award of attorney’s fees, costs and prejudgment interest.
Alford v. Metropolitan Life Insurance Co., Case No. 1:05CV207 (M.D.N.C. March 5, 2007).
The Magistrate Judge recommended that summary judgment be granted to the plaintiff, who claimed long-term disability benefits provided by MetLife based on her fibromyalgia. The Magistrate Judge recommended that the plaintiff’s motion for prejudgment interest and costs be granted but that her motion for attorney’s fees should be denied.
Alston v. Metropolitan Life Ins. Co., Case No. 1:05CV00121, 2006 WL 3102970 (M.D.N.C. October 27, 2006).
In this case there was no dispute that the plaintiff suffered from relapsing/remitting multiple sclerosis. MetLife reevaluated the plaintiff’s medical records while her symptoms were in relative remission. According to the court, “MetLife’s decision simply came down to a permissible judgment call between conflicting medical opinions. Given the differing conclusions of [the plaintiff’s] treating physicians along with those of [MetLife’s physicians], MetLife’s denial of long-term disability benefits was reasonable and not an abuse of discretion.” The Magistrate Judge therefore recommended that the district court grant MetLife’s motion for summary judgment.
Mitchell v. Metropolitan Life Insurance Company, Case No. 5:05-CV-129-BO(1) (E.D.N.C. March 24, 2006).
Summary judgment granted for the plaintiff. The plaintiff was unable to continue her work as a Group Leader at Siemens Energy & Automation, Inc. due to severe depression, bipolar affective disorder, panic disorder with agoraphobia, and seizure disorder.
Brown v. Nortel Networks, Inc., Case No. 5:03-CV-658-FL (3) (E.D.N.C. November 29, 2004).
The plaintiff’s evidence showed that she suffered from a number of medical problems, including severe depression, cognitive impairments, basilar artery migraines, coronary artery disease, hypercholesterolemia, and multiple neurological symptoms. The district court held that Nortel failed to provide the plaintiff a full and fair review of her claim and remanded the case to Nortel for an independent review of the claimant’s file.
Driver v. Nortel Networks, Inc., Case No. 5:03-CV-86-BR(3) (E.D.N.C. March 31, 2004).
The district court granted summary judgment to the plaintiff, a technical writer for Nortel Networks, Inc. The plaintiff suffered from failed back syndrome. The court held that the plaintiff’s descriptions of his symptoms constituted “clinical evidence” of disability.
Driver v. Nortel Networks, Inc., Case No. 5:03-CV-86-BR(3) (E.D.N.C. August 29, 2003).
The court granted the plaintiff’s motion to compel Nortel to produce notes prepared by an in-house attorney during a meeting of its Employee Benefits Committee at which the plaintiff’s claim was considered. The court upheld the plaintiff’s motion based on the “fiduciary exception” to the attorney-client and attorney work product privileges.
Cosgrove v. Provident Life and Acc. Ins. Co., 317 F.Supp.2d 616 (E.D.N.C. 2004).
Applying the modified abuse of discretion standard, the district court held that Provident abused its discretion by denying long-term disability benefits to the plaintiff. The court ruled that Provident lacked substantial, objective evidence to controvert the plaintiff’s claim of disability due to vertigo.
Bursell v. General Electric Co., 243 F.Supp.2d 460 (E.D.N.C. 2003).
In this case, the court held that the de novo standard of review applied to the decision by General Electric’s plan administrator to deny the plaintiff’s claim for benefits for disability due to mental illness. The court denied both parties’ motions for summary judgment, stating that fact questions remained as to whether the plaintiff was “totally disabled” by his mental condition.
Beasley v. UNUM Life Insurance Company of America, Case No. 5:02-CV-4-BO(3) (E.D.N.C. September 26, 2003).
This decision demonstrates the importance to a claimant of having strong support from all treating physicians. The court found that the plaintiff’s claim of disability was insufficiently supported in the medical records.
Garrett v. Fortis Benefits Insurance Company, Case No. 2:02-4280-18 (D.S.C. August 5, 2003).
The plaintiff’s evidence showed that his cognitive problems commenced following a hospitalization for pneumonia, during which he experienced severe hypoxemic respiratory failure and was placed on mechanical ventilation for a time. The court ruled that the plaintiff had the right to file suit after Fortis failed to decide his appeal within the time limits allowed by the regulations. After this ruling, Fortis conceded that the plaintiff was entitled to benefits.
Casey v. Pierce, Case No. 5:02-CV-945-H(3) (E.D.N.C. June 5, 2003).
The plaintiff, a small business owner, sued the insurance agent and the insurer, UnumProvident Corporation, in state court to recover disability benefits under an individual disability insurance policy. The defendants removed the case to federal court, alleging that the claim was governed by ERISA. The court ruled that the claim was not covered by ERISA under the “safe harbor” contained in the Department of Labor’s regulations.
Conrad v. Continental Casualty Co, 232 F.Supp.2d 600 (E.D.N.C. 2002).
In this case, the court ruled that Continental’s decision to deny long-term disability coverage to the plaintiff diagnosed with fibromyalgia was unreasonable based on the medical records and the language of the employee welfare plan.

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