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Even an ERISA courtroom win can be a bureaucratic nightmare

On Behalf of | May 15, 2023 | ERISA

ERISA disputes are perhaps the worst-timed legal challenges a person can encounter. People with incapacitating illnesses or injuries, often involving a cognitive impairment, must become proficient in legal jargon and the convoluted world of long-term insurance processes to retain their benefits. This grinding legal maneuvering often happens while the stress of financial ruin hangs overhead.

Sadly, forcing people to endure this bureaucratic marathon during a period of personal hardship is a tactic used by insurance companies to discourage legal action. Even after an experienced ERISA attorney has been retained, the mental and physical stamina required to see the case through till the end is considerable.

A recent case, Rhodes v. First Reliance Standard Life Insurance Company, perfectly illustrates this multi-faceted cruelty. Though the plaintiff was ultimately victorious, the procedural acrobatics couldn’t have been easy.

Failure to consult a qualified healthcare professional

After the plaintiff contested a notice that his traumatic brain injury benefits were being canceled, First Reliance insisted he submit to an independent medical examination to reevaluate his condition. But First Reliance sent the plaintiff to a PhD-trained neuropsychologist instead of a neurologist (medical doctor), a more appropriate person to assess the plaintiff’s injury.

The court rightly pointed out that this violated ERISA’s full and fair review requirements, ruling against First Reliance.

Withholding of physician’s addendum report

First Reliance did not provide the plaintiff with a physician’s addendum report on their condition, even though it was given to the neuropsychologist for their non-medical review. Withholding documents that affect benefits determinations is also an ERISA no-no.

Missed deadlines

Last but not least, First Reliance violated a deadline they themselves had set for ruling on the plaintiff’s appeal. First Reliance justified the missed deadline with the ongoing issue of the independent medical examination and additional information it was expecting from the plaintiff, but the court was not swayed.

The plaintiff won all three rulings, but getting there must have been exhausting. Imagine having to poke around like a private detective, sleuthing evidence, unearthing paperwork, and untangling procedural processes while suffering from a traumatic brain injury so severe that you can’t work.

Notably, this slow-motion activity transpired over ten months without benefits, which would have meant financial ruin for many people.

As often as ERISA law works in favor of disabled people, untold numbers fail to navigate the system – or don’t try at all. Perhaps they took the insurance company’s word that their claim was invalid. Or maybe they didn’t think they could afford to pursue their claim in court.

Most attorneys will offer a free consultation, so asking about a long-term benefits dispute doesn’t hurt. That phone call could change your life.