How Does a Successful Appeal Lead to Reinstating Terminated Disability Benefits?

The Supreme Court has established a principle for cases challenging the denial of benefits under the Employee Retirement Income Security Act (ERISA). According to this principle, such denials should generally be examined anew (de novo) unless the benefits plan specifically grants the administrator or fiduciary the power to decide on eligibility for benefits or interpret the plan's terms. The claimant, who worked as an Executive Sous Chef at the Hyatt Corporation in San Diego, California, started having symptoms of osteomyelitis, which is an infection in the spinal cord. Even after getting treatments like antibiotics and surgery, he still had a lot of pain because of the ongoing infection, degenerative disc disease in his lower back, and spinal stenosis. These health issues made him quit his job because he couldn't stand for long times, which his job required.After over eleven years of receiving long-term disability (LTD) benefits, the claimant's payments were stopped by his insurance company, Hartford. The insurer decided that the claimant no longer met their criteria for being disabled. This conclusion was based on a functional capacity evaluation and the opinion of a medical professional who agreed with the evaluation's findings.The claimant appealed the termination decision. He insisted that he was still considered disabled when the plan was terminated because he could not continuously work in any job that his education, training, or experience would have qualified him for.This is the oral argument in the 4th circuit court of appealsThese public domain recordings are brought to you by Ben Glass Law, a national long term disability and life insurance firm headquartered in Fairfax, VA.By making these recordings into a "podcast," we've made the listening easier for claimants, attorneys and claims adjusters alike. If long term disability or life insurance benefits have been denied, we'd love to review your denial letter and give you a strategy for moving forward. This is a free service and you can go here to begin submitting your denial letter.