At our law firm, we help people in their claims for short- and long-term disability insurance benefits based on a variety of impairments. As we have written about in this space, disability insurance companies now regularly use video, physical and Internet surveillance of claimants to gather evidence that might undercut their claims.
We often write about denied or terminated disability insurance claims that claimants appeal to court under the federal law ERISA. ERISA usually applies when short- or long-term disability insurance policies are available to claimants through their employers.
In Part 1 of this post, we told readers about a recent Third Circuit Court of Appeals case called McCann v. Unum Provident in which a doctor appealed his long-term disability insurer’s termination of his benefits. In that post, we explained how the Third Circuit Court of Appeals determined that the federal law called ERISA applied to the dispute.
A preliminary issue in every federal court appeal in a denied or terminated claim for benefits under a short- or long-term disability insurance policy is whether ERISA governs. ERISA is the Employee Retirement Income Security Act, the federal law governing most benefit plans available through employers.
This summer, we published a post about important new research on chronic fatigue syndrome, a debilitating illness characterized by muscle pain, inflammation, cognitive impairment and overwhelming tiredness. As we described, the disease has been renamed as myalgic encephalomyelitis, or sometimes ME or ME/CFS, and the research shows promising progress toward an eventual laboratory test for CFS.
Disability insurers all too often engage in a behavior known in the industry and among claimants’ advocates as cherry-picking. Cherry-picking refers to a practice of insurance administrators or consulting doctors who selectively assign undue weight to particular records and ignore others when they analyze medical records to determine whether claimants are disabled and eligible for benefits.
We have talked here before about the inherent conflict of interest that a long-term disability insurance company has when it administers its LTD policies, especially when deciding whether a claimant is eligible for benefits. Today we will expand on this idea as federal courts have explained it.