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Ben Glass
Ben Glass
Attorney • (703) 584-7277

The Absurdity of ERISA in disability claims.

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The First Circuit Court of Appeals issued an opinion at the end of March which again demonstrates that the federal law of ERISA (designed to protect your pension plans) has turned the disability evaluation world upside down.

The plaintiff sought disability benefits after she could no longer work due to fibromyalgia. Every doctor who examined the plaintiff, including an independent examiner found that she was not able to work from fibromyalgia. Further, an Administrative Law Judge found the claimant to be a credible witness.

According to the Court’s opinion the insurance company denied the claim in part because the plaintiff had suffered from fibromyalgia for several years and had continued working. The insurance company also ordered surveillance of the plaintiff but took only still photos, no video. It then turned this evidence over to a reviewing physician associated with National Medical Review – Elite Physicians.

The court acknowledged the insurance company’s financial conflict of interest inherent in its dual role as claim administrator and as funding source for the benefits. The court also in evaluating the case drew the inference that National Medical Review had never found in favor of the claimant in their reviews performed for Liberty and that there was a clear incentive for Liberty to contract with National Medical Review to obtain peer review supporting a benefit denial.

In discovery the insurance company admitted that between 2001 and 2003 it had paid National Medical Review over $2 million and referred over 1,200 files to it for review. The insurance company refused to disclose how many of those reviews were favorable to the insurance company.

Comment from Virginia ERISA disability attorney Ben Glass: what a great law! ERISA permits the insurance company to deny your claim on a biased review AND when you go into court, the insurance company’s decision is more or less presumed correct.

Read Robbery Without a Gun, Why Your Employer’s Long Term Disability Policy May be a Sham.