ERISA Long Term Disability Case Citations and references

DISCLAIMER: Please note that every case is different and these verdicts and settlements, while accurate, do not represent what we may obtain for you in your case.

Court Rules in Favor of Plaintiff… Returns Case to Plan Administrator?

Jo Ann Tate was a sales rep for a paper company until 1998 when her depression and anxiety became disabling.  Her long-term disability insurance company initially decided that she was disabled and she received payments for two years.  However, they then changed their minds – even though her psychiatrist and psychologist supported her ongoing claim and despite the fact that the insurance company had conducted an independent examination earlier in the claim.

So how did the insurance company justify the termination of benefits over the advice of their own psychiatrist?  They had another psychiatrist review the records.  Without ever meeting with Ms. Tate, the psychiatrist decided that the severity of her bipolar disorder was not sufficient to keep her from sustaining employment. 

Ms. Tate sued to have her benefits reinstated and the District Court found in her favor – believing the plan’s doctors opinions to be conclusory and unsupported by medical evidence, as well as arbitrary due to the plan’s failure to perform a vocational evaluation to determine what, if any, jobs Tate was capable of performing.

However, instead of simply reinstating her benefits, the Court simply remanded the case to the plan administrator – a decision which was upheld by the Court of Appeals.  The Court stated that as long as the plan could offer a “reasonable explanation” for its determination that Tate was not “totally disabled,” they would be able to justify their decision.

The Court also declined to award Tate her attorney’s fees, reasoning that Tate was not yet a “prevailing party,” because she had only won a renewed review of her records.  This decision is contrary to case law in other circuits.

Tate v. Long Term Disability Plan for Salaried Employees of Champion Intl. Corp., 2008 U.S. App. EXIS 20052 (7^th Cir. September 19, 2008).