DATE POSTED 08. 08. 2016, By

Different Standards of Review in ERISA Long-Term Disability Litigation Affect How Courts Treat Evidence Missing from the Record

Claimants in Chicago with ERISA-governed long-term disability benefits often underappreciate the value a good attorney can add early in the claim process by ensuring a complete factual record. This is not limited to providing complete medical records, but includes adding necessary facts to complete the claim, such as non-medical evidence about why you were disabled as of a particular point in time. Whether the record is complete with respect to each and every fact can affect the length of time it takes to recover your benefits if and when your case goes to litigation. While in a deferential review of an ERISA § 502 claim to recover long-term disability benefits, the court will determine whether there is enough support for the insurer’s denial, in a de novo review the court must make factual findings of its own. That requires having evidence of each allegation in front of the court. If there is not enough evidence, the case can go up on appeal, and get sent back to the district court for another trial.

A good example of how this delay affects a claimant arose recently in Cheney v. Standard Insurance Co., No. 15-1794, 2016 U.S. App. LEXIS 13692 (7th Cir. July 27, 2016), where a lawyer stopped working at the end of 2011 with a planned leave of absence to begin in early 2012, but used vacation time to bridge the two weeks between. The district court found Cheney disabled as of December 2011. The difference in disability date was important because the Standard group insurance policy used the prior year’s earnings as the baseline for predisability earnings, which were significantly higher in 2010 than 2011. The Seventh Circuit Court of Appeals, however, determined there was inadequate evidence in the record to determine Cheney was disabled as of December 2011 instead of January 2012, and remanded to the district court for a new trial to determine that fact.

If you have a claim for long-term disability insurance, don’t wait. Call an experienced ERISA long-term disability lawyer today.

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