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ERISA Case Shows How Hard for Claimants to Receive Disability Benefits

A recent ERISA case shows what a Nightmare it has become for Claimants to receive Disability benefits under that Statute:  For those readers familiar with the Dickens’ classic, Bleak House, a recent decision from the Sixth Circuit, Javery v. Lucent Tech. Long Term Disability Plan, decided February 3, 2014, shows that today’s legal system can be just as slow and serpentine as it was in London in the 1850s.  In this opinion, CIGNA acted as the Plan administrator and paid Short term Benefits to Javery from May 19, 205 through November 25, 2005, or a period of 6 months STD benefits.  At the end of this time, Lucent suggested that Javery would qualify for long term benefits LTD, but CIGNA denied the claim finding that the plaintiff did not satisfy the definition of disabled under the Plan, i.e., “prevented by reason of . . . disability . . . from engaging in [his] occupation or employment at [Lucent].”  After meandering through the courts, and a remand to CIGNA, to reexamine the issue of Plaintiff’s entitlement to benefits, CIGNA upheld its earlier denial.  The district court upheld that denial and an appeal to this Court resulted.  Luckily, for the Plaintiff, the Plan did not give discretion to the administrator so the level of review was de novo, instead of arbitrary and capricious.  Applying the de novo standard, the Sixth Circuit found that the plaintiff satisfied the definition of disabled as of November 26, 2005.  Accordingly, plaintiff was entitled to additional LTD benefits for one additional year.  In true Dickens fashion, however, because the Plan’s definition of disabled changed after receiving LTD benefits for one year, the Sixth Circuit remanded the issue of further entitlement to LTD benefits to the Plan Administrator to apply the new definition. We have no doubt, that after a thorough examination of the issue, the Plan Administrator will rule against Javery’s claim for further LTD benefits.  Unfortunately, such is the plight of ERISA claimants.