ERISA - Firing Due to Disability and the “Actively At Work” Provision

June 16th, 2017

Murray Law Office takes pride in assisting our clients with the difficult legal issues facing them when they become disabled and when their ERISA governed claims for long, or short term disability benefits are denied or terminated.

This month, Jonathan T. Macedo of Murray Law Office, helped with a long term disability appeal for an ERISA governed matter for a Business Analyst who worked at a health insurance company. Our client was an exemplary individual who worked for many years while suffering from severe Dilatin induced neuropathy and complex regional pain syndrome.
Sadly, as our client’s health detreated and she progressively struggled to perform her occupational duties, she was the only individual from her group who was fired as a result of a “business reorganization.” To make matters worse, upon her termination, her employer informed her that her employer-provided benefits and coverage for her short and long term disability benefits had ceased due to her firing.

With Attorney Macedo’s assistance, our client filed for short and long term disability benefits. The insurance carrier originally denied her claim for short term disability benefits on the basis that she did not satisfy the “Actively at Work” provision of her employer’s self-funded short term disability plan due to her termination.
After appealing our client’s short term disability denial, Jonathan T. Macedo advised our client to exhaust her administrative remedies with respect to her long term disability policy which was insured by a long term disability carrier.

As our client was disabled at the time of her termination and did not become eligible for any other long term disability benefits from another employer within thirty one days, Attorney Macedo successfully argued that the “Actively at Work” provision as it pertains to long term disability benefits was not applicable as Massachusetts State Law requires her coverage to remain in effect. Accordingly, the insurance carrier was required to consider her application for long-term disability despite her employer’s incorrect guidance.
Unfortunately, after overcoming this hurdle, the insurance carrier next denied our client’s long term disability claim on the basis that the client could perform her sedentary occupation as a Business Analyst. In support of the insurance carrier’s long term disability denial, they used a single doctor’s office note where the client mentioned that she was sore all over due to the fact that she had just returned from vacation as justification as to why she had the ability to work.

Attorney Macedo appealed on the basis that the insurance carrier’s constant cherry-picking of the medical records in disregarding the client’s well-documented medical history of polyneuropathy and complex regional pain syndrome was arbitrary and that using a single one week vacation to justify the insurer’s denial of benefits violated Massachusetts General Laws Chapter 175, Section 108 which indicates that it is bad faith to make a distinction for lawful travel plans.

Finally, after working with the client for nearly two years applying for short term disability, appealing short term disability, applying for long term disability, and then appealing her long term disability denial, the insurance carrier finally decided to approve the client’s claim for long-term disability benefits. As a result, the client was able to receive nearly two years of retroactive benefits and was put on claim for future monthly long term disability benefits.

While every case is different as each individual’s short or long term disability policy and medical history is different, retaining a competent long term disability attorney for your ERISA governed claim who is barred in your state can be essential to your success and can be greatly beneficial in enforcing your right when pursuing your ERISA governed long term disability claim for disability benefits against a large national long term disability carrier.