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November 2015 Archives

"Clear that Aetna's goal was to deny the plaintiff's claim."

A recent ruling issued by a federal court in Philadelphia illustrated a number of issues relevant to disability insurance claims brought under ERISA.  In Charles v. UPS Long Term Disability Plan, 2015 WL 6600399 (E.D. Pa. October 29, 2015), after first finding the plaintiff was limited to part time work and thus unable to work at an occupation that would generate an income equal to 60% or more of pre-disability earnings, Aetna shifted gears and denied benefits.  The claimant had been a delivery driver for UPS who became disabled on account of a seizure disorder and could no longer qualify for a commercial driver's license based on the condition and the prescribed anti-convulsant medications which cause sedation and fatigue.  The plan's insurer, Aetna, had the file reviewed by doctors and vocational consultants who issued findings that Charles could work full time and that there were occupations he could perform that would generate the requisite wages.  The court overturned that finding in a harsh ruling that included the quotation that is the title of this blog.

Intentional Infliction of Emotional Distress and ERISA

Although the ERISA law generally preempts state law causes of action that relate to claims for employee benefits, a recent federal court ruling from California Dale v. Reed Group, Ltd., 2015 WL 6954915 (N.D. Cal. November 10, 2015), permitted an exception to that general rule.  Ed Dale, an employee of Intel Corporation who became disabled, was refused long-term disability benefits.  In challenging the benefit denial, he added a claim for intentional infliction of emotional distress (IIED), which Intel and its benefit administrators tried to have dismissed on ERISA preemption grounds.  He maintained that in the course of his claim, he was accused of lying or exaggerating his claims, urged to take experimental medication and forced to undergo examinations that caused pain, emotional distress and anxiety. 

DeBofsky, Sherman & Casciari, PC