On July 27, 2016, the U.S. Court of Appeals for the Seventh Circuit handed down a decision in the case of Berg v. New York Life Ins. Co. reversing an adverse judgment in the district court against DeBofsky, Sherman & Casciari' client, Eric Berg. The court of appeals found in Berg's favor on two significant issues: First, the court ruled that a claimant for disability benefits did not have to be under a doctor's care for the claimed disabling condition as of the date the claim arose. The court found the policy lacked such a temporal requirement and that its terminology was ambiguous on the issue. Second, the court found that if the insured is unemployed when he submits a claim, his "regular job" is the occupation that was last performed, not the so-called occupation of "unemployed person."
Short-term and long-term disability plans are supposed to provide workers and professionals with coverage to make ends meet when a serious medical impairment or injury takes the person away from work. Not everybody participates in these insurance plans. In fact, the Bureau of Labor Statistics says the roughly 39 percent of people working in private industry 2014 had short-term disability (STD) coverage and 33 percent carries long-term disability (LTD) coverage. Of those in management and professional positions the participation rate was significantly higher.
The ubiquity of forum selection clauses which mandate that disputes over benefits be litigated in locations inconvenient to most workers is undermining ERISA. It has increasingly become a problem for employees who have claims under their employer's benefit plans that, instead of being able to seek redress where they live, have to travel hundreds, if not thousands, of miles to litigate these cases.