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.

The court sustained the IIED claim because it alleged harassing and oppressive conduct independent of the duties of administering an ERISA plan” and also involved a legal duty independent of ERISA. The court determined that Dale’s allegations were “based on events that involved harassing and oppressive conduct.” And most significantly, the court explained that “even without the denial of benefits our plaintiff would still have a claim for intentional infliction of emotional distress.” The last point is the key. Because Dale could potentially win a claim for infliction of emotional distress regardless of the outcome of his claim for benefits, his claim was sustained.

Related Articles

High court social security ruling’s implications for ERISA

It is a generally accepted tenet in litigation under the Employee Retirement Income Security Act that claimants challenging benefit denials must first exhaust prelitigation claim appeals as a condition precedent to filing suit. While an administrative exhaustion requirement applies to claim exhaustion, whether ERISA claimants are barred from raising new issues in court that were not previously asserted in their claim appeals remains open to question. […]

When to hire a lawyer to claim against health insurance denial

When to hire a lawyer to claim against health insurance denial

Navigating a denial of your private health insurance claim at a time when your focus is on receiving the medical care you need can seem like an uphill battle with your insurance company. Healthcare claims are often complex. It is important to consult with a lawyer who focuses on health insurance claims and possesses the expertise and knowledge to get your claim approved and prevent you from being stuck with a medical bill that your health insurer should pay. […]