Attorneys Mark DeBofsky and Bridget O'Ryan secured a victory in the U.S. Court of Appeals on May 18, 2017 in a disability benefit case involving fibromyalgia - Kennedy v. Lilly Extended Disability Plan, 2017 WL 2178091 (7th Cir. May 18, 2017)(available at Final Opinion). The court began its ruling by announcing that this case is about fibromyalgia, and then proceeds to explain the nature of the condition, its chronicity, and the severity of the pain it causes. Cathleen Kennedy was a senior human resources executive at Eli Lilly & Company, one of the world's leading pharmaceutical companies, before she became disabled due to fibromyalgia. Lilly is very familiar with fibromyalgia since it markets Cymbalta to treat the disease. Lilly has also retained Dr. Daniel Clauw, a professor of rheumatology at the University of Michigan, as a consultant on fibromyalgia. Dr. Clauw has publicly stated that many persons who suffer from fibromyalgia "end up needing to stop working because of this condition" and has also remarked that fibromyalgia "is not only very common but is typically also very disabling."
You have likely heard of the Employee Retirement Income Security Act (ERISA) that establishes minimum standards for pension plans in private industry. But, do you know anything about the agency that manages it? To best understand ERISA, it is important to know the history and structure of the agency that manages it.
In a ruling recently secured by DeBofsky Sherman & Casciari, P.C., a federal court definitively ruled that prevailing defendants in ERISA cases are rarely entitled to fees. In Geiger v. Aetna Life Ins. Co., 2016 WL 5391206 (N.D. Ill. September 27, 2016) (opinion), where a court upheld Aetna's termination of disability benefits (currently on appeal), the court denied the insurer's application for fees. Although the court acknowledged that under Hardt v. Reliance Standard Life Ins. Co., 560 U.S. 242, 244 (2010), either party is entitled to fees so long as the fee claimant has achieved "some degree of success on the merits," and also recognized "a 'modest presumption' in favor of awarding fees to the prevailing party, the court nonetheless refused to award fees to Aetna.
The lesson taught by Okuno v. Reliance Standard Life Ins. Co., 2016 WL 4655741 (6th Cir. September 7, 2016), is that the answer to the question posed by the title of this blog is a resounding NO.
The ERISA statute contains a provision that permits a large universe of potential claimants to seek "appropriate equitable relief." 29 U.S.C. Sec. 1132(a)(3). Over a series of rulings the Supreme Court has wrestled with the meaning of that term. Historically, courts of equity were limited in the remedies they could provide litigants who came before such courts. But with a growing recognition that monetary damages were sometimes necessary to allow recovery when a wrong had been committed, the courts in England and then in America permitted courts of equity to award money damages. Finally, in 1938, the distinction between courts of equity and courts of law was blurred as the divided bench was joined together.
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.
Courts strive to enforce the terms of benefit plans in order to ensure their efficient operation. However, there are times when the provisions of benefit plans make no sense under the circumstances; and Waskiewicz v. Unicare Life and Health Ins. Co., 2015 WL 5751585 (6th Cir. October 2, 2015) illustrates one of those circumstances.
A recent ruling from a federal court in Alabama - Rosen v. Provident Life and Accident Insur. Co., 2015 WL 260839 (N.D.Ala. January 21, 2015) addressed a controversial issue involving ERISA preemption. Typically, ERISA is implicated only where an employer sponsors a retirement plan or offers group coverage to its employees for disability, life, or health insurance. However, several insurance companies offer employers a discount on premiums if they are able to issue a series of individually underwritten disability insurance policies, and the premiums are billed to the employer on a single bill. This often occurs with medical and legal professional practices. Many courts have held that such a practice established an ERISA welfare benefit plan.