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The Wagner Law Group

The Wagner Law Group is a nationally recognized practice in the areas of ERISA and employee benefits, estate planning, employment, labor and human resources and investment management.

 

Established in 1996, The Wagner Law Group is dedicated to the highest standards of integrity, excellence and thought leadership and is considered to be amongst the nation's premier ERISA and employee benefits law firms. The firm has seven offices across the country, providing unparalleled legal advice to its clients, including large, small and nonprofit corporations as well as individuals and government entities worldwide. The Wagner Law Group's 34 attorneys, senior benefits consultant and five paralegals combine many years of experience in their fields of practice with a variety of backgrounds. Seven of the attorneys are AV-rated by Martindale-Hubbell and six are Fellows of the American College of Employee Benefits Counsel, an invitation-only organization of nationally recognized employee benefits lawyers.  Seven of the firm's attorneys have been named to the prestigious Super Lawyers list for 2017, which highlights outstanding lawyers based on a rigorous selection process.

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

 

Washington, D.C.

Tel: (202) 969-2800

 

Fax: (202) 969-2568

 800 Connecticut Avenue, N.W.

Suite 810

Washington, D.C. 20006

 

Chicago

Tel: (847) 990-9034

Fax: (847) 557-1312

190 South LaSalle Street

Suite 2100

Chicago, IL 60603

 

  

Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

  

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104

  

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
25 W. Moody Avenue
St. Louis, MO  63119 

 

Lincoln, MA

Tel: (617) 532-8080

Fax: (617) 532-9090

55 Old Bedford Road

Lincoln, MA 01773

 

 

www.wagnerlawgroup.com

 

 

 

    Court Says Administrator's Denial of Disability Benefit Claim Was Arbitrary and Capricious

 

August 23, 2018

 

 

 

The Tenth Circuit Court of Appeals, in McMillan v. AT&T Umbrella Benefit Plan No. 1, has affirmed a district court's decision to reverse a plan administrator's denial of short-term disability benefits on the basis that that it acted arbitrarily and capriciously in denying an employee's claim.

 

Background. The employee applied for short-term disability benefits after having worked as an IT consultant for the employer for six years. The employee had coronary artery disease, type-two diabetes, hypertension and sleep apnea, and a cardiologist determined that he had small vessel coronary disease that could not be corrected by medical intervention.

 

As a result of these conditions, the employee experienced shortness of breath even when walking on flat ground along with daytime somnolence. Moreover, a neuropsychological exam performed as part of Social Security proceedings had confirmed that the conditions had given the employee memory problems that would cause him significant difficulty in concentrating through a normal work day.

 

The employer's disability plan required the employee to provide a medical, psychiatric or psychological opinion, based on a test performed according to generally accepted principles of the health care profession, to support the disability claim. The plan did not require the employee to provide objective evidence to substantiate the disability.

 

The employee provided the plan with a report prepared by his primary doctor that provided medical records that confirmed the existence of his conditions. In turn, the plan administrator consulted with a doctor of its own selection who concluded that the employee's medical records did not support a finding that he was unable to perform the duties of his pre-disability occupation. Accordingly, the plan administrator denied the employee's claim.

 

The employee responded by filing an administrative appeal which reasserted that he was unable to perform the essential functions of his job and that the plan administrator had neglected to obtain a formal job description of his pre-disability occupation from his employer before denying his claim. In response, the plan administrator contacted the employee's former supervisor to obtain a complete job description. The supervisor explained that while there were no physical requirements, "it is a cognitive position that requires memory and thought." The plan administrator next referred the employee's appeal to four physician specialists of its own choosing, all of whom issued reports that indicated he was not disabled. However, none of these reports provided a specific discussion of the employee's job duties and its cognitive requirements.

 

In response, the employee sued the plan administrator in federal district court, claiming that its decision to deny his claim for disability benefits violated ERISA.

 

District Court.   The district court found that the plan's denial was arbitrary and capricious and awarded the employee disability benefits. In reaching this determination, the court noted that the plan administrator had failed to adequately consider the employee's ability to perform all of his essential job functions before denying his claim. The court also found that the employee's actual employment duties were inconsistent with the plan administrator's determination that he had a sedentary job. The employer subsequently appealed the decision to the Tenth Circuit.

 

Tenth Circuit. The Tenth Circuit found that the record did not contain substantial evidence that the employee could perform either the physical or cognitive duties of his job. Consequently, the court concluded that the plan's determination that the employee could perform the cognitive requirements of his job was arbitrary and capricious because it was not based on sufficient evidence for a reasonable person to accept the denial of benefits. As a result, the Tenth Circuit affirmed the district court's decision to award the employee disability benefits.

 


 

 

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.