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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 32 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 

 

 

www.wagnerlawgroup.com

 

 

 

  Participant Has Burden of Proof in

LTD Claim

  

March 28, 2018

 

 

 

The Third Circuit Court of Appeals, in Krash v. Reliance Standard Life Insurance Group, has upheld a district court's determination that a long-term disability ("LTD") policy provision that limits benefits for disabilities caused or contributed to by mental disorders is valid and enforceable against the plaintiff because she could not prove that the disability was solely due to her physical condition.

 

Background. In Krash, the plaintiff stopped working in May 2010 due to a back problem and filed a claim for LTD benefits. The LTD policy limited benefits for disabilities "caused by or contributed to" by mental or nervous disorders, to a maximum duration of 24 months.

 

The insurer proceeded to pay LTD benefits to the plaintiff for four years and then requested that she undergo an independent medical examination. The independent medical examiner determined that the plaintiff's disabilities were partly psychological in nature and that she was capable of sedentary work even with her physical condition. As a result, the insurer terminated the plaintiff's payment saying she was subject to the 24 month limit for disabilities involving mental disorders.

 

In response, the plaintiff sued the insurer in federal district court. Upon hearing the matter, the district court found in favor of the insurer, and the plaintiff appealed the decision to the Third Circuit Court of Appeals.

 

Third Circuit. In reviewing the case, the Third Circuit first noted that the LTD policy's language was clear that in order for the plaintiff to remain eligible for benefits beyond 24 months, she was required to "prove that she was totally disabled from any occupation solely due to a physical condition." Next, the Third Circuit explained that the terms of the policy's mental disorder limitation meant "that benefits may be terminated when physical disability alone is insufficient to render a claimant totally disabled." Therefore, because the record reflected that the plaintiff was capable of sedentary work even in view of her physical condition, the Third Circuit upheld the district court's determination that the insurer did not abuse its discretion in concluding that the mental disorder limitation applied to the plaintiff's claim.

 

 

 

 

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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.