Long Term Disability cases from around the country offer insight into arbitrary and capricious review in the court system. Here, we dissect one case and how it can impact your LTD claim.
As part of my continuing legal education, I routinely review all cases that might impact the law as it applies to my clients for either Short Term Disability or Long Term Disability (LTD) claims.
All claims involving group disability policies through an employer are governed by the federal statute called ERISA (Employee Retirement Income Security Act). As it is a federal statute, I review all of the cases that come out of the United States Supreme Court, the 11th Circuit Court of Appeals sitting in Atlanta (where my clients’ appeals would first go), and then all of the local District Courts sitting in the 11th circuit, including Florida, Georgia, and Alabama.
Mistarz v. Reliance Standard Life Ins. Co.
One case I recently came across greatly interested me. I was initially intrigued because the Claimant won. I like to review those Long Term Disability cases in detail because I always look for any angle to support my clients’ claims. It can also show how egregiously some insurance companies can behave, in this case, Reliance Standard.
The case is cited as Mistarz v. Reliance Standard Life Ins. Co., Docket No. 3:21-cv-466-TJC-LLL (M.D. Fla. 2023). In this Long Term Disability case, Reliance Standard forced the matter through a final determination by the Magistrate Judge. The Court found that the three jobs supposedly identified as ones Mr. Mistarz could perform were found to be clearly outside of his work capacities. Reliance Standard maintained its position even though its vocational rehabilitation specialist acknowledged that the jobs were unsuitable.
Analyzing The Opinion
The way this opinion reads, it looks like the right hand was not communicating with the left hand. It seems so often that the claims representative thinks a claim should be denied and ignores all contrary information. Indeed, it is rare that we get any indication that the Administrative Appeals we submit in response to benefit denials are even reviewed. If we prevail, we are not informed of the precise basis for the reversal, instead receiving a letter telling us a check is on the way. Fortunately, we prevail on about 70% of our appeals.
When Denials Go To Court
On the appeals that are not successful, the denial rarely even addresses the issues we raised because they have no legitimate response. Unfortunately, this usually means we are off to the courthouse. To prevail, we must prove some mishandling of the type found in the Mistarz file. This is a tricky proposition given that the Court is required by law to give the adverse benefits denial deference, meaning it is presumptively correct. This is an onerous burden of proof to carry.
Our Legal Team Can Help
If you have any questions about your Short Term Disability or Long Term Disability claim, please contact Herbert M. Hill, P.A. We would be glad to answer any questions you may have. We are a law firm located in Orlando, Florida, with a practice extending throughout Florida.
