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August 2009 Archives

Cigna's Structural Conflict Will Now Be Scrutinized

An appeals court held this month that even though Cigna's plan administrator had discre-tion to decide questions of eligibility for long-term disability benefits, remand was appropriate to allow the district court to determine how heavily the administrator's structural conflict weighed in the abuse-of-discretion balance.In this case the claimant, "Edward," suffers from a number of degenerative conditions in his right foot, and especially in his great right toe. In 2003 he stopped working because of the severe pain that these conditions cause. Edward initially received long-term disability benefits under his employer's group benefit plan, which is insured by Cigna Life Insurance Company of New York. However, two years later Cigna determined that he no longer qualified for benefits because he could not meet the plan's requirement of showing that his disability prevented him from performing any job. Edward brought suit under the Employee Retirement Income security Act of 1974 ("ERISA"). The district court concluded that Cigna did not abuse its discretion in discontinuing Edward's benefits and granted Cigna summary judgment. The Court of Appeals however applied the Supreme Court's recent pronouncement in Metropolitan Life Insurance Company v. Glenn, advising courts to take cognizance of structural conflicts in ERISA cases.

Replacing the DOT

Social Security currently relies on the Dictionary of Occupational Titles for its analysis of potential jobs in the national market related to a claimant's ability to perform a job. This reference however is woefully outdated and the Administration has concluded that it needs to rely on a more current resource.

District Court Shares The "Love" With Our Disabled Client

Our client, "Jim" received good news yesterday when the Court ordered Unum to fix its decision that had denied his long-term disability benefits. Our firm sued Unum when it refused to pay Jim's long term disability benefits under the policy it issued to Jim's employer, Trek Bicycle Corporation.

Substantial Gainful Employment

In order to be disabled, a claimant must be precluded by their medical condition from engaging in substantial gainful activity (SGA). In more common terms, SGA means substantial gainful employment, or the ability to be a reliable, productive employee. The consideration is whether the claimant can be relied upon to show up to work on time on a regular and continuous basis and perform the essential functions of the job (with or without accommodations) over a sustained period of time.

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