Long Term Disability Success Story-Post 2

Author: Charles F. Fuller

When a client comes to our office with a long term disability issue, we analyze the client’s case and take action that is needed to protect the client’s rights. Our representation is tailored to the client’s specific needs.

Recently, a client I will call John came to our office. He had been on and off long term disability several times over the past half dozen years due to ongoing back problems. He had had multiple back surgeries by the time he came to our office and was unable to do much of anything at all, physically. When John came to us, his disability benefits had been terminated. He had prepared and submitted his own administrative appeal to the disability insurance carrier, and it had been denied. Further, he had asked the disability insurance carrier to reconsider his appeal, and they denied that as well. The long term disability policy had a very short, one-year statute of limitations provision which was quickly approaching. In reviewing John’s case, it was apparent that John did not provide sufficient medical documentation to support his claim for ongoing disability benefits. John knew how terrible he felt and could not physically return to his job because he was unable to do much of anything other than rest throughout the day. The disability carrier took a different view. John contacted our office and we met with John and his wife. He brought in some medical records and claim documents which were reviewed. It was apparent that substantial information and documentation was needed to pursue his case.

It was going to take some time to obtain John’s complete medical records. Since the statute of limitations was nearing, we prepared a complaint prior to the expiration of the statute of limitations and filed it with the United States District Court for the District of Maryland. We continued to seek out John’s medical records. After obtaining all of the records, reviewing and summarizing them, we reached out to John’s doctors and obtained detailed reports as to his specific physical limitations, the reasons why he was physically restricted and their opinions as to why John could not return to his regular occupation or any other occupation. We prepared a supplemental appeal and submitted this to the disability insurance carrier. After many months, the disability insurance carrier wrote to us and advised that it was refusing to consider the supplemental appeal. It was the disability carrier’s position that John had exhausted his administrative appeal rights and they did not have to further consider his appeal. Based upon the disability carrier’s position, we filed an amended complaint to bring all of this information before the court, including the supplemental appeal with the very supportive medical evidence demonstrating John’s disability.

In the early stages of the litigation, we advised the court that we thought it would be appropriate to have the case remanded, or sent back down, to the disability insurance carrier for its consideration of John’s supplemental appeal. The disability carrier refused to voluntarily undertake this review. We filed a motion to remand the claim back to the disability carrier, asking the court to order it to review John’s supplemental appeal. The disability carrier opposed that motion and also filed a motion for summary judgment, contending that as a matter of law, the court must uphold the carrier’s decision. We vigorously opposed this action taken by the disability carrier. Ultimately, the court ordered the disability carrier to review the supplemental appeal and denied its motion for summary judgment. Subsequently, the disability carrier upheld John’s supplemental appeal and restored his benefits.

The above situation is the reason why it is very important to have competent legal counsel representing you should you have a long term disability claim. Although you know how you feel and that you cannot perform your job duties as a result, that is often not enough to successfully obtain benefits. The federal statute governing such claims, the Employee Retirement Income Security Act of 1974, as amended, (ERISA), is a very technical statute, and knowledge of that statute and its procedural roadblocks is important. Having an attorney both knowledgeable and experienced handling ERISA claims is often essential in such cases. We would be happy to speak with you about your claim.

 

 

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Qualified Domestic Relations Order Victory

Author: Charles F. Fuller

Although our firm does not practice family law, representing individuals in divorces, adoptions or similar matters, we do practice in one very important area in that field. Due to our substantial experience with employee benefits and the Employee Retirement Income Security Act of 1974, as amended, (ERISA), we are often called upon to assist clients with Qualified Domestic Relations Orders (QDROs).

Our client, who I will call Ann, sought our assistance in protecting her rights to a portion of her ex-husband’s pension retirement benefit. Ann was married to Bill for over two decades. After Bill retired and began receiving pension benefits, they encountered marital difficulties leading to divorce. The parties live in a southwestern state, and through legal maneuverings by Bill’s attorneys, the state court held that Ann had given up her right to a survivor’s benefit of Bill’s pension retirement benefit. Ann did relinquish her right to receive a marital share of her former husband’s pension benefit during his lifetime in the Property Settlement Agreement between them. Bill’s employer subsequently went bankrupt. The bankruptcy employer’s pension plan was taken over by a federal agency, the Pension Benefit Guaranty Corporation (PBGC). The PBGC, in reviewing Bill’s pension file, determined that the state court order divesting Ann of her right to receive a survivor benefit in Bill’s pension and the state court’s entry of a QDRO in favor of Bill’s subsequent wife were invalid. The PBGC determined that Ann was the proper recipient of Bill’s pension benefit upon his death because the QDRO sought to provide a form of benefit not otherwise provided under the Plan; Ann’s survivor benefit irrevocably vested when the pension benefit was first paid to Bill and therefore was not waivable or assignable.

Bill initially brought suit against the PBGC in the United States District Court for the District of Columbia claiming PBGC had violated federal law. Subsequently, Ann was made a party to the litigation on the basis that she was an indispensable party. This allowed Ann to protect her own rights in the lawsuit. After Ann entered the case, Bill amended his complaint to add several state law claims against her.

Both Bill, on the one hand, and the PBGC and Ann on the other hand, moved for summary judgment in the trial court. The District Court agreed with the PBGC and Ann that Ann could not have waived her right to Bill’s survivor pension benefit through the state law QDRO because her benefits irrevocably vested after Bill began receiving benefits and therefore were not waivable or assignable. The trial court also dismissed the state law claims against Ann because ERISA, the federal statute governing pensions, preempted state law. Bill disagreed and appealed to the United States Court of Appeals for the District of Columbia.

In the appellate case, the PBGC was dismissed as a party, leaving Bill and Ann as parties to the appeal. We successfully argued to the Court of Appeals that the federal statute, ERISA, preempted the state law relied upon by Bill and invalidated the QDRO. The Court of Appeals agreed with our position. Further, we argued that contrary to the state court’s determination, Ann could not have waived her right to the survivor pension benefit through a QDRO because her benefits irrevocably vested upon Bill’s receipt of pension benefits and therefore Ann could not legally waive or assign those benefits to either Bill or his new wife. The Court of Appeals agreed with our position and ruled in favor of Ann. Bill did not seek to appeal the case to the United States Supreme Court, and therefore the Court of Appeals’ decision was final in favor of Ann.

The importance of Ann’s case, besides the substantial monetary benefit she may recover after Bill’s death, is that it is extremely important for a spouse to protect his/her rights to a former spouse’s pension benefit at the time of divorce. By obtaining a properly drafted and entered QDRO shortly after a divorce is finalized, a spouse can protect his/her federally protected rights without the resort to litigation. This was not done in Ann’s case. The litigation to prevent Ann from receiving her federally protected right to Bill’s pension benefit after his death was filed a year or two after the divorce. It wasn’t until more than a decade later that her rights were finally protected. Addressing this issue head on, close in time to the entry of the final divorce decree can avoid much heartache and expense. We are often called upon by clients to prepare QDRO’s to protect their rights to a former spouse’s pension. We would be happy to assist you should the need arise.