Blogging Employee Benefits

January 20, 2006

Reinstatement of LTD Benefits Affirmed

Filed under: Litigation — Fuguerre @ 6:28 pm

“Significantly, the evidence contained in the administrative record shows that defendant ignored reliable medical evidence proffered by plaintiff.”

The 6th Circuit Court of Appeals has affirmed a district court ruling reinstating long-term disability benefits and insurance benefits, including past due benefit and accrued interest plus reasonable attorney fees. [Evans v. Unumprovident Corp., CA6, No. 05-5154, 1/20/06] Granting plaintiff’s motion for judgment on the administrative record, the court determined that defendant’s decision to terminate LTD benefits was arbitrary and capricious.

Evans was granted LTD benefits after suffering increasingly debilitating epileptic seizures. Under her employer’s welfare plan, she also received life insurance benefits with a waiver of premium guarantee. Unumprovident, which provided the LTD benefits for her employer’s benefit plan, continued monitoring Evans’ condition and eventually terminated the LTD and premium waiver benefits, largely on the basis of reports prepared by a Unumprovident in-house physician. Finding no evidence that Unumprovident had reasonably taken into account the medical evidence provided by Evans, both the district and appellate court ruled the benefits were wrongfully terminated.

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