SMDA was fortunate enough to receive another favorable decision from the federal court finding that the Long Term Disability insurer again wrongfully denied our client’s claim for benefits.
In Deloach v. The Great Atlantic & Pacific Tea Company (A&P) the Judge reversed the claims denial decision finding that the client was disabled as a result of his medical condition. The Court rejected the Defendant’s request to review the case utilizing a discretionary standard of review. Instead, the Court agreed with our argument that the plan documents failed to properly assign any discretionary authority to the entity that actually made the claims denial decision. (Cigna) This is a prime example of why obtaining the proper standard of review is absolutely critical in a case for ERISA governed LTD benefits.
This is the second time this matter has been litigated as the Defendant’s initially denied the claim during the “own occupation” benefit period. SMDA had previously brought suit and convinced the Court to reinstate benefits. The Court ordered a remand for consideration of benefits during the “any occupation period.” This second suit was instituted when the claim for “any occupation benefits” was denied.
Here is a link to a discussion of the decision.
For a more detailed discussion click here.