Under ERISA, at what level is a disability claim simply not worth pursuing? A case is more than a fee to us. Watch this week's client story.
Every job is physically demanding in some way, but some are more challenging than others. Work in the textile industry has its unique demands. Shortly after finishing high school, Ellie started working in the textile industry. She was young and physically fit, so the hard work did not bother her in the least. She ran a weaving machine on a factory line. She had to periodically pick up and move heavy bolts of material that were being woven into fabric. She stood on her feet the entire shift as she tended to the machine. She did this for many years.
Her employer, knowing this was hard work, provided some good benefits, including a long-term disability benefit. That benefit was 60% of Ellie's wage if she could no longer work in her own occupation. After two years, it would pay 60% if she could not perform any occupation which she was trained to work or could be trained to work. This was supposed to continue until she reached the retirement age of 67.
Standing on concrete for 20 years took a toll on Ellie. She developed osteoarthritis in her knees and problems with her veins. She also suffered from degenerative disc disease in her back and torn ligaments in her knees. At 56, Ellie could no longer continue as she had for so long. Her doctor told her to stop working. At first, she ignored him. But her body wouldn't let her for long.
She ultimately filed a claim for short-term disability benefits. That would pay for about six months until her long-term disability benefit started. She filled out the forms for short-term disability and provided the insurance company with releases so that they could obtain her medical records. She was paid with no problem. Her long-term disability kicked in when the short term expired.
Then her long-term disability carrier told her she must apply for Social Security disability benefits. Ellie resisted because she did not want welfare. She paid for this long-term disability benefit to keep her from being a burden to anyone including the government. The long-term disability carrier explained that Social Security disability is not welfare, but rather a benefit for which Ellie had also paid.
Ellie filed for Social Security disability. About 80% of Social Security benefits claims are denied on their initial application. The Social Security Administration paid her disability claim on her initial application. Her long-term disability benefit was reduced by her Social Security.
After about eight years, the insurer decided to review Ellie's claim to determine whether she was still disabled. It selected a doctor to examine Ellie and review her claim. He determined that Ellie was no longer disabled and was fit to return to work. Ellie hadn't experienced a miraculous recovery. She suffered from the same conditions as when she became disabled. The insurer simply wanted to save money by employing a doctor who would give them what they wanted.
Ellie hired us. We challenged the insurer's determination. ERISA makes such challenges very difficult. Hers was not a big case because of her age and the wage she was earning when she became disabled. But we took the matter to court anyway. Although some judges don't seem to care when an insurer reverses course after paying a claim for eight years, some do. Ellie finally received a little bit of justice, which was a big deal to her.
Everyone deserves justice. Everyone should receive the benefits for which they have paid. For us, a case is more than a fee. It's righting wrongs and helping people get what they deserve.