Blog - ERISA and Disability Rights and Benefits - Alabama - The Martin Law Group, LLC

It is critical for attorneys to protect the religious freedom guaranteed in our Constitution and statutes. Under Title VII of the Civil Rights Act of 1964, (42 U.S.C. § 2000e, et seq.), religious discrimination claims generally involve two primary theories: failure to accommodate and disparate treatment. Let’s remember the fragility of the right to religious freedom. Regardless of your own religious belief, if the rights of some are not protected, it may impact your freedom as well. Protecting that right is up to each of us.

We all know that health insurance is very important and in fact many would not receive treatment but for having health insurance in place. Sometimes the medication or treatment may have been provided for years, only for subsequent treatment claims to be denied.  Denials can be vague such as “more information needed" or “no medical necessity” despite providing coverage previously. Confusion is the friend of insurers. If a claim is denied, both the insured and the medical provider need to do all necessary to immediately challenge that decision in a timely manner.  Further, both the provider and the insured should look for options to make the medication affordable.  Sometimes charitable organizations may help temporarily or even a pharmaceutical company interested in good public relations might help in the short term. Far better to live to fight the claim denial!

In the fairly recent case, Smith v. DeJoy, No. 4:23-cv-00593-RDP, 2024 U.S. Dist. LEXIS 227911, at *39-42 (N.D. Ala. Dec. 17, 2024), the court outlined the necessity of following the administrative procedures required of Federal employees making Title VII claims, and also discussed the elements that must be met for a good case. The added requirements of exhaustion are similar to the effort to inform a human resources department or other management of the issues and provide an effort to seek a resolution.

Have you ever reviewed a “medical” authorization an insurance company or plan requested you to sign? The authorization often allows the insurer or plan to obtain your consumer credit report, documents from any governmental agency, documents from your financial institution, and documents from any other person. Sometimes it may waive the attorney-client privilege. It may provide a right to obtain and report information from "the Medical Information Bureau Inc. (“MIB”). That may impact you for years to come. That should give you cause to pause.

A recent case demonstrates the need to be careful with what is on your tax returns and the information reported to a long-term disability insurer. This case also underscores the necessity of having counsel during the claim process to make sure that red flags are avoided on claimant questionnaires. A strong claim record makes a strong case.

In the recent case, Pavia v. NCAA, NO. 3:24-cv-01336, M.D. TN, Nashville Division, (December 18, 2024), the District Court granted a preliminary injunction to the Vanderbilt quarterback Diego Pavia allowing him to play football in 2025 to 2026. And so, we will see how Pavia leverages his employment opportunity. One thing is certain and that is he will likely enjoy a very handsome paycheck.

Those words, “is it time yet?” we hear frequently around the holiday season. For example, we hear that with children anxious to leave their beds and open presents on Christmas morning.  We hear that with children anxious to start a holiday celebration such as Hannukah. The same difficulty with patience is heard from kids during a long drive to an exciting destination with the words “are we there yet?” These comments also capture the impatience of attorneys who see unfairness in the law toward health claim clients. They see outrageous unfairness but pleas for changes in the law are ignored. With the death of an insurance executive again I ask again, “Is it time yet?”

When it comes to ERISA and subrogation claims, the subtleties of ERISA may lead to presumptions. That key is to carefully read exactly what the plan/policy says. Presumptions may cause an overlooking of rights.

The case is Hornady, et al v. Outokumpu Stainless USA, LLC, 2024 WL 4471161 (11th Cir. October 11, 2024), involved more than discovery games. Games were also played with the Fair Labor Standards Act (FLSA). This article will discuss some mentioned in the case which may assist in identifying wrongs when reviewing an FLSA matter.

You may recall from 2021, a nearly 100 page Fair Labor Standards Act (FLSA) case opinion from Judge Beaverstock in the Southern District of Alabama sanctioning defendants with a default judgment for refusing to cooperate with discovery.  Of course an appeal of the $13.1 million default judgment followed and now the 11th Circuit has affirmed that decision for the most part and remanded on the statute of limitations issue. The case is Hornady, et al v. Outokumpu Stainless USA, LLC, 2024 WL 4471161 (11th Cir. October 11, 2024). 

In Baptist Homes, Inc. v. City of Madison, Civil Action 3:24-CV-92-KHJ-MTP (S.D. Miss. Oct. 2, 2024), the district court said an entity can assert a claim under the Americans With Disabilities Act (ADA). Baptist Homes is a nonprofit that provides support for those with intellectual developmental or other disabilities.

Accidental death insurance is very commonly offered in the workplace. It is usually "dirt cheap" but there may be a reason for that. The coverage may frequently be illusory, especially if there is language in the plan or policy which excludes coverage for any pre-accident condition which "contrib...

The case Roche v. TECO Energy, Inc., No. 8:23-CV-1571-CEH-CPT, 2024 WL 3966067 (M.D. Fla. Aug. 28, 2024) portrayed ERISA yet again as one of the most “snakey” statutes.  Mr. Roche had worked for years at a power company and was counting on his pension for retirement. He read his summary plan desc...

Remember this article from January 23, 2024? Do Non-Compete Agreements Really Reduce Workers' Wages, Stifle New Businesses and New Ideas, Exploit Workers and Hinder Economic Liberty? The FTC had put out a fact sheet to pave the way for its rule change anticipated a few months later in April. Then...

Many people have the impression that it is illegal to be terminated while out on disability. That is not exactly the case in non-union employment in Alabama, Georgia, and Florida.  An employee can be fired for any reason (unless protected by other law) and the employee can quit for any reason. S...

Can the Military Discriminate? Intuitively, one would assume that the military cannot discriminate if a private employer could not under 42 U.S.C. § 2000e-2 (Title VII).  However, the definition of an employer at 42 U.S.C. § 2000e (b) does not apply as it excludes the United States. Another prov...

When you no longer can work due to a physical or mental conditions, it is disheartening when the insurance company, which may have received disability premiums for years, refuses to pay your claim or terminates it after paying a while.   Since you cannot work, you lack resources to hire an attorn...

Many people are covered by accidental death insurance in the workplace. A claim on such a policy will often be refused...one has to wonder how far courts will take this opinion.

Last time, we discussed the need to utilize the class-action in the employment context, and we went over the four basic prerequisites. This time, we will look at the three paths to success for class-action in the employment law context.   The first path has two parts – an A and B part. Both opt...

Can a class action arise in the employment law context? Indeed, it can. It is not uncommon, in fact, when there is a breach of fiduciary duty, which impacts a large number of people in the ERISA context. For example, if there is a failure to provide pension benefit statements to all pension parti...

Many claimants wonder can an insurance company rely on a nurse to overrule a physician opinion? This is a matter that needs to be changed. What should occur given that there are deadlines with claim decisions is that past benefits should be paid and Unum should be permitted to evaluate the claim going forward. Otherwise, the minimum standards of a full and fair review under the claim procedure and the plan in question, is still not satisfied as the decision is being made out of time.

If you are sick or injured and not able to function, is the fact that you are not getting better a reason to find you can return to full-time employment? Unum thinks so. Ms. Proctor was a telephone call center supervisor, when the vehicle she was driving was struck from the rear by another vehicle driving about 50 miles an hour. She thought she was fine at the accident scene, but later she developed a headache and began to experience dizziness. This led to difficulty with concentrating and completing paperwork and eventually her vision was blurry. The court found that de novo review was the correct standard to use. Under that standard, the court ruled for Ms. Proctor and ordered past due benefits paid with interest, and awarded attorney’s fees and costs, and ongoing consideration of the claim. One has to wonder if the outcome would be the same under the arbitrary and capricious standard of review.