How hard can ERISA really be? Are long-term disability carriers really that aggressive? I paid a premium so surely if the insurance company sees my medical records, my claim will be paid, right?

These are very common questions people ask when they find themselves too sick or hurt to work. Mr. Madrigal, in a recent case, found out just how hard ERISA can be.

He developed back problems and could not perform his customer service position. He could not sit down all day to work. It just hurt too much. It can be very hard to focus when in pain or when on pain medication. The long-term disability carrier, Liberty Life Assurance Company of Boston, refused to pay the disability claim. It hired two doctors who merely looked at his records and opined that he could still work a sedentary job.

Generally, medical records do not reflect the degree of pain that an individual is experiencing. They are not composed for that purpose. All can agree as well that every individual experiences pain to a different degree. So how could they know this?

In this instance, it was undisputed that the plaintiff could not sit for an entire shift at his computer terminal. Since Liberty Life would not pay Mr. Madrigal was forced to file a lawsuit. The court, however, stated that it did not matter that Mr. Madrigal could not sit, because as long as he could see the monitor and talk on the phone, he could be reclining.

So, because it might be possible for Mr. Madrigal to “lay down on the job” and work the claim would not be paid. I wonder how many employers are going to spring for a bed and work set up for this? Employers beware… a claimant who is told by an LTD carrier that he can work lying down may seek an accommodation which this court and Liberty Life thought was entirely possible.