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

Artificial Intelligence (AI) can be a very useful tool, but it does not replace the necessity of independent judgment by an attorney. A recent case demonstrates the significance of this danger. There was a lot of misconduct besides just AI here. But the opinion does significantly ratchet up the concern of AI in the practice of law. 

In a very recent case, a supervisor's hiring of a disabled lady, who later requested an accommodation involving a service dog, led to the supervisor’s termination.  For now, supervisors need to beware.  You could create liability for the employer for refusing to hire a disabled employee, but if you do hire a disabled employee, you could be fired as a result. Supervisors can be stuck in the gap with no federal case.

Life insurance is a very common benefit offered in the workplace, but one with dangerous pitfalls. Rescission can be used as a tool for post-claim underwriting to save the insurer advance underwriting expense. As to beneficiaries faced with a rescission response to a claim, they should request the application and the recorded conversation and review it. There may not have been a clear “no” response or it may be confusing. There may be a case counsel can assist with.

There is a general impression that federal employee benefits are great. Many employees jump at the chance to be a federal employee often because of the benefit packages available. However, some of those benefits such as Federal Employee Group Life Insurance (FEGLI) may be illusory (A/K/A “junk”). In fact, some might say this benefit is a waste of taxpayer dollars and a means to pad the pockets of insurers like MetLife. Survivors of deceased federal employees agree. FEGLI participants beware. The coverage you think you have may just be an illusion. Based on the cause of most accidental deaths (falls and motor vehicle accidents) you likely have no coverage at all. 

Several times every year I hear from a concerned son or daughter complaining that their parent has Alzheimer's disease and cannot effectively communicate. The parent worked for decades for a pension, however, the company closed, and no pension was ever received. So how do you find a lost pension? Options to exercise self-help to find the ever-elusive lost pension.

When a state raises the minimum wage above the federal minimum wage, which 30 states have now done, some questions can be raised by the employee over whether the compensation received is proper in certain circumstances. For example, what if the employee is paid on a commission?  Does the commission received have to exceed the state minimum wage or the federal minimum wage?  Also, can an employer count tips as commissions for that calculation? Minimum wage issues raise an interesting question for Alabama. If the state is to compete with 30 other states, and especially those states nearby, should it raise its minimum wage level?

Failure to furnish evidence of insurability (EOI) has long been a means for insurance companies to avoid payment of claims.  That is especially the case with group insurance typically governed by ERISA.  EOI is an issue when someone seeks to obtain group insurance above certain levels or applies for group insurance after the open enrollment or commencement of employment. It is understandable that the insurance company does not wish to take on coverage for an undisclosed risk, such as a recently arising physical issue. Fair enough. While the EOI defense has been increasingly used, it also appears that there is push back on that, when equitable issues arise. Challenging the EOI requirement because of a breach of fiduciary duty has strict time limits that run upon knowledge of unfairness or when it should have been reasonably known. The EOI game is an old one, but it can be tricky to play. Watch for it and take action sooner than later.

If you are receiving long-term disability benefits, rest assured that your insurance company is most interested in what you are posting. And if you post the wrong thing, that may well end your benefit. So, what is the best advice here when it comes to social media? Avoid giving the insurer a reason to go after you. On social media talk about others, the weather, or local matters, but don’t talk about you.

Sometimes a Supreme Court opinion is taken in the wrong direction by lower courts. McDonnell Douglas Corp. v. Green, 411 U.S. 792 (1973) is an example.  In that case, the Supreme Court considered a discrimination case after being dismissed. The dismissal was reversed and Mr. Green was allowed to proceed. However, the language has been, at times, unclear to many courts. It no longer appears that McDonnell Douglas in this Circuit has the force of Rule 56. It is dead for that misconstrued purpose.

Reliance Standard Life Insurance Company (Reliance Standard) says “yes” it can use the “symptom net” to deny claims, but fortunately the 11th Circuit recently said “no”. Most have heard of a preexisting condition exclusion in a disability policy. But Reliance Standard goes further than just looking at diagnosed conditions. It interpreted its long-term disability policy’s preexisting condition exclusion to include preexisting symptoms regardless of their cause.  For now … contract language matters. And a “symptom net” is not allowed to substitute for a “condition net” exclusion.

On occasion, people insured by a health plan may require emergency or non-emergency care, without the ability to consent to that care. One instance may be when the person is unconscious at the scene of an accident and has to be airlifted to a hospital. If the air lift service is not in network or not covered, an astronomically large bill may surprise the patient later.  The Department of Labor calls that surprise billing.

One of the most potent and frequently raised defenses in ERISA cases is failure to exhaust claim remedies. There is unfairness in ERISA, and this is one of those instances. Requiring the assertion of a breach of fiduciary duty claim before the very people charged with the breach – is contrary to fairness and ethical principles

The Fair Labor Standards Act answers that question with its regulation 29 C.F.R. § 785.19. It explains “Bona fide meal periods are not worktime.” But what makes a good case? The answer will turn on the facts of the specific case and the circuit in which the case is heard.

You finally see your discrimination case resolved and you ask, “Am I going to be taxed on all of this?” Some may ask further, “Can I deduct attorney's fees if I am taxed?” Of course, if your litigation lawyer is not a tax attorney the response is typically "I am not a tax attorney so I cannot tel...

A recent case, Stewart v. Nissan N. Am., Inc., No. 22-cv-4734, 2025 LX 472669 (N.D. Ill. Sep. 19, 2025) reminded that moving too slowly in filing a timely EEOC charge can reduce your claims and chances of success. If you want to press an age discrimination claim don’t hesitate too long. Otherwise, you may narrow your case. There are no exceptions to the time limit for uncertainty, fear, or age.  Make sure you contact the EEOC with the complaint within 180* days of the first event involving discrimination if in Alabama and many other states. In Alabama there is no entity to hear your charge other than a court, so the time limit is 180 days rather than 300 days. This was an Illinois case so given state law the longer time frame is applied.

What is a Top Hat plan?  It is an ERISA plan which is maintained by an employer but is unfunded. The 11th Circuit however pointed out that when the plan document is unambiguous, the plan terms will be enforced as written since there is no room for the exercise of discretion when clarity exists.

Many clients are shocked to learn that in a personal injury settlement, a medical benefit paid by the insurance company which relates to the injuries suffered now must be paid back to the insurance company out of the personal injury settlement. The insurer or claims administrator must seek "appropriate equitable relief". Thus, if it is expanding its interpretation of the plan document beyond what is fair and reasonable, that likewise may run afoul of the insurer acting equitably.

You undergo the treatment. You start receiving big bills for the care. How can this be? You thought the plan was to pay in-network. What happened? You are being balanced. So, can they do that? Most, if not all states have laws on what is reasonable as to medical charges. In Alabama, there is case law prohibiting charges that are not fair and reasonable, or which exceed the usual and customary rates. See, Eufaula Hosp. Corp. v. Lawrence, 32 So. 3d 30, 36 (Ala. 2009). There is also the hospital lien statute. Alabama Code § 35-11-370. So you can be balance billed, but the charges generally must be fair and reasonable or usual and customary and arguably so must the payments made.

The answer to that may be yes and perhaps no. The recent case  Barney v. Goldoro Devs., Inc., No. 23-CV-81007-RLR, 2025 LX 16394 (S.D. Fla. May 21, 2025), addressed that issue, and serves as a warning to exempt employees. Thus, exempt employees need to be very careful regarding terms of employment as the FLSA may not provide any protection, and a breach of contract claim may not allow an award of attorney's fees as here.  So, can an employer refuse to pay your last paycheck and vacation time?  Yes, under the FLSA and perhaps no under breach of contract. 

Rubin v. Life Ins. Co. of N. Am., No. 24-10433, 2025 LX 226141 (11th Cir. Mar. 4, 2025) reminds of the danger of not being permitted any discovery during litigation if the arbitrary and capricious standard of review is applicable. There are a number of strategy decisions that must be made during the claim process if the arbitrary and capricious standard of review controls.  Otherwise, there may be no discovery.

Yes. And that is hard for a fired employee to hear. Employment lawyers regularly receive calls from an outraged employee who was terminated for reasons that were not true. While certainly a reason for righteous indignation, unless the termination is motivated by unlawful discrimination or retaliation, it is legal to fire an employee for false reasons. In the end, it remains that you can be terminated for false reasons. We all can sympathize with being accused wrongfully, however, that alone does not make a case of wrongful termination. There must be proof that the reasons are a pretext for unlawful discriminatory or retaliatory conduct.

This Chapter discusses litigation concerns that can arise with disability policies, including Entire Contract, Merger Clause, Discretionary Authority, Jurisdiction and Venue, Legal Action Limitation, Next of Kin and Estate

Let's say you started working for a job that had an excellent benefit package. And one of the key benefits was that you received health insurance up to age 65, if you retired with 25 years of service or if you had to retire earlier because you are disabled. But then let's say that the employer decided, after you had been working a few years, that it would change that policy and limit health insurance benefits for those disabled to twenty-four months rather than up to age 65.  Can it do that given the Americans with Disabilities Act bars discrimination? That sure sounds like discrimination against those disabled. The Supreme Court recently said “yes” the employer can legally do that without running afoul of the ADA. In the end, what remains clear is that the ADA doesn’t protect welfare-type (e.g. health, disability or life insurance) benefits for retired and disabled employees who may be dependent on them. (Neither does ERISA for that matter.) It also remains clear that employers may take away such benefits as a cost-saving mechanism notwithstanding assurances made when the employee entered into employment. Generally, protection may be extended under ERISA if promises are made in plan documents that the benefit is vested and will never be taken away.   That will be rare.

Chapter 7 discusses common return to work issues, such as Recurrent Disability and Waiver of Premium.