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What Does a Pop Band & ERISA Have in Common?

Posted by David P. Martin | Sep 09, 2017 | 0 Comments

They were both in a recent case opinion written by Magistrate Judge Jonathan Goodman in Johnston v. Aetna Life Ins. Co., 2017 WL 4654431(M.D. Fla. 2017).

Judge Goodman pulled lyrics from No Doubt's song “Don't Speak” to illustrate the Plaintiff's case wherein he was seeking an explanation as to exactly why his claim for long term disability benefits has been rejected.

“In their song ‘Don't Speak,' the rock band No Doubt sang the following lament about being rejected: ‘Don't speak / I know what you're thinking / I don't need your reasons / Don't tell me cause it hurts.' But in the instant case, the Plaintiff urges a completely contrary theme: he wants to know why he was rejected.”

A common problem in ERISA cases is that little information is provided by insurance companies as to why they have rejected a claim. In particular, Aetna has been chastised before for using boilerplate language to deny a claim. In Helms v. Gen. Dynamics Corp., 222 F. App'x 821, 830 (11th Cir. 2007), the Court found that

“No reasonable interpretation of Aetna's plan documents permitted Aetna to send boilerplate letters that did not sufficiently disclose Aetna's reasons for the denial of Helms's STD claim.”

In this case, not only had Aetna failed to provide clear enough reasons as to why it denied Dr. Johnston's disability claim, but in litigation, it had also wanted to deny discovery and require the Court to make a decision on what it had compiled and considered to be the administrative record.

One of the key issues regarding discovery pertained to the attorney-client communications between Aetna and its attorneys before the lawsuit was filed as well as communications after the lawsuit was filed but before the final decision was made. Since the attorneys were supposed to be representing the plan, which is to be operated in the interests of participants and beneficiaries, the Court easily permitted discovery regarding communications between Aetna and its attorneys before suit was filed. The Court also permitted discovery and agreed to conduct an in camera inspection regarding attorney client communications which occurred before a final decision was made and after a lawsuit was filed.

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David P. Martin

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