Sisung v. UNUM Life Ins. Co. of Am., 2022 U.S. App. LEXIS 15028 (11th Cir. June 1, 2022) Review of benefit denials under an arbitrary and capricious standard often presents a significant hurdle to claimants. In Sisung, however, the Eleventh Circuit found Unum’s denial of disability benefits to be unreasonable, a significant victory for a disabled individual.
ERISA and Employment Musings
“ERISA is not, however, all sunshine and lollipops.”
-Baker, James P. and Garcia-Yow, Emily L. “The Nuts and Bolts of Severance Plans under ERISA,” BENEFITS LAW JOURNAL, VOL. 28, NO. 2,, P.4 (SUMMER 2015)
A recent decision from the Fourth Circuit indicates that, even under an abuse of discretion standard, one flawed medical report can taint the entire “deliberate, principled reasoning process” that is required under ERISA. Further, a claimant cannot be required to exhaust conservative treatment options before undergoing surgery if that is not an explicit term in the applicable plan. Finally, a plan that continuously errs in its decision-making process may be denied remand, even where there is no evidence of bad faith. In short, three strikes and you’re out.