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)
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.
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.
Pridgen Bassett Law is committed to answering your questions about your ERISA or employment disputes. While located in the metro Atlanta area, our practice spans nationwide.
We'll gladly discuss your case with you at your convenience. Contact us today to schedule an appointment.