What Changes Will the Tenth Circuit’s Decision in Van Steen v. Life Insurance Company of North America Bring to ERISA Litigation?

Like many cases brought under the legal provisions of the Employee Retirement Income Security Act (ERISA), Van Steen v. Life Insurance Company of North America (LINA) began when Mr. Van Steen’s long-term disability insurance company, LINA, wrongfully terminated his long-term disability benefits. The judges eventually agreed with Mr. Van Steen and reinstated his long-term disability benefits, but it’s important to understand the history of his case and the state of American individual and group disability insurance law.

The United States is a common law country, so many of our laws are interpreted, applied, and even created by judges. In other words, how our judges apply statutory laws, such as the ERISA statutes passed by Congress, to the facts of a specific disability case, can become law. The decision of a high-level federal court, such as the United States Court of Appeals for the Tenth Circuit, often becomes binding on lower courts in the circuit and respected by courts around the nation.

Our common law system for individual and group long-term disability law is always changing. Some legal arguments that work in one jurisdiction will not work in another. Accordingly, if your individual or group long-term disability insurance benefits were wrongfully delayed or denied, always contact an experienced long-term individual disability lawyer or group ERISA attorney at DarrasLaw. We do one thing, and it’s individual and group disability insurance law.

Our award-winning ERISA lawyers and individual disability attorneys are constantly monitoring changes in individual and group long-term disability case law and legislation to ensure we’re at the forefront of our field. With more than 100 years of combined individual and group long-term disability insurance litigation and claim experience, nationally renowned disability lawyer Frank N. Darras and his firms have recovered nearly $1 billion in wrongfully delayed and denied insurance benefits. Call us today to schedule your free, confidential policy analysis and free claim consultation at 800-898-7299 or contact us online.

Group Administrative Appeals and Disability Litigation Under ERISA

ERISA is a set of complicated federal laws that govern the majority of employee benefits plans in the country, including health, retirement, and group or employer-sponsored disability insurance plans. If you have group long-term disability insurance through your employer, union, or professional association, you likely have an ERISA plan.

Individual disability policies—those you select and purchase out of your own pocket from an agent or broker—are generally not governed by ERISA and carry superior consumer rights and outstanding legal remedies.

Although ERISA has its benefits, such as requiring your disability insurance carrier to provide you with information and make financial disclosures, it has many more major downfalls. You have far fewer legal rights and consumer protections under ERISA than individual disability policyholders:

• You have no right to a trial by jury
• You have no right to discovery
• You may not call any witnesses to testify
• You cannot receive emotional distress, punishment, or attorney fees

If your group long-term disability insurance benefits are wrongfully delayed or denied under a group ERISA plan, you must file a timely, comprehensive administrative appeal with your disability insurance carrier first. Any future litigation is generally limited to a review of the administrative appeal and the underlying claim. You must submit a legally sufficient, persuasive administrative group disability appeal if you hope to prevail.

Van Steen v. Life Insurance Company of North America (LINA)

If your long-term disability insurance benefits are formally terminated after an administrative appeal, you may file an ERISA lawsuit federal district court. The judge will typically decide the case on cross-motions for summary judgment, and the losing party has the right to appeal its case to the applicable federal court of appeals. This is what happened in Van Steen.

Sadly, Mr. Van Steen suffered a traumatic brain injury when he was attacked while walking his dog. He was employed as an analyst at that time, and he had an ERISA long-term group disability insurance policy through LINA. Mr. Van Steen received full long-term disability insurance benefits under his ERISA governed disability insurance plan for about a year. After this time, he was cleared to return to work part-time, but he still experienced cognitive impairments. He received partial long-term disability insurance benefits under his policy. Though his condition was listed as “not likely to improve,” his long-term disability insurance carrier terminated his disability insurance benefits because it believed he was able to work full time. After losing his ERISA administrative disability appeal, Mr. Steen took his case to federal court.

Both the Federal District Court and the Court of Appeals for the Tenth Circuit overturned LINA’s termination of Mr. Van Steen’s group ERISA disability insurance benefits. The courts held that the disability insurance company’s decision was arbitrary and capricious because the medical evidence showed that Mr. Van Steen was entitled to disability insurance benefits under the direct language of the long-term disability plan. His disability insurance policy actually stated that he was entitled to partial disability insurance benefits if he could not perform all of his material duties for an eight-hour day, something the disability insurance company’s doctors ignored.

The courts focused on vague conclusions of the “independent physicians” Mr. Van Steen’s long-term disability insurer used to support its wrongful termination of his group ERISA disability insurance benefits. The courts found that these insurance company-paid physicians came to no meaningful conclusions about Mr. Van Steen’s ability to perform the important tasks of his occupation full time, as required under the language of his ERISA-governed plan.

Instead, both the district court and Tenth Circuit reiterated what the parties already agreed to—that Mr. Van Steen could perform some of his work duties part of the time. The disability insurance company’s physicians listed none of the essential tasks of Mr. Van Steen’s occupation, nor did they explain how his injury would affect his ability to perform those duties reliably during an eight-hour day. Accordingly, Mr. Van Steen was entitled to disability insurance benefits under the direct terms of his disability insurance plan, which his long-term disability insurance carrier ignored.

The Importance of Calling a Top-Rated ERISA Attorney or Individual Disability Insurance Lawyer From DarrasLaw After Van Steen

Know your individual or group disability insurance company is trying to save money by not paying out disability insurance benefits and many individual and group long-term disability plans contain provisions allowing you to receive partial disability insurance benefits for part-time work. Van Steen is important because it both reiterated Mr. Van Steen’s right to partial disability insurance benefits and criticized the insurance company’s so-called independent insurance physicians for failing to make any medical conclusions that actually supported the application of the disability insurance policy’s provisions.

If your individual or group long-term disability insurance benefits were terminated after an “independent” medical examination or by a medical review company, call the top-rated long-term individual disability lawyers and group ERISA attorneys at DarrasLaw today. We will know how recent conclusions in Van Steen and other disability court cases might affect your case. To schedule a free, confidential disability policy analysis or claim consultation, call our office today at 800-898-7299 or contact us online.