Disability Benefit Claims Law Blog : Disability Benefits Lawyer & Attorney : Dell & Schaefer : Disability Insurance Claims Law Blog

Attorneys Dell and Gavidia filed suit against Federal Express (“FedEx”) on behalf of their client, Richard Bilheimer, in Palm Beach County Circuit Court, alleging that their client’s former employer Federal Express had breached the terms and conditions of the Federal Express Short-term Disability Plan by denying Mr. Bilheimer’s claim for disability benefits. Moreover, FedEx prevented Mr. Bilheimer from applying for long-term disability benefits as a result of denying his claim for short term disability benefits. Shortly after the lawsuit was filed in state court, FedEx removed the case to the U.S. District Court for the Southern District of Florida, arguing that the short-term disability plan was an employee welfare benefit plan governed by the Employee Retirement Income Security Act (“ERISA”), a federal law which governs most employer provided disability, health and life insurance plans.

Attorneys Gavidia and Dell moved to remand the case back to state court and claimed that the short-term disability plan fell within the “payroll practice” exception of 29 C.F.R. § 2510.3-1(b)(2) and was not governed by ERISA. Attorneys Gavidia and Dell also moved to recover attorney fees and costs against FedEx.

U.S. District Judge Kenneth Marra ruled in favor of Mr. Bilheimer, concluding in part, “[t]hat the payroll practice exception to ERISA applies and that remand is appropriate….” The opinion issued in this case is a precedent setting case that will set new standards for the way group disability plans are structured by employers. A claimant is always at a disadvantage if their claim is governed by ERISA, therefore Attorneys Dell & Schaefer are always challenging the applicability of ERISA in all disability insurance claims. Fedex offers short and long-term disability insurance as an employee benefit for thousands of employees. This case is currently pending in Palm Beach County Circuit Court.

For additional information please contact Attorneys Dell & Schaefer at 800-828-7583.
 

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Prior to September 11, 2001 our client, Mr. B, was a government securities repo trader. His office was located on the 26th Floor of Tower 1 of the World Trade Center. On the morning of September 11, 2001, Mr. B reported to work at his brokerage firm and started his day buying and selling government securities for his commercial clients, institutions such as Bank of Tokyo and Lehman Brothers. At around 8:45 a.m., Mr. B and his co-workers heard a loud explosion and felt the building shake, ceiling tiles began falling in Mr. B’s office and thick smoke filled the hallways and stairwells. Fifty minutes later, after descending 26 floors of smoke, heat, and chaos, Mr. B was out of Tower 1. Mr. B’s life was forever changed that day and nightmares of his escape would haunt him for years.

Mr. B, like many of his co-workers, returned to work, this time across the river in New Jersey with an unobstructed view of the altered New York City skyline. For two years following September 11th, Mr. B reported for work despite battling daily depression and severe anxiety resulting from Post Traumatic Stress Disorder. He was no longer the same person. Mr. B’s medical condition made it difficult for him to work. The nightmares were daily and he was finding it impossible to effectively perform his job duties in the high stress and cut throat trading pit in which he worked. Mr. B sought help from mental health experts, but despite his treatment, his symptoms continued to worsen to the point that he was forced to stop working and file for long-term disability benefits with his disability insurance carrier. Mr. B had purchased his long-term disability policy from his insurance agent approximately 10 years prior to his date of disability.

In 2003, upon review of the abundance of medical support from his therapist and treating psychiatrist, his disability insurer determined Mr. B was totally disabled and began paying benefits. For approximately three years, Mr. B’s long-term disability insurance carrier paid him without any problems. Shortly thereafter, Mr. B’s disability insurer began questioning the extent of his limitations and restrictions. It was at this point that Mr. B hired Attorneys Dell & Schaefer to assist him in dealing with the various requests which were being made by his disability insurance company.

Mr. B’s disability carrier requested that he undergo an independent medical examination. Not long after the IME the insurer terminated Mr. B’s benefits relying greatly on the opinion of the insurance company’s hired independent psychiatrist and claiming that Mr. B was at best partially disabled but since he was not gainfully employed - a requisite to being partially disabled under Mr. B’s disability policy - he was not eligible to receive partial disability benefits.

In 2006, Attorneys Dell & Schaefer appealed the denial of benefits with the disability insurer and successfully had the denial overturned. The disability carrier continued to pay total disability benefits for another 2 years, however, in late 2008 the disability carrier sought the opinion of the same independent psychiatrist and again found cause to terminate benefits. Attorneys Cesar Gavidia and Gregory Dell began preparing the case for litigation. Prior to filing suit, the parties agreed to participate in mediation as a method of attempting to resolve the dispute. Mediation took place in New York City where the parties were able to successfully reach a confidential settlement which involved a complete lump-sum buyout of Mr. B’s long-term disability policy.
 

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Prior to becoming disabled, Mrs. C was an eighth grade English literature teacher in southern California. In 1996, Mrs. C began experiencing pain in her muscles and joints as well as fatigue and disturbed sleep. Her physicians soon diagnosed her with various connective tissue disorders, including: Sjogren’s syndrome, rheumatoid arthritis, atypical lupus , Raynaud’s phenomenon, fibromyalgia and muti-nodular goiter. She was experiencing pain in a number of small joints in her upper extremities, as well as her knees, ankles and hands. The stress and emotional toll was even causing her to experience hair loss. In 2002, Mrs. C was forced to stop working and file a claim for disability benefits under her long-term disability policy provided through her teacher’s association. After reviewing her claim and giving careful consideration to the medical evidence, the disability insurer approved Mrs. C’s claim and began paying total disability benefits.

In April 2008, the insurer terminated Mrs. C’s benefits and informed her that they had consulted a vocational rehabilitation consultant who opined that Mrs. C’s occupation as a teacher did not require her to lift more than 20 pounds and did not require her to stand or walk for more then 4 hours a day.   The insurer also mistakenly informed Mrs. C that if she disagreed with the decision that she could bring civil suit under the Employee Retirement Income Security Act of 1974(“ERISA”). Devastated and confused, Mrs.C contacted Attorneys Dell & Schaefer. 

 

Attorneys Cesar Gavidia and Gregory Dell immediately began by requesting the administrative record and claim file from the disability insurer. After reviewing the records provider by the insurer, Attorneys Gavidia and Dell submitted a detailed appeal letter to the insurer demanding they pay all back benefits due and immediately place Mrs. C back on claim. Following several weeks of negotiations the parties reached a confidential settlement which required the insurer to pay a confidential lump sum amount for Mrs. C’s back and future long-term disability benefits.

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