By Michail Hack
Schwartz, Conroy & Hack applauds Bloomberg Law’s recent investigative report, “Doctors Rebuffed by Courts in Long Covid and Disability Fights.” This probe highlights the troubling claims practices that insurance companies are often permitted to employ due to the limited judicial scrutiny applied in disability claims governed by the Employee Retirement Income Security Act (ERISA).
Erosion in Protections for Claimants
Under a series of federal court decisions interpreting ERISA – the federal law governing most group long-term disability claims – claimants have seen a significant erosion of procedural and constitutional protections, including the ability to:
- Conduct meaningful document discovery;
- Take witness depositions;
- Present expert testimony;
- Obtain a trial by jury;
- Present live witnesses at trial; and
- Receive review under a standard that does not heavily defer to the insurance company.
Instead, most ERISA cases are reviewed under the highly deferential “arbitrary and capricious” standard. Under this framework, courts frequently uphold an insurer’s denial so long as the decision is supported by “more than a scintilla” of evidence – even in cases where substantial evidence demonstrates that the claimant is, in fact, disabled.
Impact on Disability Claims
In practice, this framework means that if an insurance company can produce a physician willing to conclude that a claimant is not disabled, courts will often uphold the denial despite compelling evidence to the contrary. There are even cases in which courts acknowledge that a claimant satisfies the policy’s definition of disability, but still rule in favor of the insurer because one of its repeatedly retained physicians reached a different conclusion.
Under ERISA, ties often go to the insurance company.
It is therefore no surprise that insurers continue to rely heavily on physicians with established histories of supporting claim denials. Significantly, even the United States Supreme Court recognized this concern in Black & Decker Disability Plan v. Nord, observing that physicians repeatedly retained by benefits plans may have “an incentive to make a finding of ‘not disabled’ in order to save their employers money and to preserve their own consulting arrangements.”
Despite acknowledging this inherent conflict, the Court declined to require greater weight be given to the opinions of a claimant’s treating physicians over those retained by insurers.
Standing Up to Unfair Practices
At Schwartz, Conroy & Hack, we have refused to accept the status quo. We have successfully argued that our clients are entitled to de novo review, meaningful discovery, and full trials with relevant witnesses where appropriate. These victories often begin during the administrative appeal process and continue through litigation and trial.
When handling an ERISA-governed long-term disability claim, the procedural details matter at every stage of the process.
If your disability insurance claim has been denied or is being challenged, contact Schwartz, Conroy & Hack, PC. We have the expertise and tenacity to make insurance companies keep the promises they made to policyholders like you.
