Recent Cases and Decisions

In White v. Eaton Corporation Short Term Disability Plan, - F.3d - (4^th Cir. 2009), the firm's Attorney Rob Hoskins represented the plaintiff. White involved an ERISA governed short term disability plan. In fact, the case involved the same benefit plan that was the defendant in both Mr. Hoskins' cases Donovan v. Eaton Corporation Long Term Disability Plan, 462 F.3d 321 (4^th Cir. 2006) (click here to see a discussion of Donovan) and Evans v. Eaton Corporation Long Term Disability, 514 F.3d 315 (4^th Cir. 2008) (click here to see a discussion of Evans). On January 21, 2009, the Fourth Circuit issued its per curiam decision in White v. Eaton Corporation Short Term Disability Plan ruling with White. The White opinion discusses both Donovan and Evans and finds that White's "case is substantially similar to Donovan. In both cases, Eaton has either failed to elaborate on, or outright ignored, evidence favorable to the claimant." Particularly, the court notes "deficiencies in the plan's decision-making process . . . reflected especially in its treatment of White's FCE, its failure to address conflict explanation of White's job requirements, and its failure to adequately address medical evidence supporting White's claims." In the end, the court distinguishes the facts before it in White from Evans and states:

". . . the Plan failed to address evidence favorable to White "thoughtfully and at length." Evans, 514 F.3d at 326. It relied on a fundamentally flawed FCE, based its determination on a description of White's lifting duties that was contradicted by evidence in the record and disregarded medical evidence favorable to White, even though the evidence met the Plan's own definition of "objective findings." Eaton's failure to seriously engage in a discussion of White's favorable evidence suggests that, as in Donovan, Eaton abused its discretion by denying White benefits. See Donovan, 462 F.3d at 329 (finding an abuse of discretion where there was a "wholesale disregard" of evidence in the claimant's favor); Glenn v. Metropolitan Life Ins. Co., 461 F.3d 660, 672 (6th Cir. 2006) (finding an abuse of discretion in a case where the administrator "offered no explanation for its resolution of [an inconsistency in the evidence] or, for that matter, whether it was given any consideration at all"), aff'd, 128 S. Ct. 2343 (2008)."

Click here to view the Fourth Circuit's decision in White.

In Jerry Isaacs v. Metropolitan Life Insurance Company, 2008 U.S. App. LEXIS 12584 (4^th Cir. 2008), the firm's attorney, Rob Hoskins, represented the plaintiff. This is a case that I lost, but as the introduction to this case log points out, the purpose of this log is not just to list the firm's victories, but to provide cases that are of interest to the firm's clients. I post this case because it exemplifies and underscores a very important point under ERISA. This case demonstrates what can happen if a claimant does not timely provide all of the paperwork that an insurer asks for during claim processing. In this ERISA case, my client, timely filed a short term disability (STD) clam. According to MetLife, the insurer of the long term disability (LTD) plan, the client was required to provide LTD claim forms separately from the STD forms which were submitted. MetLife contends that the LTD claim forms were due within 90 days from the date of disability. MetLife contends that it never received any LTD claim forms from the client. I became involved about 9 months after my client went out on disability and I wrote several letters to MetLife asking if my client needed to fill out any additional claim forms to perfect his long term disability claim. MetLife never responded to my letters so I filed a lawsuit. I argued that my client had essentially submitted all of the information needed to perfect his LTD claim in a timely manner even if he did not submit claim forms that MetLife contended were necessary to perfect the claim. MetLife filed a motion for summary judgment asking the court to throw the case out because it asserted no long term disability claim had been filed and because it was too late to file one. The District Court agreed and granted the defendant's motion for summary judgment. (Click here to see a copy of the District Court order dismissing my client's claim.) The District Court held:

"It is also clear that plaintiff cannot "bootstrap" his LTD claim onto his properly made short-term disability claim. The LTD plan was separate and distinct from the short-term disability plan. The LTD plan and the short-term disability plans have different plan documents, and one was covered by ERISA while the other was not. As outlined above, the uncontroverted evidence is that plaintiff did not strictly comply with the procedures outlined in the plan document for filing an LTD claim.

Plaintiff asserts the exhaustion requirement is excused in this case by the doctrine of futility. Under the doctrine of futility, a claimant is not required to exhaust administrative remedies if doing so would have been futile, which a plaintiff can demonstrate by showing he was denied access to the procedures outlined in the plan. See Makar v. Health Care Corp. of Mid-Atlantic (Carefirst), 872 F.2d 80, 83 (4th Cir. 1989).  Plaintiff argues his counsel's communications with defendant demonstrate the futility of pursuing administrative remedies in this case. Importantly, however, all of those communications occurred well after the 90-day claim period ended. Plaintiff has not offered any evidence that pursuing his administrative remedies was futile at the time he was able to file an LTD claim. Thus, plaintiff has not made a "clear and positive" showing of futility so as to excuse his failure to file a timely claim for LTD benefits. See Makar, 872 F.2d at 83."

I appealed to the Fourth Circuit Court of Appeals in Richmond, Virginia, making various arguments. The Fourth Circuit affirmed the District Court holding that Isaacs had never filed an LTD claim stating:

"Isaacs also argues that his receipt, completion, and return of the forms Woods gave him on June 6, 2005 was the functional equivalent of filing a claim under the LTD Plan. We disagree. Aside from the February 18, 2005 claim discussed above, Isaacs has never properly initiated any other claim for benefits with MetLife. Moreover, the documents faxed by Isaacs's doctor referenced either the STD and FMLA claims or no claim at all. We therefore hold that the faxed forms were insufficient to initiate a claim under the LTD Plan.6 Isaacs's attorney's subsequent letters were likewise insufficient either to initiate an LTD claim or to put MetLife on notice that Isaacs believed that such a claim existed separate and apart from his STD claim."  (Click here to see a copy of the Fourth Circuit's order.)

I felt that the outcome of this case was so unjust that I actually petitioned the US Supreme Court to hear the matter raising a technical issue about my client's right to do discovery before his case was dismissed. I knew it was a long shot when I filed the petition with the Supreme Court and, as I expected, the Supreme Court denied our petition for writ of certiorari (our request to have the court consider the case) on December 1, 2008. Of the many, many cases I have handled over the years, this case had one of the most unjust and unfair outcomes of any I have ever handled in my opinion. But, the outcome does stress that a claimant needs to do everything that an insurer requests of it during the claim process and this case demonstrates that the failure to do can, by itself, destroy a claim.

Foster Law Firm Attorney Rob Hoskins represented Auddie Brown Auto Sales of Florence, Inc. in an action brought against it by its former health insurer, Carolina Care Plan (CCP). Auddie Brown is an automobile dealership located in Florence, South Carolina, which established an ERISA governed health benefits plan for its eligible employees. The plan was insured by CCP. An employee became covered under the plan and remained covered as an active employee until she ceased working entirely in June of 2004. Thereafter, the individual continued coverage for exactly 18 months under the federal law known as COBRA (which is a part of ERISA). However, the insurer, CCP, was not made aware that the client was no longer actively employed or that her coverage status had changed to COBRA continuation coverage. Because of that, the insurer asserted that it should not have to pay for approximately $650,000.00 in medical bills that were incurred to treat the individual between June of 2004 and December of 2005. The insurer filed suit alleging state law causes of action of negligence and breach of contract. The case was tried on its merits and after a day long non-jury trial. Judge Michael Nettles, ruled with the Foster Law Firm client and held that, in light of all of the evidence, ERISA preempted the state law causes of action and, even if it did not, CCP was not entitled to any recovery on its state law causes of action. (Click here to see the circuit court order.) After issuance of Judge Nettles' order, the case was featured on the nationally prominent health insurance site, http://www.healthplanlaw.com/. (Here is the link to read the write up on the case: http://healthplanlaw.com/?p=654)