In Lavery v. Restoration Hardware Long Term Disability Benefits Plan, the First Circuit Court of Appeals upheld a decision in favor of a Fair Work client whose claim for disability benefits had been denied by insurance giant Aetna. The client worked for a large retail company but lost his job after a cancer diagnosis. When he filed a claim for disability benefits through his company’s disability plan, Aetna said the claim was barred by a preexisting conditions clause. A federal district court ruled that Aetna’s decision was unreasonable, and the First Circuit agreed, resulting in a large payment of back benefits and ongoing monthly payments.
Many of the benefits you get at work – like health insurance, disability insurance, and retirement plans – are controlled by a federal law known as ERISA. When your employer or its insurance company denies a claim for benefits, it can be very difficult to challenge the denial. Under ERISA, you usually have to show that the denial was “arbitrary and capricious,” which is a tough standard. Having an experienced attorney can make a huge difference, because it is critical to present your case using the right evidence and arguments.