Ex-Reporter Prevails In ERISA Suit Against Prudential

Cheshire

Cheshire

Senior Member (Voting Rights)
Law360 (June 1, 2018, 5:33 PM EDT) -- A New Jersey federal judge sided with a former Washington Post science reporter with chronic fatigue syndrome Thursday in his Employee Retirement Income Security Act suit against Prudential Insurance Company of America, which had dropped his short-term disability benefits and denied his bid for long-term ones.
U.S. District Judge Katharine S. Hayden granted summary judgment to Brian Vastag, saying he was improperly denied short-term and long-term disability benefits that were payable under his employer’s health insurance plan. The judge said there was objective medical evidence in the record showing that Vastag had a “seriously debilitating disease.”
Click to expand...

https://www.law360.com/articles/1049513/ex-reporter-prevails-in-erisa-suit-against-prudential-

(I can't remember Brian's name on the forum...)
 
This is HUGE.

For those outside the USA, the ERISA laws, at least the parts covering long term disability (LTD) insurance, are really messed up. So many folks with ME (and many other chronic illnesses) have been denied claims over the years.

Getting an ERISA LTD claim approved is A LOT HARDER than getting a social security claim approved. Lots of complex legal issues that I can't remember (and would probably mess up with my brain fog).

My congrats to @B_V and I hope this paves the way for more patients with ME getting their ERISA LTD claims approved.
 
Shows how important the information that the CDC website has on it as it's quoted several times as an information source by the judge in explaining the judgement.

This was a nice bit as well
Vastag’s personality shines through his writings, perhaps leading Prudential’s reviewers to conflate good communication skills with good health.

But “disability does not mean that a claimant must vegetate in a dark room excluded from all forms of human society.” Smith v. Califano, 637 F.2d 968, 971 (3d Cir. 1981). Nor need a claimant lose his special talent for communication in order to be found disabled.
Click to expand...
 
John Mac said:
I wonder if this evidence is coming from the NIH study in which Brian is a patient?
Click to expand...
Hi - No, this lawsuit was about the first two years of the long-term disability policy I had through my job, which basically covers 2014-2015, before the NIH study began. I did a two-day CPET, had a qEEG with Mark & Marcie Zinn, and did a bunch of other stuff detailed in the judge's opinion, which you can see here:

My lawyers, Barbara Comerford & Associates, did an amazing job and they deserve all the credit for winning this case. Barbara is a recovered patient (as she puts it) and has spent 25+ years fighting these horrible insurance companies and the terrible ERISA law that governs group disability plans. I recommend her to anyone in the U.S. fighting for Social Security or private disability benefits. Her folks have now helped me win both.

Edit: I should mention that the NIH doctors WILL provide test results & letters supporting Social Security and private disability cases for volunteers enrolled in the study.
 
Last edited:
Sasha said:
What an awful, stressful experience that must have been - so sorry that Brian had to undergo it.
Click to expand...
I'm fortunate that I found a good lawyer willing to take my case on contingency (meaning they don't get paid much unless we win the case) and that I could afford - both in $$$ and in energy - the testing required to prove my disability. The ERISA law is really messed up & tilted heavily in favor of the insurers. There are no jury trials and no punitive damages possible. So if an insurance company acts in bad faith and f*cks people over, the worst thing that can happen for them is having to pay the original benefit. In very rare cases the judge orders the insurance company to pay the plantiff's lawyer's fees, but my judge did not do that. So I'm a little bummed because her opinion is so strong and that is really the only punishment available under the law.
 
Congratulations @B_V and i agree with you the insurance company should have been made to pay for lawyer fees and punitive dammage to you as these proceedings are quite stressful and harmful on patient’s health.

There doesn’t seem to be anything preventing the insurance company to reject disability insurance again, and it seems like they have anything to gain in doing so. I hope it changes very soon as we get closer to biomarkers and scientific breakthroughs.
 
Milo said:
Congratulations @B_V and i agree with you the insurance company should have been made to pay for lawyer fees and punitive damage to you as these proceedings are quite stressful and harmful on patient’s health.
Click to expand...

Sadly, if a long term disability (LTD) policy falls under ERISA law (and that includes most LTD policies that are provided by an employer) then the insurance company is protected from ever having to pay any damages. They don't even have to pay any interest even if it has taken 3-4 years before they paid your claim.

Of course the insurance companies want to do what makes them the most money. So they delay an LTD claim as long as possible.

The only way to fix this situation would be to reform ERISA laws. But the current political climate in the USA is not even in favor of basic health care for all. Many politicians want to cut medicare, medicaid, food stamps, etc. So I doubt there is any chance of reforming ERISA laws.
 
Sisyphus said:
ERISA is a legal nightmare, it is one of those things that no one knows or cares about until it affects them personally, and thus continues to lurk in the shadows.
Click to expand...
Not quite no one. A good friend of mine in DC works on disability policy, and has for 20 years, first on Cap Hill for various senators and now with a non-profit. They are trying but it's uphill. Recently some new Dept of Labor regulations for ERISA went into effect that help beneficiaries. I'll see if I can find a write-up somewhere.

Edit: Here is a DOL fact sheet. Major ERISA overhaul is needed but these changes are helpful.
 
Last edited:
You must log in or register to reply here.
Back
Top Bottom