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Court Rules That Walgreens Employee’s Long Term Disability Claim Lawsuit Shall Not Be Dismissed

From our law firm’s experience it seems that Walgreens will look for any excuse to deny short term or long term disability benefits to a plan participant. In a recent disability lawsuit filed in Michigan, Walgreens tried their best to use a legal technicality to dismiss the lawsuit of a former employee. Fortunately, the court did not buy Walgreen’s unreasonable argument.

Matthew, a Walgreens Store Manager was forced off work on December 29, 2005 due to Dercums Disease, Chairi Malformation, Carpal Tunnel Syndrome and various other illnesses. As a participant in the Walgreens Income Protection Plan for Store Managers, Matthew was eligible for Long-Term Disability benefits if he met the Plan’s terms and conditions. The Plan administrator found Matthew eligible and began paying him disability benefits.

Unfortunately, Matthew’s claim was terminated in December 2007 after receiving disability benefits for two years. According to the Plan, Matthew had a limited amount of time in which to bring a claim against his insurer for denying him benefits. The Plan provided that a legal action could be filed no later than three years after proof of disability must be filed.

So when Matthew brought a legal action against his insurer more than a year after the plan limitation had run out his insurer argued it was too late.

All disability insurers governed by ERISA are required to provide plan participants with a Summary Plan Description (“SPD”) designed to simplify and explain important terms of their Plan. Matthew received a SPD but it did not mention this three year limitation and as a result he had no idea the limitation existed – until now.

Insurers Must Include The Contractual Limitations Period In Its SPD

Matthew and his Michigan Disability Attorney argued that ERISA requires insurers to include their plans’ contractual limitations periods in their SPDs. The court agreed.

Even though the Disability Plan included the three year contractual limitation period the insurer must include the same information in its SPD. As the reviewing court explained “the contractual limitation is an integral part of the Plan and [Mathew’s] failure to comply would result in possible loss of benefits; it is reasonable that [Mathew] would rely on the SPD’s silence in determining when he could file a cause of action. The contractual limitation is an essential part of the Plan and must be included in the SPD.”

As a result of the SPD’s silence regarding the contractual limitation, the court concluded that Michigan’s six-year period of limitations for breach of contract applies. Because Matthew brought his claim within the six-year limitation period he was able to proceed with his disability lawsuit. This lawsuit was not handled by our law firm.

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There are 2 comments

  • Deb,

    In a nutshell, yes. Did you also have a concurrent claim for worker’s compensation? Have you already submitted your appeal?

    Stephen JessupApr 26, 2015  #2

  • I don’t understand why Sedgwick can stop paying me disability when they paid for 12 weeks. I can get a leave of absence without pay even though I was hurt at work and after I was hurt Walmart emplimented a safety device so employees would not be injured the way I was anymore. I have had money taken out of every check for short and long term insurance for 24 years and now when I need it Sedwick stopped paying me. Is this their way of forcing you back to work because of financial distress?

    Deb G.Apr 25, 2015  #1

FAQ

Do you help Sedgwick claimants nationwide?

We represent Sedgwick clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Sedgwick disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Sedgwick. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Sedgwick.

How do you help Sedgwick claimants?

Our lawyers help individuals that have either purchased a Sedgwick long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Sedgwick:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Noah P.

A few years ago I found myself unable to work and needing treatment. While I was getting the treatment I needed my employer fired me. This left me still needing treatment as well as needing to find a source of income. Not knowing where to turn or what to do my wife an I contacted Dell & Schaefer for help. Upon speaking with attorney Stephen Jessup we felt assured that we had found the help we needed. Attorney Jessup worked with the attorneys from my former employer and explained my situation to them. During the weeks of negotiations attorney Jessup kept us informed as to the progress and ultimately called us with a settlement offer. We were so relieved and grateful!

But that is not where our story ended. After informing us of the offer presented by my former employer, attorney Jessup advised me that he felt he could get us a better settlement with just a bit more time. I discussed it with my wife and we both felt confident in attorney Jessup’s advice so we allowed him to further negotiate on our behalf. Sure enough, a more equitable settlement was reached in a very short time. During the entire process attorney Jessup and the staff at Dell & Schaefer handled everything with very little input needed from us. This allowed me the time and reassurance that I needed in order to heal. Their professionalism and reassuring manner never left me feeling concerned that I wasn’t being fully represented despite the fact that they rarely needed participation directly from me. In the end my confidence in them was rewarded with a better settlement than I was expecting. My wife and I are forever grateful. From my experience it would be very difficult for Dell & Schaefer to improve upon their process.

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