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First Circuit Finds for Plaintiff and Awards Retroactive Mental Health Benefits

In Jane Doe v. Standard Insurance Company, plaintiff Doe spent more than 25 years as an environmental attorney for a Maine law firm prior to become ill with depression and anxiety. She filed a claim for mental health disability benefits under the law firm’s disability policy. Her claim was approved, but based on a disability date of January 2012, when she claimed the date should be October 2011. Standard also awarded benefits based on the general occupation of an attorney instead of her own occupation as an environmental attorney.

After several administrative appeals, Doe filed an ERISA lawsuit in the Maine District Court, which ruled in favor of the insurer and Doe appealed. The Court of Appeals for the First Circuit reversed the lower court decision and ruled that Standard was wrong on both issues. By using the definition of a general attorney instead of environmental attorney the Court stated that Standard “eviscerated the Own Occupation coverage, and its evaluation as to Doe’s disability onset date was based on the wrong standards.”

Onset Date of Disability

On March 22, 2012, plaintiff filed a claim for mental health disability benefits stating she had been unable to work since October 2011. Standard argued she was not disabled until January 28, 2012. The date is significant in that benefits are calculated based on the prior year’s earnings. In this case, the difference in onset made a difference of more than $100,000 in payments.

After reviewing the medical reports and Doe’s work history, the appeals Court agreed that she had become disabled in October 2011. The amount of benefits then turned on whether her own occupation was that of an environmental lawyer or a general lawyer.

Own Occupation Standard

Doe paid an additional premium to Standard in order to have coverage if she was disabled from working in her own occupation: that of an environmental lawyer. When Standard calculated benefits, it did so on the basis of earnings of a general lawyer and used the Dictionary of Occupational Titles (DOT) for the job description and calculation of benefits.

The Court disagreed noting that “No evidence in the record supports the assumption that ‘environmental lawyer’ and ‘lawyer’ are equivalent terms that may be used interchangeably. Environmental law is a distinct specialty, and the expertise demanded from environmental lawyers distinguished that specialty from a generic ‘lawyer’ role.”

After determining that Standard’s use of the 2012 disability onset date was wrong, and the calculation of benefits on the basis of work of a general lawyer instead of an environmental lawyer, the Court then sought to determine the appropriate remedy.

Remedy is to Order Insurer to Pay Retroactive Benefits

The Court noted that it had “considerable latitude” in selecting a remedy in an ERISA case. Plaintiff here suffered through several administrative appeals over several years period of time.

The Court concluded, “We think it most equitable in these circumstances to bring an end to this dispute and to award Doe retroactive benefits instead of remanding the matter to Standard.” It remanded to the district court with orders to Standard to calculate benefits based on the 2011 onset date under plaintiff’s own occupation as an environmental lawyer.

This case was not handled by our office, but we think it can be beneficial to those struggling to obtain long-term disability or mental health benefits based on the policy definition of their own occupation. If you have any questions about your own disability claim, contact one of our attorneys at Dell & Schaefer for a free case evaluation.

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Questions About Hiring Us

Do you help Standard claimants nationwide?

We represent Standard 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 Standard disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Standard. 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 Standard.

How do you help Standard claimants?

Our lawyers help individuals that have either purchased a Standard 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 Standard:

  • 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.

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Jay and Sonia have been patient with my questions, especially when they were repetitive. At no point in time did I think the we would not be successful. Jay and Sonia have shown the epitome of professionalism. I am grateful that I was referred to your firm!

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