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Long term disability benefits wrongfully denied

Hartford Life's decision to terminate Gessling's disability benefits was arbitrary and capricious. In many ERISA cases where plans have acted improperly to deny benefits, a remand for further consideration is the appropriate remedy, but where the plaintiff was actually receiving disability benefits that were improperly terminated, as they were here, the Seventh Circuit directs that the more appropriate remedy is reinstatement of benefits that were being paid before the improper denial. See Hackett, 315 F.3d at 775-76 (reversing grant of summary judgment for plan and ordering reinstatement of benefits that were improperly terminated); see also Halpin v. W. W. Grainger, 962 F.2d 685, 967 (7th Cir. 1992) (affirming reinstatement of benefits that were improperly terminated). "The distinction focuses on what is required in each case to fully remedy the defective procedures given the status quo prior to the denial or termination. Hackett, 315 F.3d at 776. And here, as in Hackett, "the status quo prior to the defective procedure was the continuation of benefits. Remedying the defective procedures requires a reinstatement of benefits." Id., accord, Schneider v. Sentry Group Long Term Disability Plan, 422 F.3d 621, 630 (7th Cir. 2005) (finding that where benefits had been terminated by improper procedures, the "appropriate remedy is an order vacating the termination of her benefits" and directing the plan to "reinstate retroactively the benefits").

Accordingly, Gessling is entitled to retroactive payment of his benefits, with interest, for the remainder of the "own occupation" period, and the court remands the matter to the plan and its administrator to determine whether Gessling was disabled from working in "any occupation" within the meaning of the policy after the "own occupation" period expired. No later than March 30th (14 days), the parties shall submit either one joint or two separate calculations of the principal and interest due as of March 31, 2010. The court will then enter final judgment accordingly.

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Indiana Long Term Disability Lawyer Blog - Long term disability denial
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