SMDA was hired by an employee of ArvinMeritor when her claim for Short Term Disability benefits was rejected. The client had suffered a fractured coccyx in a slip and fall and overtime was eventually diagnosed with Fibromyalgia and Depression. Despite the universal support of each of her treating physicians her employer rejected her claim for benefits upon the recommendation of the third party disability benefits administrator, Cigna.
After SMDA filed suit the case was submitted to private arbitration with a retired Circuit court judge. The Judge agreed with our argument to apply a De Novo standard of review because of the manner in which the claim was handled which was critical:
Because the Plan does not authorize the delegation of the Plan Administrator’s discretionary authority, LINA’s determinations with respect to Claimant’s claim for benefits under the STD provisions of the Plan are subject to de novo review.
After examining the evidence and arguments submitted by the parties the Judge determined:
Based upon the record submitted to the arbitrator, it appears that claimant meets the definition for “disabled” as set forth in the Plan. Her condition, regardless of label, has rendered her unable to perform the material and substantial duties of her regular occupation.
The client will receive her entire STD benefit amount as a result.