Texas Court Rules in Favor of Disability Claimant, Applies De Novo Review
A Texas District Court applied de novo review in an ERISA disability case - the first since the Fifth Circuit issued an important decision in 2018.
Pike v. Hartford
In Pike v. Hartford, the plaintiff filed a lawsuit under ERISA challenging Hartford’s termination of her long-term disability benefits. The Hartford had paid Pike for more than eight years before cutting her benefits. Pike suffered from severe chronic back pain and degenerative disc disease. The parties in Pike agreed that the standard of review was de novo as a result of Texas state law banning discretionary clauses. The Court noted that for Pike to be entitled to long-term disability benefits, she had to prove by a preponderance of the evidence that she could not work in any occupation. The court found that she did.
Pike is the first comprehensively briefed and tried ERISA disability cases under the de novo standard of review since the Fifth Circuit issued an important decision in 2018 in Ariana v. Humana.
Ariana v. Humana
In Ariana v. Humana Health Plan of Texas, Inc., the Fifth Circuit Court of Appeals overruled prior decisions that held courts would give claims administrators deference on factual determinations even when reviewing the case de novo. Before Ariana, Texas courts would give deference to claims administrators’s decisions in its factual determinations but not in its legal determinations. The Ariana decision put the Fifth Circuit in line with seven other courts of appeals across the country, requiring de novo review on claims administrator’s plan interpretations of factually or legally based eligibility determinations.
Working with an Experienced Disability Insurance Lawyer is Important
This law firm has always focused only on disability insurance law. Our disability lawyers are very familiar with the complexities of ERISA. We help people like Ms. Pike every day in their fight for disability benefits. This includes successfully seeking discovery from the insurance company.
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Call today to speak with an experienced disability attorney.