12/29/2010 // Attorney Keith Clouse

The Fifth Circuit Court of Appeals recently resolved a case concerning the Employee Retirement Income Security Act of 1974.  Leipzig v. Principal Life Ins. Co., No. 10-10394 (Nov. 29, 2010), available at http://www.ca5.uscourts.gov/opinions/unpub/10/10-10394.1.wpd.pdf. The plaintiff alleged that the insurance company denied his disability insurance claim in violation of ERISA, and he appealed a summary judgment for the insurer.  The plaintiff was a surgical ear, nose and throat doctor.  After being diagnosed with double vision, he ceased performing surgeries and began receiving disability benefits.  Following an eye surgery, he resumed a non-surgical practice two days per week, and the insurer continued to pay reduced benefits.  Later, the insurer stopped paying benefits after it determined that the plaintiff was working a reduced schedule because he did not have enough patients to justify a full-time schedule, not because of his disability. Where a plan subject to ERISA gives the administrator discretionary authority to determine eligibility for benefits, the Court applies an abuse-of-discretion standard to the denial of a benefits claim.  Here, because the insurer’s interpretation of the plan was both a uniform construction and a fair reading, it was legally correct.  Thus, the insurer did not abuse its discretion when it denied the disability claim.  The Court affirmed the summary judgment. To speak to a Dallas, Texas employment law attorney about a workplace disability matter or an ERISA matter, contact the employment lawyers at Clouse Dunn Khoshbin LLP at info@cdklawyers.com.  

Contact Keith Clouse

KEITH A. CLOUSE

Clouse Dunn LLP

214.220.2722 214.220.3833 ( fax) keith@clousedunn.com

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