If you are interested in the full opinion of Blankenship v. MetLife, be prepared for a clever critique of problems and shortcomings of ERISA.

Judge William Acker, Jr. of the USDC Northern District of Alabama continued his assault on the judicial application of ERISA recently with his opinion of Blankenship v. Metlife.

Blankenship was Manager in a large Sears Roebuck store in Alabama, which had a significant cardiac history and suffered from advanced heart disease. His doctors said that he could continue his job in the stressful environment and he submitted to the disability. After several reversals on the MetLife part of the benefits was denied.

A short time later Blankenship knee surgery underwent and received benefits based on this condition. MetLife continue to verify the claim and had to check professional specialist of Blankenship's job functions. The specialist ignored his heart problem and focused solely on jobs that were open to anyone with knee problems. The specialist found several jobs, which excluded from his heart condition would have, and was again denied his claim.

Blankenship again appeal and MetLife had a cardiologist, review the file. The cardiologist never addressed the main concerns of the Blankenship doctors, the stress of work would cause him further cardiac episodes. Having regard to the report, MetLife denied the appeal.

His opinion, judge Acker ERISA is critical on some points. Cited first the problem with ERISA cases based solely on paper and the fact that the courts claim to "Credibility determinations, disputes between incompatible unsworn written testimony."With these questions the judge the weight given to experts for the insurance companies. These experts often present their opinions following a simple file review and without depending on the examination of the plaintiff. The reviews is this doctors then faced both the doctors.

Second field of the inherent conflict of interests facing the insurer in ERISA cases treated. The insurance that determine, even those who pay the benefits are that benefits should be granted. The possibility of this conflict and the apparent actions of insurers is secure enough to suspect that it is indeed an active conflict. Employees make decisions whether her give the employer money. This conflict as many are not practicing and file reviews make their living entirely on insurance also extends to the doctors set to verify the files. A conflict exists because a physician who is not ready to "deny, deny, deny" the insurance company loses business and suffer financial losses.

Finally harps of the judges on the perversion of ERISA, employee retirement income security Act, a law meant to protect the benefits of American employees by giving them access to the courts for denial-of insurance. Unfortunately, the courts have the spirit of the law defied, and it now serves as a bastion for insurance and not as a reprieve for the policyholders.

One comment to "a federal judge explains why ERISA sucks (believe me, it doesn't)"

Message:

Notify me of follow up comments via e-Mail.

Off for security reasons, enter the image text in the box below: [press F5 when you can't read the text]

View the original article here