TB was a 56 year old truck driver for Mississipi Lime Company and did work hauling debris and serving as a dump truck driver his whole career. While he was at Mississippi Lime, the company offered an employee benefit's package including a long term disability policy that was underwritten by Prudential Insurance Company. Because the plan was offered by the company, it fell into an area of Federal Law commonly know as ERISA law. It is important for a client to follow all of the administrative policies and procedures set forth in the plan documents, or the client does not stand a very good chance of winning his/her case if it goes to court. After suffering a neck and shoulder injury, TB had applied for long term disability benefits and was initially granted benefits after the administrator determined that his low back and neck and shoulder pain had prevented him from returning to work for greater than 180 days. His back had significant degenerative conditions including spurring at L2/3 and advanced degenerative conditions at L4/5. He had trouble sitting for long periods of time which caused him pain and limitations with driving the truck. He also started experiencing right arm numbness and pain in the hand causing trouble holding the wheel of the truck the longer the day progressed. The physicians had trouble determining what was the exact source of the arm pain but it was believed to be from a cervical nerve entrapment or severe spinal stenosis. Eventually a rotator cuff tear was diagnosed and he had surgery but the pain from the neck continued and he never returned to work. After one year the standard definition of disablity changed from TB not being able to do his own job to be eligible for disablity benefits, to having to show that he was unable to perform any job that he was suited for based upon his age, experience and education.
Prudential Insurance Company hired a vocational expert who assessed TB's condition and found that he could do work of a sedentary nature in such jobs as a routing clerk, a dispatcher, a scheduler, a meter reader or an order clerk. They denied him after this assessment claiming he was employable under the definition of disability under the plan after the first year of benefits had been paid. They claimed that he could not show that he was disabled under the plan.
Phil Tatlow hired a Psychological and Vocational expert to do a complete battery of testing of TB to assess his job skills, his academic skills and his reading and math skills to see if he was employable in the open labor market. The expert determined that he was not employable in anything but manual labor due to his medical conditions, when measured with his limited education and job experience and test results. The expert found that due to his back pain, his neck and shoulder pain he can never perform manual labor or truck driving again and that he was unable to do any other work based upon his limited education and job experience. His scores on the educational assessment test revealed that he had low performance on dictation, writing, math and reading. As a result the expert felt that the skills would not be enough to perform the jobs that Prudential identifed him being able to do.
After a couple of administrative appeals, Prudential reversed their denial and indicated that TB's claim would be paid in full. However, unfortunately, due to offsets of other benefits from the disablity benefits, his LTD montly benefits were reduced by the amounts paid under Social Security.
TB was also being represented by another attorney on a worker's compensation claim and a Social Security Claim while Phil Tatlow handled the ERISA claim. This is common is such cases as many attorneys may not handle ERISA even though they do handle Social Security or worker's compensation matters. The attorneys need to work together to make sure that they are consistent in their approach because of the fact that one report in one case could help or hurt the other case. In addition there are usually coordination of benefit clauses in the ERISA plans and both attorneys should advise the clients as to how these plans work and what to expect upon being awarded benefits.
