Phil respresented Ray Martin in a claim for his life insurance benefits against Aetna Insurance Company and Anheuser Busch. Mr. Martin had a policy that required the plan to pay him his life benefits of $113,500 if he was disabled due to illness or sickness. Under the terms of the plan he was required to file a claim within 36 months after the last date of employment for such a claim. Mr. Martin retired in 2003 and did not file a claim for nearly 7 years. Anheuser Busch and Aetna denied him throughout the appeals process claiming that his claim was untimely and barred due to not satisfying the time requirements of the plan and also not being disabled. Phil filed this case in Federal Court claiming that Aetna and his employer, Anheuser Busch, frequently failed to provide Anheuser Busch workers and plan participants with the annual documents under ERISA such as the Summary Plan description and the plan in order to deliberately and fraudulently deprive them of the knowledge that they have a claim for life insurance benefits if they become disabled. Mr. Matin's Complaint alleged that the Defendants fraudulently conceled his rights and engaged in a course of conduct designed to conceal Mr. Martin's right to benefits and that they also created a misleading Summary Plan Description that did not advise him or others of the proper things required under ERISA. AB and Aetna's attorneys fought to dismiss the Complaint and Amended Complaints in Federal Court arguing that the statute of limitations barred the claim as well as that the case did not state proper causes of action. However, Judge Hamilton of the United States District Court for the Eastern District of Missouri, ruled in Martin v. Aetna Insurance Company and Anheuser Busch (Discussed in the Blog section of our website) that the case stated a valid cause of action and that if Anheuser Busch or Aetna fraudulently concealed the terms of the plan, that the time to sue them had been tolled (stopped running) and was still valid.
After this ruling, the Defendants decided to settle the pending case in Federal Court by agreeing to pay the attorney's fees incurred to get it that far and to remand the case to Aetna, waiving the time period that Mr. Martin had to sue and make a claim. However, Aetna and Anheuser Busch would still not pay Mr. Martin's claim. Instead, they agreed to accept the claim 7 years late and let Phil Tatlow submit all the evidenc that he wanted to and they in turn agreed to decide the claim on the merits. Initially, Aetna again denied the claim and it looked like Phil Tatlow would have to sue them a second time. However, Phil was allowed to appeal this denial again and he submitted much more evidence of Mr. Martin's disablity including a report from an orthopedic surgeon detailing his neck, back and leg problems, a report from a vocational expert, older VA records, affidavits from him on his inablity to work which forced him to retire, and a detailed set of arguments on his disablity and inablity to compete in the labor market. Mr. Martin claimed disablity due to neck, back, leg and pain along with depression caused by the Supervisors at Anheuser Busch who created an intimidating and hostile environment by transferring him from various departments at an advanced age when younger workers were given better jobs. He ended up retiring at 55 and later applying for Social Security disability and being awarded benefits. After this he learned of the life insurance plan years later and tried to make a claim and was denied due to the time limits.
After this appeal and after Phil representing Mr. Martin and fighting with Anheuser Busch and Aetna Insurance Company for nearly six (6) years, they finally awarded Mr. Martin his life insurance policy limits of $113,500 and declared him disabled under the terms of the plan.
Also of interest is that Mr. Tatlow has made a number of claims against Anheuser Busch and Prudential Insurance and Aetna Insurance for similar claims of them not providing plan documents to employees and insurers. See: Knorr v. Aetna Insurance and others in the prior blogs on this site. See also: Kostecki v. Anheuser Busch and Prudential Insurance, in U.S. District Court, ED of MO.