Michael Horrow represented Otilia Sullivan in an ERISA action in federal court to recover long-term disability benefits. One of the disputed issues in the case was whether the district court should evaluate the plan’s denial of benefits under the de novo or the abuse-of-discretion standard of review. The plan argued that because the “Summary Plan Description” (SPD) document that it provided to plan members to summarize the plan benefits said that the abuse-of-discretion standard applied, the court should apply that standard. But Michael Horrow pointed out that, notwithstanding the statement in the SPD about the administrator having discretion, the plan itself contained no such grant of authority. Mr. Horrow convinced the district court that, in the absence of a grant of discretion in the plan document itself, a statement in the SPD to that effect was insufficient. As a result, the court applied the de novo standard of review.
April Cabana suffered back and leg injuries in an automobile accident. She succeeded in obtaining long-term disability (LTD) benefits from her employer’s disability plan, which was administered by Reliance. After the accident Cabana received extensive treatment on her back, undergoing two spinal-fusion surgeries. Yet she continued to have severe pain. Reliance agreed that she was totally disabled under the “own occupation” disability standard that applied for the first 24 months of the plan. After the 24-month period, the plan applied an “any occupation” test for total disability, and the plan continued to find that she was disabled. But roughly a year later, the plan changed its finding, found that Cabana was no longer totally disabled, and stopped paying benefits.
Cabana retained Michael Horrow to file an action in federal court under ERISA to reinstate her LTD benefits. He marshalled the evidence of her ongoing pain and medical difficulties, and convinced the district court at trial that Cabana was, in fact, totally disabled and entitled to benefits.