Plan Administrator Must Address Benefits Claims Before Courts Rule

An infection in Jose Chavez’s hand qualified him for “own occupation” disability benefits according to his insurer, Standard Insurance. These benefits could last up to 24 months. During that time, Chavez sustained an injury to his rotator cuff. Standard then limited his benefits to 12 months. Chavez brought an ERISA claim in federal court. The district court held for Chavez, and Standard appealed. Chavez died in early 2021 and his widow Melinda Marinez was substituted as a party to the appeal. The Fifth Circuit Court of Appeals reversed the district court’s decision and remanded the case with instructions that the district court should remand the case first to the plan Administrator for a determination of Chevez’s any-occupation benefits. Read more about the case here.

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