FAVORABLE RULINGS RECEIVED IN PERA DISABILITY CLAIM
This office handles a great many number of claims on behalf of PERA Members who are seeking disability benefits. The PERA Disability Program is administered by Standard Insurance Company. For a more detailed discussion of PERA issues, please refer to the PERA disability section of our website by clicking here.
This office recently concluded litigation in the case of Leticia Nunez v. Standard Insurance and PERA. Several important rulings on legal issues were obtained from Judge Frank Plaut who was sitting by designation as the district court judge in Kit Carson County. On behalf of Ms. Nunez, we took the position that the short term disability (STD) policy issued by Standard Insurance Company to PERA for the purpose of covering all PERA members contained a definition of disability that did not comply with the definition of short term disability benefits established by state law. More specifically, we argued that the “second prong” of the definition which requires a PERA member to prove not only an inability to perform the essential functions of their own job, but to also show an inability to earn 75% of predisability earnings in some other occupation, should not exist in the policy. The second prong of the definition tracks the language found in PERA Rule 7.45(e). We argued that PERA inappropriately adopted that rule as it was inconsistent with the statutory definition. Judge Plaut agreed.
Additionally, the Court ruled that Standard’s handling of the voluntary, third level of review was done incorrectly. The PERA statutes and rules guarantee that a PERA member whose disability benefit claim has been denied is entitled to a final medical determination to be conducted by a “panel of independent experts.” In Ms. Nunez’s case, the final level of review was performed by one physician. Judge Plaut ruled, as a matter of law, that a review by one physician does not constitute a review by a panel of independent experts. Based upon Judge Plaut’s ruling, Standard Insurance informed our office that it intended to re-conduct the third level of review in two other cases we are currently litigating.
The Law Office of Shawn E. McDermott, LLC is actively pursuing these same and other issues on behalf of other PERA members. We represent these individuals following a denial of benefits by Standard Insurance Company. We have experience representing individuals through the internal appeal process with Standard Insurance and in litigation against Standard and PERA, if necessary.