Why do you need an ERISA attorney? If you read Knolley v. Bellsouth Long Term Disability Plan for Non-Salaried Employees, you will find more reasons why. The plaintiff proceeded pro se (without an attorney representing her) when she appealed from an adverse decision from the lower court. Unfortunately on appeal, she did not know the legal arguments to present. The court easily found that the Sedgwick claim decision denying her claim was not wrong and affirmed the lower court’s decision. The treating psychiatrist had concluded that she was incapable of working so she did have evidence in her favor. The 11th Circuit, however, noted that Sedgwick had had multiple “independent physician advisers” to merely review medical records and all concluded “there were no objective findings substantiating the conclusion that she was unable to work.”
What is striking about this is that the Merck Manual directs physicians to conduct a personal interview with an individual experiencing depression. A mere review of records is insufficient. Furthermore, what objective evidence exists as to depression? Absent independent medical evaluation involving a personal interview of the claimant, such matters raise important legal issues underscoring the importance to have representation on such claims. Get experienced ERISA counsel at the first hint of adverse action by an insurance company. You need experience and power on your side.