It has been the law for several years in the 5th Circuit, which includes Mississippi, Texas, and Louisiana, that a Plan Administrator should take into account a Social Security Disability decision finding a claimant disabled when evaluating a long term disability claim. However in Nugent v. Aetna Life Insurance Company, 2014 WL 28641, the 5th Circuit determined that its prior opinions on that issue did not require a court or a plan administrator to give the Social Security decision more weight, but rather merely take it into account. In this instance, the Social Security decision was disregarded because Aetna believed the decision was based on outdated medical records. The court agreed.

Insurance companies making ERISA long term disability claim determinations frequently disregard Social Security decisions in my experience. A good ERISA attorney will attempt to articulate why the Social Security decision is relevant and should be seriously considered. This should occur during the claim process. The unwary claimant may not be aware of the need to point out the helpful matters in the decision and the reasons it must be considered. Therefore, it is critical to obtain counsel during the claim process.