Client Wins

Bachrach and Austin Obtain Summary Judgment in Disability Case Involving Focal Epilepsy

Philadelphia partners Josh Bachrach and Heather Austin obtained summary judgment in favor of our carrier client in an ERISA case pending in federal court in Pennsylvania. The plaintiff previously worked as a registered nurse but stopped due to symptoms related to focal epilepsy. She described her symptoms as a déjà vu-like feeling that lasted for one to two minutes, followed be a few hours of fatigue and brain fog. Benefits were initially approved but denied after 24 months when the plaintiff had to prove that she was totally disabled from pursuing any occupation. The court rejected the plaintiff’s procedural challenges to the claim decision, including to the applicable standard of review in court. On the merits, the court concluded that our client reasonably rejected the opinions of the treating doctor, who overstated the number of episodes the plaintiff experienced each month and recommended testing to objectively confirm the claimed symptoms, but testing was never performed. The court also concluded that the alternative occupations identified by our client were reasonable. Therefore, the denial of additional benefits was not arbitrary and capricious and Josh and Heather proved our client was entitled to judgment in its favor. 

Joshua Bachrach and Heather Austin

Austin, Bachrach and Stone Obtain Summary Judgment on Preexisting Conditions Limitation

Heather Austin (Partner-Philadelphia, PA), Josh Bachrach (Partner-Philadelphia, PA) and Parks Stone (Partner-Atlanta, GA) obtained summary judgment in favor of our client carrier in an ERISA lawsuit pending in the U.S. District Court for the Northern District of Georgia. The plaintiff sought disability benefits shortly after she began working for the policyholder. But in the months before her coverage began, she was seen by doctors for fatigue, joint pain and swelling, muscle weakness, nausea, lung issues and stomach issues. A few months after she began working she was diagnosed with scleroderma and then stopped working. While scleroderma was responsible for all of the plaintiff’s symptoms, she argued that the policy’s preexisting conditions limitation did not apply to her claim because a diagnosis was not made until after she stopped working. Citing to an earlier Eleventh Circuit decision in which Wilson Elser represented the defendant, the court reached “the inescapable conclusion” that the client’s decision was reasonable and it was entitled to judgment in its favor. 

Heather Austin, Joshua Bachrach and Parks K. Stone

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