ERISA 510 Retaliation Claims

Welcome to Season 3, Episode 16 of Winning Isn't Easy, the podcast that delves into the complexities of disability insurance claims. In this episode, we focus on a significant topic: ERISA 510 Retaliation Claims.

Join our host, Nancy L. Cavey, as she dives deep into ERISA 510 Retaliation Claims. With her extensive experience as a disability attorney, Nancy shares her insights, knowledge, and strategies for navigating these complex claims.

Throughout the episode, Nancy will discuss the legal aspects surrounding ERISA 510 Retaliation Claims. She'll provide guidance on recognizing potential instances of retaliation, understanding the rights of disability claimants, and taking proactive steps to protect oneself during the claims process.

Whether you are a disability claimant concerned about potential retaliation, or simply seeking a deeper understanding of ERISA 510 Retaliation Claims, this episode offers valuable information to help you navigate the challenges and advocate for your rights effectively.

Tune in to empower yourself to navigate the complexities of disability insurance claims with confidence.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.    

Transcript

Speaker 1: 0:15

Hey, I'm Nancy Cavey , national ERISA and Individual Disability Attorney . Welcome to this week's episode of Winning Isn't Easy. Before we get started, I've gotta give you a legal disclaimer. This podcast is not legal advice. The Florida Bar Association says, I've gotta say it, so I've said it, but nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Now, in today's episode, I'm going to be exploring , uh, what an ERISA section five 10 , uh, claim might be, what a retaliation claim entails. And , uh, I'm gonna give you these , uh, two specific insights about five 10 claims. First is, can you bring an ERISA section five 10 RETALIA retaliation claim against your employer if you are terminated because of the cost of medical treatment? And the second insight I wanna bring to you is the issue of whether you can sue your employer if they interfered with your rights to claim disability benefits. Got it. Will be back in a second.

Speaker 2: 1:34

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Speaker 1: 1:55

Welcome back to Winning Isn't Easy. Can you bring an ERISA five 10 retaliation claim against your employer if you were terminated because of the cost of medical treatment? Well , ERISA section five 10 makes it unlawful for any person to discharge fine, suspend, expelled discipline or discriminate against a planned participant or beneficiary for exercising any right that they're entitled to or may become entitled to , uh, under the employer's ERISA plan or policy. So that sets the framework, but what is erisa ? Well, the Employee Retirement Income Security Act of 1974 , uh, is a federal law. It governs , uh, employer sponsored benefits like group health, life, disability, and even pension benefits. Now, what's important for you to understand also is it municipal employers like cities, counties, school districts, and states are exempt from M ERISA as are church plans. So we are, you know, dealing with a , a finite number of employers. Now, the employer's plans or policies in that situation is governed by applicable state law. So if you've got an arisa section , uh, 10, 5, 10 claim, the question is how can it protect you? Now they can come as part of a general wrongful discharge claim, an age discrimination claim, or a whistleblower action, where the employee also is alleging that the employer has attempted to interfere with the employee's protected rights or benefits. That's normally how we see these claims come. Now, section 5 0 2 of the irisa statute is the enforcement provision for ERISA five 10 violations. You and your beneficiary can bring a claim to recover benefits that can be due under the terms of the employer's plan, enjoin any action that might violate the ERISA statute or obtain other equitable relief. What's that relief? Well, that relief can include a reinstatement to your former position if you're fired. However, the relief doesn't include punitive damages, compensatory damages or even monetary damages back pay may also be available in the form of restitution. The question becomes, well, who's got the burden of proof? You or your employer? The burden of proof and the order of production of evidence in a Section five 10 action is governed by one of two court created analysis or theories. The first possible analysis or theory is done under what's called the Price Waterhouse Mixed mode of analysis. Sounds like a legal term, doesn't it? This is used when you are , when you present direct evidence such as conduct or statements by decision makers reflecting a discriminatory attitude that could have influenced the ultimate decision to terminate you. If you prove that, then the burden of proof is going to shift, and that's gonna shift to your employer to prove by a preponderance of the evidence that it would've made the same decision to terminate you absent , uh, any alleged discrimination. Now, the second type and the more commonly used analysis is the McDonald Douglass , uh, analysis that's known as the pretext analysis. Now, this is most used , uh, because many employers are just too smart to make comments or worse yet to document the discrimination. So as a result, we are often having to present circumstantial evidence to establish the discrimination. The employer then has to present legitimate reasons or reasons for your discharge. If the employer presents a legitimate reason for your discharge, then the burden shifts back to you. This is a shifting burden analysis, then you have to prove by a preponderance of the evidence that the true motive of your employer was to interfere with your ERISA benefits or your employment status. So how do you prove that causal connection, particularly in a health claim? Now, the key issue is going to be proving, as I said, that causal connection between the protected activity i e the use of your benefits and the adverse employment action that's taken by your employer against you. What's relevant in a health insurance claim? Well, unfortunately, it's often a matter of who said what or who did what sounds common like a dispute between kids. Now, some of the most common relevant evidence is who made the decision to terminate you? Are they typically involved in a termination decision? Did they have access to the plan or policy? What was the knowledge that the decision maker had about your health and work that have , uh, covered , uh, beneficiary, including any access they might have had to your healthcare expense information? What data did your employer have to evaluate the cost of the healthcare plan and the cost of this treatment? And whether they monitor that on a group basis or an individual basis? How closely and how often did your employer monitor the cost of the premium, the cost of each participant and the beneficiaries healthcare costs to the employer? Does your employer do future healthcare cost projections for all employees or on an individual basis? And who gets that information? What is there in terms of internal correspondence including emails, notes or summaries of conversations that relate to your health, absenteeism, your health claim , uh, and ultimately the decision to terminate you? And we are looking in that written material for information about the basis of the termination and any other evidence that might be relevant to a discrimination claim. Now, there that correspondence can also be internal. And what we're looking for there is information regarding the healthcare cost projections based on what they're gonna cost your care is gonna cost, monitoring of costs and ways to reduce healthcare costs , expenses. And of course, the another issue is, was your termination the part of a reduction in force and who else was terminated? That's quite a laundry list, but the question ultimately becomes how does this laundry list really work in the real world? So we're gonna take a quick break and when I come back, I'm gonna tell you the story of Thomas Caris and his employer Southern Pine Trucking. So you see how all of this actually works in the real world. Got it. Let's take a quick break. Welcome back to Winning Isn't Easy. Now, ensuing your employer for discrimination or termination for exercising your ERISA rights to medical or disability benefits. I've explained that the court will use two possible tests with shifting burdens of proof. There's the Price Waterhouse Direct Evidence test, or there's the McDonald Douglas Pretextual analysis. Um, and you could go back and listen to the first segment of this to kind of refresh your memory, but let's talk about what happened to Mr. Cares . Because of the cost of bilateral hip replacement, he was terminated and he filed a lawsuit and he filed both an employment discrimination claim and an ERISA Section five 10 retaliation claim. After his employer had paid him an $11,458 performance bonus, they fired him one week later. Now, he had been diagnosed with degenerative arthritis in both hips. He had undergone one hip replacement surgery, which was covered by the company's self-insured health insurance plan. That's a magic word. Being self-insured means that Southern Pines Trucking paid every penny of the bill. Now, obviously, they had a natural incentive to keep costs low because it was coming out of their bottom line. When the company owner Patrick Gallagher, learned of the first hip surgery, he was not happy. In fact, witnesses testified at the hearing that he was very, very upset. But things got worse when Gallagher learned that cares was gonna have a second total hip replacement. Obviously, on the other side, Gallagher was really unhappy that he was paying for not just one but two total hip replacements. And that was gonna cost at least $150,000. So less than one week after being paid this bonus , uh, cares was fired by Gallagher who made the decision unilaterally. So cares claimed in his lawsuit that he was fired, both because of the cost of his first hip surgery and that Southern Pines wanted to avoid the cost of a second , uh, surgery. So he was fired for using his ERISA disability benefits. After hearing testimony, the court decided in the case of CARES versus Southern Pines Trucking, this case out of Pennsylvania , uh, that cares had met his burden of proof to show that his employer's reason for terminating him was pretextual and that the use of his ERISA disability group health benefits , uh, played a role as terminate role in the termination. And the judge found in his favor awarding him $67,500 in lost wages, and found that his employer had to pay for his attorney's fees and costs . Now , uh, the lesson here is don't give up. Don't let your employer get away from firing you just to deny you your ERISA disability insurance benefits. There is help and obviously that help can come in the form of an experienced ERISA disability attorney or ERISA group health attorney and and her experienced ERISA attorney who understands five 10 retaliation claims. Got it. There is help. Let's take a break.

Speaker 2: 12:20

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Speaker 1: 12:56

Welcome back to Winning Isn't Easy. Can you sue your employer if they're interfered with your rights to claim disability benefits under Arisa Section five 10? It's unlawful for an employer to retaliate against an employee for exercising their rights under an ERISA plan or policy and interfering with the employee's receipt of benefits. And obviously that can be an issue both in group health claims and also an issue for disability benefits. So what happens if you're injured while driving your tractor trailer for your employer and you file a claim for your , uh, disability benefits and it's denied on the basis that text messages you send about the accident and potential injuries fail to satisfy the plan requirement that the claim benefit be submitted in writing really well, can you sue your employer for retaliation or interference with protected rights? And what do you have to prove in a Section five 10 claim? Now remember, in a Section five 10 claim, you have to make a prima facie showing of a prohibited or adverse employer action i e determination action taken for the purposes of interfering with the attainment of your disability benefits and any right to which you were entitled to those benefits. So once you've done that, once you've established the basis of the five 10 claim , then the burden of proof is gonna shift to the employer to establish a non-discriminatory reason or an explanation for its actions. Now, if the employer can establish a non-discriminatory explanation, then the burden is gonna shift back to you to show that whatever the employer's explanation is that it was a pretext and the real purpose was the denial of benefits. We've talked about this pretextual denial process before, and it sounds like a ping pong match, right? To commit a prohibited or adverse action the employer has to discharge fine , suspend, expel, discipline, or discriminate against a participant or beneficiaries. That's the key. That's the analysis that we're always looking at. So how does an arisa section five 10 retaliation or interference claim with protected rights work in the real world as it relates to disability benefits? Now, I started this segment by talking about the story of Ms . Cervantes, and she was a truck driver who delivered auto parts. Her employer offered her an insurance plan covered under the ERISA statute. And the plan required that when an employer or participant was involved in an accidental injury, that they had to do several things. They had to immediately report it in writing to their supervisor. And the failure to do so could subject the participant to disciplinary action, including termination and a denial of benefits. So there were some significant consequences. The term immediately was defined to mean no later than 24 hours after the end of the shift during which the occurrence took place, the injury or the accident. So she was involved in a collision resulting in a personal injury and a property damage claim. And within hours following the incident, she called her supervisor to report the incident and she was instructed to undergo a drug test. She communicated via text message in writing to her supervisor and the owner of the company. She met with her supervisor at a drug testing facility near El Paso a and completed the drug testing that was required. She texted her employer providing the phone number and the name of the officer who responded at the scene of the accident. And she also sent photos of the text messages discussing the accident , uh, to them and provided photographs to her employer. So there's a lot of communication here. 11 days after the accident, she met with a supervisor to discuss, discuss the accident, and at that time, and only at that time was she given an employee report of injury to complete. Now she refused to sign it because it contained, as it often does, inaccurate and incomplete information about the incident. And ultimately, of course, her claim was denied on the basis , uh, that the medical providers were not authorized and she hadn't timely reported the accident pursuant to the terms of the plan. Now, you gotta really wonder about that, don't you? She appealed and that the appeal was denial and the case ends up in federal court. So what does the court do? The court said, look, Mr . Cervantes had provided evidence that could lead to a conclusion that her employer interfered with her ability to meet the plan requirements, and that was because they prevented her from accurately completing the required form and then basing the benefit denial in part on the fact that she didn't sign the form. Now, the court also found that her text messages could meet the requirements of the plan and that the employer's denial of the claim, you know, could have been motivated by their desire to interfere with her rights to get medical treatment and of course, to collect disability benefits. The court denied the employer's motion for summary judgment and let's hope that she gets her disability benefits and her medical benefits. In the next round, you can see that facts matter and each particular , uh, situation is different. So the law provides the framework for the analysis for these types of , uh, five 10 retaliation claims. And then you have to go through the laundry list of , uh, facts as we've discussed in , in the second segment of this podcast. And then you've gotta apply the law and the facts to the case, and you can see and both of the stories I , uh, told you about , uh, the results of the these particular cases. So I hope that you have enjoyed this week's , uh, episode of Winning Isn't Easy like our page. Please, please leave a review and please share it with your friends and family. Please subscribe to this. I think this is a great educational podcast that will help you learn more about ERISA disability and medical benefits, and you're gonna be notified every time that a new episode comes out. Tune in please for our next episode of Winning Isn't Easy. Talk to you later.