In Nunnelly v. Life Insurance Company of North America, No. 21-12537, 2022 WL 1640790 (11th Cir. May 24, 2022), Plaintiff-Appellant Terry Nunnelly appeals the district court’s determination that Defendant Life Insurance Company of North America (LINA) was correct in finding him not entitled to long-term disability (LTD) benefits because his medical records did not establish that he was continuously disabled throughout the disability policy’s 26-week Elimination Period (waiting period).
Under the initial de novo review step of the Eleventh Circuit’s six-step framework for reviewing claims for benefits under ERISA, the court found that LINA correctly denied Nunnelly’s LTD claim because there was no medical support for his disability throughout the 26-week elimination period which ran from January 18 to July 19, 2017. One of his doctor’s records only spoke to Nunnelly’s condition through June 5, 2017. His doctor opined in February 2018 that based on his June 5th evaluation that Nunnelly is unable to return to work, but the court found this unconvincing because “without examining Nunnelly on or after July 19, how could Dr. Archibald know, eight months later, that a disability continued for weeks after he last saw the patient?”
The court also found that the district court did not err in denying Nunnelly’s motion to remand to LINA to consider a Social Security Disability Insurance (SSDI) award that came in February 2020, well after Nunnelly had filed a lawsuit for his benefits. The court distinguished its decision in Melech v. Life Ins. Co. of N. Am., 739 F.3d 663 (11th Cir. 2014). Here, the SSDI decision came months after LINA removed this lawsuit to federal court and over a year after the administrative appeals process concluded. In Melech, the court remanded with instructions to reconsider the plaintiff’s LTD claim because the administrator ignored an intervening SSDI award that came between the time it denied the plaintiff’s claim and the plaintiff’s subsequent appeal. In Melech, the SSDI decision was available to the administrator before it rendered its appeal decision. Here, the SSDI decision was not available until over a year after LINA affirmed its decision to deny Nunnelly’s LTD claim.
If LINA has denied your claim for long-term disability benefits, contact us for possible assistance.
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