ERISA Claims: A Diagnosis is Not Always Sufficient to Establish a Disability

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ERISA Claims: A Diagnosis is Not Always Sufficient to Establish a Disability

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that governs employer sponsored retirement plans. ERISA is notoriously complex, and many individuals run into confusion and challenges when they are seeking to assert a disability claim under their plan. Here, our experienced Chicago ERISA disability attorneys discuss a recent case that highlights one the most important ERISA concepts: the difference between diagnosis and disability.

The Case of Decovich v. Venetian Casino Resort, LLC

  • Factual Background

Decovich v. Venetian Casino Resort, LLC was decided in January of 2017 by a Nevada district court. That being said, this case provides instructive information for ERISA claimants all around the country, including in Illinois. The case centered around a Las Vegas casino card dealer who developed a medical condition that left her with widespread, chronic pain. She received a valid medical diagnosis for this condition from her local physician. However, when she sought disability benefits, her claim was denied. This remained true despite the fact that she had a valid diagnosis.

  • Why the ERISA Disability Claim Was Denied

The court accepted that her diagnosis was valid. However, the court agreed with the insurance company’s argument that the plaintiff failed to present any evidence that her diagnosis actually prevented from her working. More specifically, the court pointed to the fact that none of her medical records contained any information related to ‘job restrictions’ or ‘the inability to work’. Thus, while the medical diagnosis was valid, there was simply insufficient information provided to establish a disability claim.

  • What This Means For You

This case provides a textbook demonstration of the importance of getting proper medical documentation and records. The burden of proving a disability is always on the plaintiff. The courts have made it very clear, under ERISA regulations, a diagnosis is not, by itself, sufficient to get disability benefits. Getting your condition properly diagnosed is a required first step in the claims process, but you also need to ensure that you have medical documentation that explicitly asserts that your condition will prevent you from working. Disabled individuals should always work with an experienced ERISA claims attorney who can help them ensure that they have the proper supporting evidence needed to prevail in their case.

Contact Our ERISA Attorneys Today

Were you denied disability benefits in Illinois? If so, we can help. At the Comerford Law Office, LLC, we have extensive experience handling a wide array of ERISA claims. To learn more about what our lead attorney, James Comerford can do for you, please call us today at (312) 863-8572 to set up your free initial legal consultation.

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