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Mr. Touhey was employed by Maryville University as a Director of Planned Giving Development in order to obtain funds for the University through estate planning and gifts. While employed at the University he was offered a long-term disability policy as part of his group employee benefits. He signed up and paid premiums for the policy that was insured by Hartford Life and Accident Insurance Company under a 2003 plan. The policy was governed by the Employee Retirement Income Security Act of 1974 (ERISA). The plan administrator and other fiduciaries had discretionary authority to determine the eligibility and entitlement of benefits for the plan participants. On September 4, 2007, Mr. Touhey filed a claim for benefits alleging that his depression and anxiety prevented him from performing the essential functions of his employment and therefore, he was permanently and totally disabled under the plan. The Hartford hired a Nurse, a Psychologist and a Psychiatrist who evaluated all of his records and conditions and concluded that because he could work part-time in a winery, complete the necessary tasks to move to another state and do his activities of daily living, that he was not disabled. Mr. Touhey, through Mr. Tatlow, appealed the denial of his disability claim and exhausted his administrative remedies, before filing a lawsuit in Federal Court for his benefits. In Part I of the case Plaintiff alleged that Hartford breached its’ fiduciary duty by applying the wrong plan to the case and using a 2003 plan when it should have been using the amended plan from 2007. The court remanded the case back to Hartford for a new decision and Hartford denied the claim again under the 2007 plan. Mr. Touhey continued to utilize Mr. Tatlow.

The court ruled in Part II of the case that:1) Hartford continually relied upon the paper-review reports of its experts despite their own internal inconsistencies, while giving scant weight to the contrary, more detailed, and consistent reports of Plaintiff’s treating physician, Dr. Minchin. 2 ) Hartford failed to follow the procedures of its own claims manual in processing the claim. 3) Hartford did not engage in a principled reasoning process, either initially or on remand, or reach a reasonable result, but rather abused its discretion in its handling of Plaintiff’s claim.

As a side note, it is very difficult to obtain discovery of ERISA insurers policies and practices and of insurance claim’s manuals in an ERISA case. Plaintiff was allowed to do some discovery in this case, due in part to Hartford’s conflict of interest in serving in a dual role as a claim’s administrator, while also being liable on the claim if it was granted. Plaintiff accused the Hartford of a financial conflict of interest and was able to conduct some limited discovery in the case.

The amount of the Judgment under Part II of the case was $155,900 and was paid by the Defendant. This amount included benefits and nearly six years of prejudgment interest.

After winning the case, Plaintiff moved for an award of attorney’s fees and costs due to Defendant’s conduct in the case and because he prevailed in the case. Under ERISA statutes, if the Plaintiff prevails, the Court has the discretion to award attorney’s fees. It takes into account the result obtained, the conduct of the Defendant and the complexity of the issues in the case, among other factors. The firm was awarded a total attorney’s fee award for the time of three attorneys at who worked on the case, of $73,912.00 and the litigation costs of $1,603.85.

During the course of the case, Defendant continued to deny responsibility and refused to pay a reasonable sum to settle the case.  Plaintiff obtained a total of $231,415.85 after litigation of the case. Plaintiff had offered to accept approximately $150,000 at one time, but Defendant refused to pay anything over $65,000 making the litigation necessary.

Mr. Tatlow worked on the case along with our associate attorney Jeffrey Herman and Christine Roche, Mr. Tatlow’s paralegal.

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