{"id":7521,"date":"2020-04-08T19:29:44","date_gmt":"2020-04-09T00:29:44","guid":{"rendered":"https:\/\/www.nickortizlaw.com\/?p=7521"},"modified":"2024-01-30T15:18:36","modified_gmt":"2024-01-30T20:18:36","slug":"lash-v-reliance-standard-court-dismisses-case-for-failure-to-state-claim-against-matrix","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/lash-v-reliance-standard-court-dismisses-case-for-failure-to-state-claim-against-matrix\/","title":{"rendered":"Lash v. Reliance Standard – Court Dismisses Case For Failure to State Claim Against Matrix"},"content":{"rendered":"\n
Case Name: <\/strong>Kimberley Lash v. Reliance Standard Life Insurance Co, et al.<\/p>\n\n\n\n Court: <\/strong>U.S. District Court for the Eastern District of Pennsylvania<\/p>\n\n\n\n Date of Decision: <\/strong>April 4, 2017<\/p>\n\n\n\n Type of Claim:\u00a0<\/strong>Long-Term Disability<\/a> under the Employment Retirement Income Security Act of 1974 (\u201cERISA\u201d)<\/a><\/p>\n\n\n\n Insurance Company:\u00a0<\/strong>Reliance Standard Life Insurance Company<\/a>\u00a0(\u201cReliance Standard\u201d).\u00a0Matrix Absence Management, Inc.<\/a>\u00a0was the claim’s third-party administrator (\u201cTPA\u201d).<\/p>\n\n\n\n Claimant\u2019s Employer: <\/strong>Temple University Health System<\/p>\n\n\n\n Claimant\u2019s Occupation \/ Job Position: <\/strong>Payroll Supervisor<\/p>\n\n\n\n Disabilities: <\/strong>An MRI performed in May 2012 revealed that Lash had a tumor in her lower back. Lash had surgery to remove the tumor on May 24, 2012, which caused her to become totally paralyzed in her lower extremities<\/a>.<\/p>\n\n\n\n Benefits Paid?\u00a0<\/strong>Yes \u2013 for the first two years under the \u201cown occupation<\/a>\u201d definition of disability. Matrix initially approved Lash\u2019s claim for long-term disability benefits. At that time, Matrix informed her that \u201cin order to be eligible for benefits beyond 24 months<\/a>,\u00a0she had to be disabled from performing the material duties of any occupation beginning August 3, 2014.\u201d To determine Lash\u2019s continued eligibility, Matrix collected documentation from her medical providers and had its Nurse Case Manager review her claim on April 10, 2014.<\/p>\n\n\n\n Basis For Denial \/ Termination of Benefits:\u00a0<\/strong>On February 6, 2015, Matrix informed Lash that her claim for long-term disability benefits was denied, as Matrix determined that she could perform other occupations despite her disability.<\/p>\n\n\n\n