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Kevin M. Zietz and co-counsel Todd Krauss represented Jeffrey Kopicko on a claim for long-term disability benefits denied by Anthem Life Insurance Company (Anthem). The case involved the denial of Long-Term Disability (LTD) benefits under a group plan insured by Anthem Life Insurance Company (Anthem). Mr. Kopicko was initially denied LTD benefits on the basis that his claim was excluded by a pre-existing condition provision in the insurance policy. Kevin M. Zietz and Todd Krauss were successful in getting Anthem to reverse the denial of benefits based upon application of the pre-existing condition exclusion in the policy. Anthem approved LTD benefits for a closed period of time between November 9, 2017 and May 7, 2018. Anthem went on to deny benefits beyond May 7, 2018 based upon a medical record review completed by a psychiatrist who opined that the medical evidence only supported disability for the aforementioned period of time based upon the diagnoses of major depressive disorder, generalized anxiety disorder, and agoraphobia. The nature of agoraphobia is that it causes people to self-isolate to the point where it can even be difficult to go out of the house to seek medical attention. Plaintiff in-fact self-isolated and did not seek any medical attention for almost nine months. This left a massive gap in his psychiatric medical treatment in 2018, and created a factual scenario that was in stark contrast to the LTD policy’s requirement that he be under the continuous care of a doctor for his disabling medical condition(s). When Mr. Kopicko resurfaced, he sought to establish continuity of care with new mental health professionals so that he could resume his course of treatment and have the disability paperwork filled out as required by the LTD policy. During the administrative appeal process, Anthem hired a second psychiatrist to review Mr. Kopicko’s medical records.The second peer reviewer also opined that the medical records did not meet the diagnostic criteria set for by the DSM-5 for the psychiatric conditions that Mr. Kopicko alleged were causing him to be impaired to the point that he was unable to work. The district court Judge’s ruling is important because (1) It shows that people who are disabled due to agoraphobia (and therefore not always able to seek continuous psychiatric medical treatment for perhaps as long as six months or longer) should not be penalized by having their disability benefits denied because the very essence of their medical condition makes it difficult for them leave their residence to seek medical treatment; (2) reported district court cases show that insurance companies have routinely attempted to deny disability benefits based upon psychological conditions, claiming there to be a lack of “objective” medical evidence to support disability. After reviewing the totality of circumstances in Mr. Kopicko’s case, the district court judge was not persuaded by Anthem’s peer reviewer who opined that lack of “objective psychological testing” suggested that he was not disabled beyond May 8, 2018. The judge’s decision is consistent with other rulings in the Ninth Circuit that have noted that psychiatric impairments are not as amenable to substantiation by objective laboratory testing as are physical impairments. Therefore, even though mental disorders cannot always be ascertained and verified like physical ailments, that does not mean that people with psychiatric conditions cannot successfully support their disability.

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In 2011, Kevin Zietz was hired to assist a Federal Express Company employee who had a long term disability claim denied by Aetna, the claims paying administrator for the Federal Express Long Term Disability Plan. The Plan provides employees with 180 days to submit a written appeal challenging the denial of benefits. The 180-day period ended in this case on a Saturday. The employee submitted his appeal to Aetna by mail on Monday, the next business day. This was 182 days after Aetna denied the employee’s claim. Aetna denied the employee’s appeal as untimely. Kevin Zietz filed a legal action in federal district court pursuant to 29 U.S.C. Section 1132, the civil enforcement provision of ERISA. Aetna filed a motion for judgment on the pleadings under Federal Rule of Civil Procedure 12(c), and argued that the employee failed to exhaust his administrative remedies because he mailed his appeal after the 180-day period. Kevin Zietz argued at the hearing on Aetna’s motion that Federal Rule of Civil Procedure (Rule 6) applies to ERISA which would extend a deadline to the next business day when it falls on a Saturday, Sunday, or holiday. The federal district court judge ruled that the employee’s appeal was untimely and dismissed the case.

Kevin Zietz sought assistance from the law firm Kantor and Kantor to appeal the federal district court’s decision to dismiss the employee’s case. The Kantor law firm did a very skillful job and obtained a ruling from the 9th Circuit Court of Appeals that was consistent with Kevin Zietz’s argument to the trial court. The 9th Circuit ruled that ERISA common law required that Aetna accept the employee’s appeal as timely because he mailed it on the first weekday following the weekend. Federal Courts in the 9th Circuit had never before this case agreed to apply Federal Rule of Civil Procedure 6 to ERISA cases, thus giving employees additional days to submit an appeal when the 180 day deadline fell on a Saturday, Sunday, or holiday.

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This case presents a dispute concerning a short-term disability benefit plan offered my client’s employer, Federal Express Corporation (“FedEx”). When my client was injured at work, Aetna Life Insurance-the claims-paying administrator of the policy-denied Meguerditchian’s claim as untimely. As a result my client brought this action seeking recovery of benefits under Employee Retirement Income Security Act (ERISA) § 502(a)(1)(B). For the reasons discussed in the attached decision, the Court reversed the administrator’s denial of STD benefits claim as untimely and remanded the case to the claims-paying administrator for a decision on the merits.

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