Fannin County Court Upholds Long-Term Disability Benefits Denial
One person filed a lawsuit seeking long-term disability benefits after stopping work due to medical conditions. These conditions were allegedly caused or worsened by a past motor vehicle accident and subsequent hip surgery. The person also claimed inability to work due to mental health issues. The insurance company argued the person was not disabled and could perform other jobs. The court ruled in favor of the insurance company, finding their denial of benefits was reasonable.
Case Information Updated: October 2025
Case Outcome
- Outcome
- Verdict-Defense
- Amount
- Undisclosed
- County
- Fannin County, GA
- Resolved
- 2025
Injury & Accident Details
- Injury Type
- Back Strain / Soft Tissue
- Accident Type
- Other
- Case Type
- Motor Vehicle Negligence
Case Overview
A Fannin County resident and former employee filed a lawsuit against the insurer of her former employer's employee welfare benefit plan, seeking long-term disability benefits. The plaintiff ceased working in 2020, alleging an inability to work due to medical conditions, including right hip osteoarthrosis, shoulder, neck, and back pain, which she attributed to a 2014 motor vehicle accident and subsequent hip surgery. She also claimed disabling post-traumatic stress disorder and major depressive disorder.
The defendant insurer denied the benefits, asserting the plaintiff did not meet the plan's definition of disability and could perform sedentary work. The insurer presented medical evaluations indicating the plaintiff could exert up to 10 pounds of force, walk and stand for up to 2.5 hours per day, and sit for up to 5.5 hours per day. It contended she could perform alternative occupations, such as Information Clerk or Gate Guard, which would exceed the plan's earnings threshold, and argued she did not suffer from any disabling psychiatric impairment.
On May 9, 2025, the Court granted the defendant's motion for judgment on the administrative record. The Court determined that the insurer's denial of long-term disability benefits was reasonable and not arbitrary or capricious, concluding there was no improper claim denial under the Employee Retirement Income Security Act (ERISA). The judgment resulted in no damages awarded to the plaintiff.
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