Philadelphia partners Joshua Bachrach and Heather Austin and Peter Moore (Partner-McLean, VA) obtained summary judgment in favor of insurance company client in connection with a dispute over eligibility for long-term disability benefits under ERISA. While a chief resident, the plaintiff suffered cardiac arrest and other significant complications following gastric sleeve surgery. His disability claim under a different company's policy covering residents was approved, and several months later he was able to return to work and was eligible for coverage under our client's disability policy covering attending physicians. Unfortunately, his condition worsened and he again became disabled. Because the doctor was able to return to work, albeit briefly, his coverage under the prior policy ended. But because he became disabled within 12 months of his eligibility under our client's policy, the claim was denied under the policy's preexisting conditions limitation. The doctor argued that his coverage should have transferred automatically from the prior carrier to our client's policy because he was always an employee of the hospital. But the court disagreed based on the language in the policy and his effective date of insurance. Based on its de novo review of the claim, the court entered summary judgment in favor of our client.
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