After Defendant has provided its rationale and Plaintiff has submitted additional evidence, if any, Defendant should evaluate Plaintiff’s claim as it would an appeal from an initial denial of benefits. If Defendant denies Plaintiff’s request for physical long-term disability benefits, Defendant must set forth its reasons and rationale, and allow Plaintiff to submit additional evidence supporting his claim for physical disability benefits. Upon remand to the administrator, Defendant must provide Plaintiff a full and fair review. The court’s order specifically provided that: The District court ordered Matrix to determine whether DeMoss was eligible for LTD benefits because of his claimed physical disabilities. More than seven years later, in December 2010, DeMoss sought review in district court asking the court to award him LTD benefits based on physical disability or to order Matrix to conduct further evidentiary review. After receiving notice of the decision, DeMoss requested administrative review of the decision, but Matrix never responded. However, Matrix denied LTD benefits due to diabetes complications, cardiac neuropathy, and eye problems. On Matrix found DeMoss eligible for LTD benefits based on a mental, emotional, or nervous illness. (Matrix).Īs an employee of LSI Logic Corporation, Robert DeMoss was a participant in his employer’s LTD group insurance policy administered by Matrix. Plaintiff Robert DeMoss appeals from an order of the district court in favor of the defendant, Matrix Absence Management, Inc.

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