Court: Diabetic Complications Not Covered Under ERISA Occupational Injury Plan

October 25, 2004 ( - A federal judge has ruled that a man whose toe was amputated due to diabetic complications cannot receive benefits from his company's Employee Retirement Income Security Act (ERISA) occupational injury plan.

>US Magistrate Judge Jeff Kaplan of the US District Court for Northern Texas ruled that Stanley Vore, who had his toe amputated and thus could not work, was not eligible for benefits because the amputation was the result of an ordinary disease of life, and not by an occupational hazard. Kaplan has allowed a suit under the Americans with Disabilities Act (ADA) to go forward, however.

>Vore had worked as both a Medicare manager and a nurse assessor at the Colonial Manor Nursing Center, and in 1998 began experiencing complications secondary to diabetes. In August of 2001 he was hospitalized due to a toe infection stemming from a diabetic ulcer. A director suggested he take leave under the Family and Medical Leave Act (FMLA) and apply for disability benefits. Vore was fired after exhausting his FMLA leave.

>In December of that same year, Vore asked for benefits under Colonial’s occupational injury plan, alleging that he was forced to work as a floor nurse in a wheelchair while he had a fever, which he claims led to his toe infection. Vore’s attorney wrote a letter to the Equal Employment Opportunity Commission (EEOC) alleging disability discrimination under ADA.

>In his ruling, Kaplan found that Vore was not entitled to ERISA plan benefits because he did not apply within the allotted amount of time and because the disability was not the result of workplace stress but was rather an ordinary life disease.

>Vore also alleged a conflict of interest in benefits distribution at Colonial because the company directly put funds into the bank account of a third-party administrator. Vore believed there should be a heightened standard of review of the claim processing. Kaplan, however, disagreed, stating that without more evidence of a conflict of interest there were no grounds for claims that the administrator’s performance reviews or compensation levels were linked to the amount of benefits paid out.

>Kaplan did however allow the plaintiff’s ADA claims to go forward. This only applies to claims made with the EEOC within 300 days of the discriminatory act, and not for claims that extend beyond this 300 day limit. The claims focus on Colonial’s inadequate accommodation of Vore’s disability, according to the court.

>The case is Vore v. Colonial Nursing Center, N.D. Texas, No. 3-03-CV-1660-BD(P), 10/19/04.