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AN ERISA WIN INVOLVING A PRE-EXISTING CONDITION

My client, let's call him “Mr. Jones”, purchased disability insurance in early 2006. Not long after, he experienced a fall and suffered a brain injury. At the hospital, his blood alcohol level measured .205 g/dl: two-and-a-half times the .08 threshold for a DUI. Because Mr. Jones's insurance went into effect less than 2 months earlier, the carrier conducted a review of the policy, looking for preexisting conditions. They learned he had been treated for alcoholism during the relevant timeframe, and denied the claim on the basis that his alcoholism disqualified him. Mr. Jones came to my firm after the carrier had made its final decision. The case looked dire.

As lead attorney, I decided to pursue the case, No. 1:07-cv-303 (E.D. Tenn.), despite its risks and expenses the plaintiff could not recoup if the case was lost. I did this because, after reviewing the file, I felt the link the carrier drew between the pre-existing condition and ultimate disability was too tenuous. I did not believe alcoholism alone could meet the carrier's burden of proof to exclude Mr. Jones's injury from coverage.

My decision was based on the age-old concept of proximate cause, as illustrated in the famous Palsgraf v. Long Island R.R., 162 N.E. 99 (N.Y. 1928). In Palsgraf, Chief Justice Cardozo explained an action for negligence would not lie where the causal link between purported negligence and harm was so tenuous as to not be rationally connected. During Mr. Jones's case, I argued, Palsgraf-style, that the connection between Mr. Jones's pre-existing alcoholism and his brain damage was not rationally connected.

The carrier said Mr. Jones's inability to perform his occupation because of brain damage stemmed from a subdural hematoma, caused by a fall. The actual cause of the fall was unknown, but the carrier surmised it happened because Mr. Jones was intoxicated, which happened because he had been drinking alcohol, which resulted from Mr. Jones's alcoholism—a preexisting condition. It took five causal steps to make this connection.

My client's injury was not the “proximate” result of alcoholism — it was the result of an accidental fall, the exact cause of which was unknown. In 2009, a federal court agreed, ruling that although it was “possible that Mr. Jones's history of alcohol consumption ‘contributed' in some way to his ultimate severe head injury, [it was] not a close enough connection to exclude under ERISA's requirements pertaining to preexisting condition exclusions.”

The carrier appealed, but eventually the case settled. My decision to proceed with this case was a good one, and provided compensation for Mr. Jones, whose brain injury disabled him from earning a living.

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Seth Holliday

As a partner at the McMahan Law Firm, LLC, D. Seth Holliday litigates disability, health and life insurance claims on behalf of individuals who have been wrongfully denied their benefits. He is also dedicated to representing the seriously injured in personal injury litigation. Regarding private insurance benefits, Mr. Holliday has sued such insurance companies as Unum, Hartford, Prudential, Standard, Guardian/Berkshire, Cigna, MetLife, Aetna, Liberty Mutual, Mass-Mutual, and others that have denied individuals their private disability insurance (called “long-term disability” or “LTD”), life insurance or health insurance claims. His track record here is superb, and he obtains excellent results for his clients. Mr. Holliday is one of only a handful of attorneys across the United States who practices heavily in these areas. He has represented well over two thousand claimants at Social Security hearings and has a very high success rate. Attorney Holliday is a 1996 graduate of Washington University School of Law and he initially practiced in Chicago, Illinois. There, in the personal injury context, he had a principal role in obtaining three awards which were confirmed by the local jury verdict reporter as being the highest on record in the State of Illinois in their respective category. Attorney Holliday has been a leader in prominent organizations. He is a former member of the Board of Governors of the Tennessee Association for Justice, past-chair of the Disability Law Section of the American Association for Justice, past-chair of the TBA's Disability Law Section of the Tennessee Bar Association, and past-president of the Chattanooga Trial Lawyers Association. These are all associations of lawyers who advocate on behalf of injured or disabled individuals. Mr. Holliday has lectured regularly on disability issues to other attorneys and has also taught trial advocacy at the DePaul University College of Law in Chicago and business law at Chattanooga State Technical Community College in Tennessee. Additionally, Mr. Holliday provides free legal services to a variety of charitable organizations in the Chattanooga area, including the Chattanooga Community Kitchen and Legal Aid of East Tennessee. He is a two-time past recipient of the Pro Bono Excellence Award. Mr. Holliday is a former member of the board of directors for Hospice of Chattanooga, having served as chairman of its governance committee and as a member of its executive and finance committees. PRACTICE AREAS Social Security disability Health and life insurance claims Administrative law Personal injury claims Long-term disability and ERISA claims Insurance litigation Disability law BAR ADMISSIONS Illinois, 1996 U.S. District Court, Northern District of Illinois, 1996 Tennessee, 2003 U.S. District Court, Eastern District of Tennessee, 2004 U.S. District Court, Middle and Western Districts of Tennessee, 2008 U.S. Court of Appeals for the 6th Circuit, 2009 U.S. District Court, Middle District of Georgia, 2010 Georgia, 2013 U.S. District Court, Northern District of Georgia, 2015 CERTIFICATIONS Certified as a Specialist in Social Security Disability Law by the National Board of Social Security Disability Advocacy. HONORS AV® Distinguished™ Peer Review Rated by Martindale-Hubbell® Legal Aid of East Tennessee Pro Bono Excellence Award EDUCATION J.D., Washington University School of Law, 1996 B.A, Millsaps College, 1991 PROFESSIONAL ASSOCIATIONS National Association of Social Security Claimants' Representatives American Association of Justice Tennessee Bar Association Tennessee Association of Justice Chattanooga Trial Lawyers Association SOCIAL MEDIA AVVO Linkedin Facebook ADJUNCT PROFESSOR Chattanooga State Technical Community College, spring 2008 DePaul University College of Law, fall 1999 SEMINARS Moderator - Social Security Disability and ERISA Law Sections Presentation American Association for Justice Annual Convention 2012 Moderator - Disability Benefits Forum Tennessee Bar Association CLE Seminar 2011 Speaker - What Trial Lawyers Need to Know About Subrogation and Offsets in Long Term Disability & Social Security Kentucky Justice Association CLE Seminar 2010 Speaker - Interplay Between Social Security Disability and Long-Term Disability Arkansas Trial Lawyers Association CLE Seminar 2010 Speaker - Ethical Considerations for Social Security Disability Attorneys Tennessee Bar Association CLE Seminar 2009 Speaker - Social Security Disability: The Basics and Beyond Tennessee Association for Justice CLE Seminar 2008 Speaker - Social Security Disability National Business Institute CLE Seminar 2007 Speaker - Social Security Disability National Business Institute CLE Seminar 2006

Excellence

Seth has always been compelled to excel, whether it meant earning his Eagle Scout as a teenager, participating in theater, debate and varsity football in high school, his Rhodes Scholar candidacy in college, or opening his own law firm. He also perseveres in situations others might shy away from, whether it involves sky-diving, rappelling down a mountain, white-water rafting, participating in marathons and triathlons, writing a novel, or lecturing nationally to large audiences about the vagaries of ERISA.

Committed

Seth is committed to serving disabled individuals. He is proud of his work in prominent organizations such as the American Association for Justice (AAJ), the Tennessee Bar Association (TBA) and Hospice. Seth is past-Chair of both AAJ's & TBA's Disability Law Sections, past-President of the Chattanooga Trial Lawyers Association, a 2-time recipient of the Pro Bono Excellence Award, and a 7 year member of the Board of Directors for Hospice of Chattanooga.