Former stuntwoman Leslie Hoffman has gained one other ruling earlier than the U.S. Ninth Circuit of Appeals in her decade-long battle with the SAG Pension Plan and the SAG-AFTRA Health Plan over whether or not she is entitled to obtain an occupational incapacity pension, which might give her lifetime well being protection due to the accidents she suffered over her lengthy profession.
The case has bounced backwards and forwards between the decrease district court docket and the appellate court docket since she first filed swimsuit in 2010 — when the Plans denied her occupational incapacity pension and well being – after which once more in 2015, when the Plans took away her pension, which he’d been receiving since 2002, saying that she wasn’t disabled anymore and will return to work.
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In their ruling, Circuit Court judges Andrew Kleinfeld, Richard Tallman and John Owens repeatedly cited the “curious facts in the case” and “the unusual posture of this case.” The litigation over her entitlement to advantages “has a tortured history and is now on its fourth district judge and its third panel of circuit judges,” they wrote in a ruling made public right this moment.
Hoffman as soon as was amongst Hollywood’s high stuntwomen and the primary ever elected to the SAG Hollywood board of administrators, and later to AFTRA’s Hollywood board and nationwide boards of administrators. She’s been twice recognized with a traumatic mind damage that she says was the results of one too many concussions sustained throughout her a few years of stunt work. She hasn’t been capable of work since 2002, however the Plans, whereas acknowledging that she’s disabled, have insisted that it’s the results of emotional issues unrelated to her years of stunt work.
After she grew to become disabled in 2002, she started accumulating SAG incapacity pension advantages. But after a slipshod investigation, the Plan trustees decided that she had labored and held herself out for work whereas accumulating these advantages and ordered her to repay $123,827.50 in advantages she’d acquired over a 13-year interval, plus one other $8,457.72 in curiosity on these funds.
Hoffman filed swimsuit, and her case has been rattling round within the courts ever since. It seems, nevertheless, that the trustees and the Plans’ attorneys have recognized all alongside that she by no means labored below SAG’s jurisdiction whereas disabled. In truth, the Plans’ personal data, obtained by Deadline, present that she has had no SAG earnings in any respect, besides residuals, since 2001.
And but, regardless of realizing that she had no earnings below the union’s contract as a stunt performer or coordinator throughout all these years, the Plans’ trustees accused her of getting “been engaged on certain projects as a stunt coordinator during the course of your claimed disability.”
In its third ruling in her favor, the Circuit Court now has directed the district court docket to reopen the primary of her two instances (often known as Hoffman I), or to reopen the second case (Hoffman II) and consolidate them after which determine whether or not she is entitled to persevering with well being advantages. As the results of an earlier partial settlement, the events stipulated that the Plans would pay her an extra $54,516.67 in arrears, pending re-adjudication of whether or not she was “totally disabled” below the Plans’ definitions.
Hoffman has sought advantages from the Plans since 2004. In 2010, the Plans denied her 2008 request to change her present $952 month-to-month Disability Pension into an Occupational Disability Pension – and the lifetime well being care protection it offers – after figuring out her incapacity from extreme main melancholy was not linked to her stunt work. Following an unsuccessful administrative attraction, she sued in 2010, difficult the Plan’s conclusion that her ‘total disability’ was not attributable to her work.
The district court docket granted abstract judgment in favor of the Plans in 2012, however the Circuit Court reversed that ruling after concluding that the Plans had “denied Hoffman a full and fair review of her claim of entitlement to coverage” below its Occupational Disability Plan.
The district court docket then issued its remand order to the Plans, however expanded the scope of assessment to embody all information that bore on her incapacity declare. On remand, the Plans confirmed their earlier willpower that her incapacity was not work-related, whereas additionally informing Hoffman that they have been retroactively reviewing her entitlement to the $952 month-to-month Disability Pension she had been receiving for years.
“Although the Plans had denied the claim on grounds that her disability was not work-related,” the Circuit Court judges stated of their newest ruling, “the district court subsequently denied Hoffman’s first motion to reopen Hoffman I on January 20, 2015, reasoning that “the case is not presently closed, and the Plan has apparently not completed administrative review of whether she is disabled.” The Circuit Court denied her petition to compel the district court docket to assessment the incapacity subject in February 2015.
In June 19, the Pension Plan retroactively terminated her Disability Pension, figuring out she had not really met the Plans’ definition of “totally disabled” since at the very least December 31, 2004. It sought restitution for all incapacity funds beforehand paid, plus curiosity. Hoffman unsuccessfully administratively appealed that call, after which filed her second lawsuit, which challenged that retroactive choice. “The district court again granted summary judgment for the Pension Plan, but we again reversed,” the Circuit Court judges famous.
On remand, the district court docket discovered that the Pension Plan abused its discretion in terminating Hoffman’s incapacity advantages and additional remanded the matter to the Pension Plan in October 2019. Several months later, nevertheless, the district court docket entered the events’ stipulated judgment in Hoffman’s favor and later awarded Hoffman lawyer charges for Hoffman II.
In April 2020, Hoffman filed her second movement to reopen Hoffman I so she may pursue her declare for lifetime medical advantages, “which for some reason was not resolved in the earlier litigation,” the Circuit Court judges wrote. They added:
“The district court docket entered the Order now earlier than us on May 1, 2020, restricted solely to permitting Hoffman’s lawyer charges movement to proceed for the work in Hoffman I, however rejecting Hoffman’s request to reopen the case to adjudicate her entitlement for future well being advantages below the Occupational Disability Pension.
“We have been knowledgeable at oral argument that on remand the Pension Plan has achieved nothing as a result of it has paid out all Disability Pension financial advantages to which it believes Hoffman could be entitled and that the Plans now not search restitution of the advantages paid. The briefs inform us that the Health Plan has achieved nothing additional to adjudicate Hoffman’s declare for persevering with medical health insurance as a result of it considers the case closed. We now maintain that in mild of this odd procedural historical past we have now jurisdiction to assessment the Order.
“The district court docket’s basic assumption that the Plans will sometime determine whether or not Hoffman is completely disabled primarily based on her work as a stunt actress, and due to this fact entitled to future well being advantages, is inconsistent with the expedited timeline inside which the Plans should act below the Employee Retirement Income Security Act laws. It was due to this fact an abuse of discretion to disclaim her movement to reopen primarily based on that assumption. The Plans have achieved nothing to adjudicate Hoffman’s excellent declare for medical protection below the Health Plan and can do no extra as a result of they imagine there’s nothing left to be determined.
“By not finding the Plans had constructively denied Hoffman’s claim as to the Occupational Disability Pension continuing health care obligations Hoffman seeks, the district court erred. Accordingly, we direct the district court to reopen Hoffman I, or to reopen Hoffman II and consolidate the cases below if necessary, and then decide de novo whether Hoffman is entitled to continuing health benefits.”
In reversing, vacating and remanding with directions, the judges awarded prices to Hoffman, who has been represented by lawyer Chuck Fleishman.
source https://infomagzine.com/ex-stuntwoman-wins-round-in-court-battle-for-sag-aftra-pension-health-benefits-deadline/
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