Mealey's Disability Insurance
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August 23, 2021
Panel Affirms Finding In Favor Of Disability Plan, Says No Abuse Of Discretion
ST. LOUIS — A district court properly found that a disability claims administrator did not abuse its discretion in terminating a claimant’s long-term disability (LTD) benefits under the plan’s total disability standard because substantial evidence supported the termination of benefits and the term “any compensable employment,” as defined in the plan, was properly interpreted, the Eighth Circuit U.S. Court of Appeals said Aug. 20.
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August 20, 2021
Void Ab Initio Claim By Insurer Tossed By Illinois Federal Judge
CHICAGO — A counterclaimant won summary judgment July 29 when an Illinois federal judge agreed that a request by an insurer for a declaration that a disability income insurance policy is void ab initio based upon the insured’s failure to satisfy conditions precedent to coverage fails as a matter of law.
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August 13, 2021
NFL Player’s Disability Claim Remanded For Full And Fair Review
SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Aug. 10 agreed with a district court’s finding that a disability plan administrator abused its discretion and did not provide a National Football League player with a full and fair review; however, the panel said the lower court erred in remanding the player’s claim to the plan administrator rather than awarding the player benefits.
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August 05, 2021
Disability Claimant Failed To Prove He Was Disabled Under Terms Of Plan
SAN JOSE, Calif. — A California federal judge on Aug. 2 granted a disability insurer’s motion for judgment after determining that a disability claimant failed to prove by a preponderance of the evidence that he was disabled as defined by the plan.
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August 05, 2021
Disability Claimant Entitled To STD Benefits; LTD Claim Remanded For Consideration
SANTA ANA, Calif. — A California federal judge on July 29 determined that a disability claimant is entitled to short-term disability (STD) benefits and remanded the claimant’s long-term disability (LTD) claim to determine whether the claimant is entitled to LTD benefits under the any-occupation standard.
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August 05, 2021
Disability Claimant Is Barred From Relitigating Cause Of Disability
LOUISVILLE, Ky. — A Kentucky federal judge on Aug. 2 granted a disability insurer’s motion for summary judgment on breach of contract and bad faith claims because the claimant is barred from relitigating the issue of whether the suspension of his medical license predated his actual disability and because the disability policy at issue excludes payment of benefits if the suspension of a professional license contributes to the disability.
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August 03, 2021
Claimant Not Disabled From Performing Own Occupation With Another Employer
CINCINNATI — The majority of the Sixth Circuit U.S. Court of Appeals on July 8 affirmed a district court’s judgment in favor of a disability insurer after determining that the district court did not err in finding that the disability claimant was not disabled from performing the duties of her own occupation with a different employer.
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August 03, 2021
Disability Insurer Did Not Abuse Discretion In Denying LTD Claim, Judge Determines
GREENVILLE, S.C. — A disability insurer did not abuse its discretion in denying a long-term disability benefits claim based on the plan’s pre-existing condition exclusion because the administrative record includes evidence showing that the claimant’s disability may have been pre-existing, a South Carolina federal judge said July 23 in granting the disability insurer’s motion for judgment.
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August 02, 2021
Bad Faith Claim Against Disability Income Insurer Cannot Proceed
OKLAHOMA CITY — An Oklahoma federal judge on July 29 dismissed an insured’s bad faith claim against a disability income insurer after determining that the insured failed to allege sufficient facts in support of the allegation that the insurer acted in bad faith in terminating the insured’s disability benefits.
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July 30, 2021
Disability Claimant Unable To Perform Essential Functions Of Own Occupation
GREENVILLE, S.C. — A South Carolina federal judge on July 27 reversed a disability insurer’s denial of long-term disability benefits after determining that the claimant has proven that he was unable to perform essential mental functions his own occupation.
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July 29, 2021
Breach Of Contract Claim Not Preempted; Disability Plan Not Governed By ERISA
GREENBELT, Md. — A disability claimant’s breach of contract claim is not preempted by the Employee Retirement Income Security Act because the disability policy at issue was not part of an employee welfare plan governed by ERISA, a Maryland federal judge said July 28 in denying the insurer’s motion for summary judgment.
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July 29, 2021
Magistrate Judge Recommends Denying Disability Insurer’s Motion For Attorney Fees
ORLANDO, Fla. — A Florida federal magistrate judge on July 26 recommended denying a disability insurer’s motion for attorney fees based on the conclusion that an offer of judgment made by the disability insurer to the claimant before the court’s entry of judgment in favor of the insurer was invalid.
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July 29, 2021
Disability Claimant Is Not Entitled To Additional Benefits, Judge Determines
BOSTON — A Massachusetts federal judge on July 28 dismissed a disability claimant’s suit after determining that the claimant is not entitled to any additional benefits under the plan because the plan clearly states that no benefits would be paid after the claimant’s 65th birthday if the claimant became disabled before the claimant’s 61st birthday.
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July 28, 2021
Disability Claimant Entitled To Attorney Fees, Costs Based On Success On Merits
OAKLAND, Calif. — A disability claimant is entitled to an award of attorney fees in the amount of $202,490 and costs in the amount of $3,130 because the claimant achieved success on the merits of her disability claim, a California federal judge said July 26.
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July 25, 2021
California Law, Not ERISA, Governs Disability Policy, Federal Judge Says
LOS ANGELES — California law and not the Employee Retirement Income Security Act governs a disability policy because the policy at issue was an individual policy and the disability claimant paid the policy premiums directly to the insurer, a California federal judge said July 20 in granting the disability claimant’s motion for summary judgment and allowing breach of contract and bad faith claims to proceed.
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July 21, 2021
Breach Of Fiduciary Duty Claim Dismissed; Claimant Failed To Support Claim
MEMPHIS, Tenn. — A breach of fiduciary duty claim against a disability insurer must be dismissed because the disability claimant failed to plead facts to support a separate claim for breach of fiduciary duty, a Tennessee federal judge said July 8.
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July 16, 2021
District Court Properly Found Disability Policy Had Only 5-Year Benefits Period
NEW ORLEANS — A district court properly found that a disability insurer did not breach its contract because the policy at issue provided only a five-year maximum benefits period and the claimant failed to offer any evidence in support of his argument that the policy provided a 10-year maximum benefit period, the Fifth Circuit U.S. Court of Appeals said July 15.
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July 08, 2021
Disability Claimant’s Suit Is Barred By Res Judicata, Georgia Federal Judge Says
SAVANNAH, Ga. — A Georgia federal judge on June 21 granted a disability insurer’s motion to dismiss after determining that the claimant’s lawsuit is barred by the doctrine of res judicata because the claimant filed a suit in 2017 that was based on the same denial of long-term disability benefits.
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July 08, 2021
Plan Administrator’s Termination Of LTD Benefits Was Not Arbitrary, Capricious
DETROIT — A Michigan federal judge on June 23 granted a disability plan administrator’s motion for judgment on the administrative record after determining that the administrator’s termination of benefits was not arbitrary or capricious based on the plan language.
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July 08, 2021
Disability Claimant Was Not Disabled From Performing Duties As Lawyer, Judge Says
LANSING, Mich. — A disability insurer’s termination of long-term disability benefits is supported by the medical evidence, a Michigan federal judge said July 7 in denying the claimant’s motion for judgment on the administrative record after determining that the claimant was not disabled from performing his duties as a lawyer.
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July 07, 2021
Misrepresentation, Fraud Claims To Proceed Against Disability Insurer
FRESNO, Calif. — A California federal judge on June 28 denied a disability insurer’s motion for partial summary judgment on misrepresentation and fraud claims because the claims are based on conduct that occurred outside of the contract and are not preempted by the applicable Illinois law.
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July 07, 2021
California Federal Judge Denies Disability Insurer’s Motion To Dismiss
OAKLAND, Calif. — A California federal judge on June 25 denied a disability insurer’s motion to dismiss after determining that the disability insurer is a proper defendant for the claimant’s short-term disability (STD) claim and that the disability insurer failed to prove that the claimant did not exhaust all administrative remedies on the claim for long-term disability (LTD) benefits.
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July 07, 2021
Disability Claimant Failed To Show Benefits Termination Was Not Reasonable, Judge Says
SAN FRANCISCO — A disability claimant failed to show that a disability insurer’s termination of long-term disability (LTD) was not reasonable, a California federal judge said June 23, noting that the claimant offered very little evidence in support of her claim for disability benefits.
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July 07, 2021
Termination Of LTD Benefits Was Not De Novo Wrong Or Unreasonable, Judge Says
MACON, Ga. — A disability insurer’s termination of a claimant’s long-term disability benefits based on a finding that the claimant was not disabled from any occupation was not de novo wrong or unreasonable because the claimant failed to show that the reports of the insurer’s consulting physicians were unreliable or that the report of her treating physician was more reliable, a Georgia federal judge said June 23 in granting the insurer’s motion for judgment.
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July 07, 2021
Federal Magistrate Judge Denies Disability Plan’s Motion For Protective Order
LOS ANGELES — A California federal magistrate judge on June 24 denied a disability plan’s motion for a protective order, rejecting the plan’s argument that the disability claimant is not entitled to conduct discovery because the plan already produced the entire administrative record.