SAN FRANCSICO — The Ninth Circuit U.S. Court of Appeals on June 21 affirmed a district court’s award of own-occupation long-term disability (LTD) benefits in favor of a disability claimant but vacated and remanded the lower court’s award of attorney fees in favor of the claimant for recalculation (Dave Nagy v. Group Long Term Disability Plan for Employees of Oracle America Inc., et al., Nos. 16-16160, 17-15491, 9th Cir., 2018 U.S. App. LEXIS 16883).
DENVER — A disability insurer did not act arbitrarily or capriciously in denying a plan participant’s claim for long-term (LTD) disability benefits because the insurer’s denial was supported by substantial evidence, the 10th Circuit U.S. Court of Appeals said June 21 (John Dardick v. Unum Life Insurance Company of America, et al., No. 17-1412, 10th Cir., 2018 U.S. App. LEXIS 16753).
CHICAGO — The Seventh Circuit U.S. Court of Appeals on June 21 affirmed a district court’s ruling that a disability claimant suffering from invasive basal cell carcinoma in the right ear is not entitled to total disability benefits from his insurer because he is still able to perform all but one of the functions of his occupation as a company president (Henry Fiorentini v. Paul Revere Life Insurance Co., No. 17-3137, 7th Cir., 2018 U.S. App. LEXIS 16741).
ST. LOUIS — A Missouri federal judge on June 19 remanded a long-term disability (LTD) claim and instructed the claims administrator to evaluate if the side effects of the claimant’s prescribed medications affected the claimant’s ability to perform any occupation (Lisa Conner v. Ascension Health, et al., No. 17-021, E.D. Mo., 2018 U.S. Dist. LEXIS 102064).
SAN FRANCISCO — A disability claimant is entitled to long-term disability (LTD) benefits because the evidence from the claimant’s treating physicians and evidence obtained from the disability insurer’s medical reviewers support a finding that the claimant is disabled under the plan’s any-occupation standard, a California federal judge said June 18 (Sarabjit Sangha v. Cigna Life Insurance Company of New York, No. 17-5158, N.D. Calif., 2018 U.S. Dist. LEXIS 101725).
SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on June 15 remanded a disability benefits dispute to the district court to determine whether the claimant is entitled to equitable relief based on the disability plan’s failure to properly offset the claimant’s disability benefits (Petar Mrkonjic v. Delta Family-Care and Survivorship Plan, et al., Nos. 16-56335, No. 16-56487, 9th Cir., 2018 U.S. App. LEXIS 16162).
NEW ORLEANS — A Louisiana federal judge on June 12 granted a disability plan administrator’s motion for summary judgment after determining that the disability claimant’s suit must be dismissed because the claimant failed to file suit within the disability plan’s limitations period (Michael Faciane v. Sun Life Assurance Company of Canada, No. 17-17429, E.D. La., 2018 U.S. Dist. LEXIS 97969).
NEW ORLEANS — A Louisiana federal judge on June 13 ordered a disability insurer to supplement its answers to a disability claimant’s interrogatories to include communications with all attorneys consulted regarding the participant’s claim for benefits (Anne Wittmann v. Unum Life Insurance Company of America, No. 17-9501, E.D. La., 2018 U.S. Dist. LEXIS 99042).
WASHINGTON, D.C. — The U.S. Supreme Court should grant a petition for writ of certiorari because the Colorado Supreme Court’s dismissal of two long-term disability insurance lawsuits based on the failure to serve the proper parties has widened an existing conflict between federal courts of appeal regarding whether a benefit plan governed by the Employee Retirement Income Security Act is a proper defendant, the petitioners argue in their May 11 brief filed in the high court (Brenda Olivar v. Public Service Employee Credit Union Long Term Disability Plan, and Caroline Burton, et al. v. Colorado Access, et al., No. 17-1543, U.S. Sup., 2018 U.S. S. Ct. Briefs LEXIS 1932).
RICHMOND, Va. — A North Carolina woman is asking the Fourth Circuit U.S. Court of Appeals to reverse a lower court’s ruling regarding her disability insurance coverage claim because benefit increases that she purchased on her policy were wrongly retracted when the insurer initially denied her claim and then later elected to pay benefits to a retroactive date (Jessica Slice-Sadler v. Principal Life Insurance Company, No. 17-2249, 4th Cir.).
BIRMINGHAM, Ala. — An Alabama federal judge on May 30 granted a disability insurer’s motion to dismiss a claimant’s breach of fiduciary duty claim after determining that the claim seeking recovery of benefits under the Employee Retirement Income Security Act provides an adequate remedy to the claimant (Carol H. Stewart v. Hartford Life & Accident Insurance Co., No. 17-1423, N.D. Ala., 2018 U.S. Dist. LEXIS 89508).
SACRAMENTO, Calif. — A California federal judge on June 4 recommended dismissing a disability claimant’s state law claims because the state law claims are preempted under the Employee Retirement Income Security Act (Jerome Clay v. AT&T Umbrella Benefit Plan No. 3, No. 17-749, E.D. Calif., 2018 U.S. Dist. LEXIS 93784).
WASHINGTON, D.C. — A District of Columbia federal judge on June 6 dismissed claims alleging that a short-term disability (STD) insurance provider violated the Employee Retirement Income Security Act by engaging in prohibited transactions after determining that the plan’s trustees failed to prove that the insurer engaged in any transactions that are prohibited under ERISA (Joseph Sellers Jr., et al., v. Anthem Life Insurance Co., No. 16-2428, D. D.C., 2018 U.S. Dist. LEXIS 95278).
By Vivian Cullipher
DETROIT — A Michigan federal judge on June 1 upheld a magistrate judge’s order permitting a disability claimant to conduct limited discovery on the number of times a disability insurer employed a specific doctor to complete medical reviews of long-term disability claims because the claimant made “a sufficient predicate showing” to warrant the limited discovery (Precious Robert Johnson v. Harleysville Life Insurance Co., No. 17-10321, E.D. Mich., 2018 U.S. Dist. LEXIS 92833).
NEWARK, N.J. — A New Jersey federal judge on May 31 determined that a former newspaper reporter is entitled to short-term disability and long-term disability benefits under a disability plan issued by his employer because the wealth of medical evidence supports a finding that the claimant is disabled as a result of chronic fatigue syndrome under the terms of the plan and unable to perform the duties of his own occupation (Brian Vastag v. Prudential Insurance Company of America, No. 15-6197, D. N.J., 2018 U.S. Dist. LEXIS 91458).
SAN FRANCISCO — A district court did not abuse its discretion in dismissing a disability claimant’s amended complaint because the prelitigation costs and attorney fees sought by the claimant are not available as equitable relief under the Employee Retirement Income Security Act, the Ninth Circuit U.S. Court of Appeals said May 31 (Larry A. Benson v. Life Insurance Company of North America, No. 17-55253, 9th Cir., 2018 U.S. App. LEXIS 14367).
SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on May 31 reversed a district court’s ruling in favor of a disability insurer after determining that genuine issues of fact exists regarding whether the insurer improperly denied the claim before the amount of time to submit additional materials had expired (Narciso Cuaresma Jr. v. Farmers Group Disability Income Plan, et al., No. 16-16946, 9th Cir., 2018 U.S. App. LEXIS 14368).
PHOENIX — An Arizona federal judge on May 29 granted an insured’s motion for summary judgment after determining that a disability insurer incorrectly classified the insured’s disability as resulting from a sickness rather than from an accidental injury because the insured was not totally disabled by a pre-existing degenerative disc disease until after the accidental injury occurred (Thomas Scott Wood v. Provident Life and Accident Insurance Co., No. 17-2330, D. Ariz., 2018 U.S. Dist. LEXIS 89056).
ALEXANDRIA, Va. — A Virginia federal judge on May 29 granted a disability insurer’s motion for summary judgment after determining that the insurer’s termination of benefits based on the policy’s mental and nervous disorder limitation was reasonable and not an abuse of discretion (Roger D. Shepard v. Liberty Life Assurance Company of Boston, No. 17-1055, E.D. Va., 2018 U.S. Dist. LEXIS 89241).