Mealey's Disability Insurance

  • February 22, 2017

    6th Circuit Finds Disability Coverage Claims Preempted By ERISA

    CINCINNATI — After finding that a former marketing director's claims for coverage against a medical review company were completely preempted by the Employee Retirement Income Security Act, the Sixth Circuit U.S. Court of Appeals on Feb. 17 affirmed dismissal of the claims and found that a previous lawsuit filed against a plan administrator was the proper recourse (James Hackney v. Allmed Healthcare Management Inc., No. 16-5651, 6th Cir., 2017 U.S. App. LEXIS 2877).

  • February 22, 2017

    High Court Denies Cert In Case Over Termination Of Long-Term Benefits

    WASHINGTON, D.C. — The U.S. Supreme Court on Feb. 21 denied a petition for a writ of certiorari in a case in which the 11th Circuit U.S. Court of Appeals said a district court did not err in determining that a disability plan did not wrongfully terminate a claimant’s long-term disability benefits (Elizabeth Jenkins v. Grant Thornton LLP, et al., No. 16-682, U.S. Sup.).

  • February 16, 2017

    Substantial Evidence Supports Plan Denial Of LTD Benefits, Ohio Federal Judge Says

    COLUMBUS, Ohio — The denial of a claim for long-term disability (LTD) benefits was not arbitrary and capricious because the claimant was provided with a fair review procedure and substantial evidence supports the denial of benefits, an Ohio federal judge said Feb. 14 in granting the plan’s motion for judgment on the administrative record (Angela Schofield v. Nationwide Insurance Cos., et al., No. 16-371, S.D. Ohio, 2017 U.S. Dist. LEXIS 20687).

  • February 16, 2017

    Federal Judge Says Claimant Is Residually Disabled, Not Totally Disabled As Required

    ATLANTA — A disability claimant is not entitled to benefits under a policy’s lifetime sickness rider because the claimant is residually disabled and not totally disabled as required for benefits under the rider, a Georgia federal judge said Feb. 15 (William F. Nefsky v. Unum Life Insurance Company of America, No. 15-2119, N.D. Ga., 2017 U.S. Dist. LEXIS 21152).

  • February 16, 2017

    Claimant’s Suit Was Timely Filed, California Federal Judge Says

    SAN FRANCISCO — A disability claimant’s suit alleging wrongful termination of benefits was timely filed, a California federal judge said Feb. 13 after determining that the plan’s three-year limitations period did not begin to run until after the 180-day deadline to appeal the termination of benefits ended (Nancy Hart v. UNUM Life Insurance Company of America, No. 15-5392, N.D. Calif., 2017 U.S. Dist. LEXIS 20198).

  • February 15, 2017

    Disability Plan Is Governed By ERISA, California Federal Judge Determines

    LOS ANGELES — A California federal judge on Feb. 10 denied a plaintiff’s motion to remand a disability suit to state court because the disability plan at issue is not a “church plan” and is governed by the Employee Retirement Income Security Act (Melvyn L. Durham v. The Prudential Insurance Company of America et al., No. 16-8202, C.D. Calif., 2017 U.S. Dist. LEXIS 19402).

  • February 9, 2017

    Insurer Failed To Consider Physician’s Statement Of Functionality, Judge Says

    KALAMAZOO, Mich. — A Michigan federal judge on Feb. 8 reversed a disability insurer’s denial of benefits after determining that the insurer failed to provide any reasonable explanation for disregarding the only assessment, made by the claimant’s treating physician, of the claimant’s functionality (Mary Beth Tobin v. Hartford Life and Accident Insurance Co., No. 14-187, W.D. Mich., 2017 U.S. Dist. LEXIS 17455).

  • February 8, 2017

    New York Federal Magistrate: In Camera Review Of Insurer’s Documents Is Necessary

    NEW YORK — A New York federal magistrate judge on Feb. 6 found that an in camera review of an insurer’s documents requested through discovery by a disability claimant is necessary to determine if the documents are protected under the work product doctrine or if the  fiduciary exception to the attorney-client privilege applies (Cherylle McFarlane v. First Unum Life Insurance Co., No. 16-7806, S.D. N.Y., 2017 U.S. Dist. LEXIS 16433).

  • February 8, 2017

    New York Federal Judge Awards Disability Claimant Reduced Attorney Fees And Costs

    NEW YORK —  A New York federal judge on Feb. 3 awarded a disability claimant more than $233,000 in attorney fees and more than $5,000 in costs but only after determining that a reduction of the hours charged by the claimant’s counsel is warranted (Dimitra Dimopoulou v. First Unum Life Insurance Co., et al., No. 13-7159, S.D. N.Y., 2017 U.S. Dist. LEXIS 15944).

  • February 7, 2017

    Claimant Failed To Meet Plan’s Work Requirements, Federal Magistrate Says

    NASHVILLE, Tenn.  — A Tennessee federal magistrate judge on Jan. 30 recommended that a disability claimant’s motion for judgment on the record be denied because the claimant did not work at least 120 hours during the year in which he claimed he became disabled or in the year prior to becoming disabled as required by the plan at issue (Jeffrey Brent Brooks v. Boilermakers-Blacksmith Union National Pension Trust, No. 15-1034, M.D. Tenn., 2017 U.S. Dist. LEXIS 13235).

  • February 3, 2017

    Pennsylvania Federal Judge: Benefits Termination Was Not Arbitrary And Capricious

    PHILADELPHIA — The decision to terminate a claimant’s long-term disability (LTD) benefits was not arbitrary and capricious because the insurer’s termination was reasonable based on all of the available evidence, a Pennsylvania federal judge said Jan. 31 in granting the insurer’s motion for summary judgment (Donna J. Killian v. Hartford Life and Accident Insurance Co., No. 16-1377, E.D. Pa., 2017 U.S. Dist. LEXIS 12874).

  • February 3, 2017

    11th Circuit Affirms Insurer Did Not Abuse Its Discretion In Denying Benefits Claim

    ATLANTA — A disability insurer did not abuse its discretion in denying a claim for long-term disability benefits because the claimant failed to prove that she was disabled under the plan and the insurer’s denial was reasonable based on the available evidence, the 11th Circuit U.S. Court of Appeals said Jan. 30 (Susan Till v. Lincoln National Life Insurance Co., et al., No. 16-14799, 11th Cir., 2017 U.S. App. LEXIS 1589).

  • February 2, 2017

    Louisiana Federal Judge Remands Claim To Plan Administrator For Reconsideration

    NEW ORLEANS — A Louisiana federal judge on Jan. 17 remanded a claim for long-term disability benefits to the plan administrator for reconsideration after determining that the plan administrator did not substantially comply with procedural requirements when it denied the claimant’s appeal (Tommy W. Senegal v. Reliance Standard Life Insurance Co., No. 16-1961, E.D. La., 2017 U.S. Dist. LEXIS 6044).

  • February 2, 2017

    Claimant Owed Back Benefits And Future Benefits, Federal Judge Says

    PHOENIX — A disability insurer must pay back benefits to a disability claimant in addition to future benefits for as long as the claimant remains disabled because the insurer failed to prove that the claimant was not disabled prior to the claimant’s termination from his place of employment, an Arizona federal judge said Jan. 17 (Eduardo L. Nieves v. Prudential Insurance Company of America, No. 16-768, D. Ariz., 2017 U.S. Dist. LEXIS 6187).

  • January 31, 2017

    Issue Of Fact Exists As To Whether Claimant Was Disabled, Federal Judge Says

    SEATTLE — A Washington federal judge on Jan. 26 denied a disability insurer’s motion for summary judgment after determining that an issue of fact exists as to whether the claimant was disabled pursuant to the policy’s terms (Tracie D. Morgan v. Hartford Life and Accident Insurance Co., No. 16-5183, W.D. Wash.; 2017 U.S. Dist. LEXIS 11168).

  • January 31, 2017

    Issue Of Fact Exists As To Whether Claimant Was Disabled, Federal Judge Says

    SEATTLE — A Washington federal judge on Jan. 26 denied a disability insurer’s motion for summary judgment after determining that an issue of fact exists as to whether the claimant was disabled pursuant to the policy’s terms (Tracie D. Morgan v. Hartford Life and Accident Insurance Co., No. 16-5183, W.D. Wash.; 2017 U.S. Dist. LEXIS 11168).

  • January 30, 2017

    Michigan Federal Judge: Benefits Must Be Reinstated; Evidence Supports Disability

    GRAND RAPIDS, Mich. — A Michigan federal judge on Jan. 25 determined that a claimant’s long-term disability benefits must be reinstated because the claimant’s medical records support the claim and surveillance video obtained by the insurer does not support the insurer’s termination of benefits (Michelle R. Rouleau v. Liberty Life Assurance Company of Boston, No. 15-546, W.D. Mich.; 2017 U.S. Dist. LEXIS 9984).

  • January 26, 2017

    Arbitrary And Capricious Standard Of Review Applies In Disability Benefits Suit

    PITTSBURGH — An arbitrary and capricious standard of review will be applied in a suit challenging the denial of a long-term disability benefits because the plan clearly granted the insurer the discretionary authority to determine a claimant’s eligibility for benefits, a Pennsylvania federal judge said Jan. 23 (James Neal v. Life Insurance Company of North America, et al., No. 16-1146, W.D. Pa.; 2017 U.S. Dist. LEXIS 8498).

  • January 25, 2017

    Louisiana Federal Judge Says Claimant Failed To Provide Evidence To Support Claim

    NEW ORLEANS — A Louisiana federal judge on Jan. 18 determined that summary judgment in favor of a disability plan administrator and the employer that sponsored the plan is appropriate because the claimant failed to submit any evidence in support of her claim for benefits (Deborah Davis v. Aetna Life Insurance Co., No. 16-4263, E.D. La.; 2017 U.S. Dist. LEXIS 6529).

  • January 25, 2017

    Claimant Is Entitled To Reduced Attorney Fee Award, Michigan Federal Judge Says

    ANN ARBOR, Mich. — A Michigan federal judge on Jan. 17 awarded a disability claimant more than $44,000 in attorney fees after determining that the claimant’s request of more than $58,000 was excessive based on the number of hours logged and hourly rate charged by the attorneys (Miguel Mendez v. FedEx Express, et al., No. 15-12301, E.D. Mich.; 2017 U.S. Dist. LEXIS 5948).