Mealey's Disability Insurance

  • November 06, 2020

    Additional Discovery Will Not Benefit Court In Review Of Termination Of Benefits

    PHOENIX — Additional discovery in a disability benefits dispute is not warranted because additional discovery will not aid the court in its de novo review of the disability insurer’s decision to terminate the claimant’s benefits under the plan’s any-occupation standard, an Arizona federal judge said Oct. 21 (Sherry Hasslacher v. Life Insurance Company of North America, No. 19-5272, D. Ariz., 2020 U.S. Dist. LEXIS 201190).

  • November 06, 2020

    Disability Claimant Not Precluded From Asserting Breach Of Contract Claim

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Nov. 4 reversed and remanded a district court’s ruling in favor of a disability insurer on breach of contract and bad faith claims after determining that the disability claimant was not precluded from asserting a breach of contract claim based on a prior ruling by the Sixth Circuit (James H. Pogue v. Principal Life Insurance Co., No. 20-5133, 6th Cir., 2020 U.S. App. LEXIS 34937).

  • November 03, 2020

    Additional Disability Benefits Owed Under Disability Plan, Federal Judge Says                            

    LOS ANGELES — A disability insurer’s termination of a long-term disability (LTD) benefits claim is not supported by the medical evidence, a California federal judge said Oct. 29 in determining that the insurer must pay the claimant additional benefits under the disability plan (Joel Groch v. Dearborn National Life Insurance Co., No. 18-6614, C.D. Calif., 2020 U.S. Dist. LEXIS 204171).

  • November 03, 2020

    Magistrate Judge Says Disability Insurer Must Produce Unredacted Documents

    COLUMBUS, Ohio — An Ohio federal magistrate judge on Nov. 2 determined that a disability insurer must produce unredacted copies of information related to disability claims because the information is relevant to a disability plan participant’s claim (Barbara Cluck v. Unum Life Insurance Company of America, No. 18-56, S.D. Ohio, 2020 U.S. Dist. LEXIS 204429).

  • November 02, 2020

    Insurer’s Termination Of Benefits Supported By Evidence, Judge Determines

    SANTA ANA, Calif. — A disability insurer did not wrongfully terminate a disability claimant’s benefits after 17 years because the medical evidence, the claimant’s Facebook posts and the insurer’s investigative reports support the insurer’s conclusion that the claimant was no longer disabled from performing the duties of her own occupation, a California federal judge said Oct. 28 (Michele Reed McCoy v. Aetna Life Insurance Co., et al., No. 19-575, C.D. Calif., 2020 U.S. Dist. LEXIS 202032).

  • October 27, 2020

    Issues Of Fact Exist On Regular Occupation Of Disability Claimant

    ANNISTON, Ala. — An Alabama federal court on Oct. 26 determined that genuine issues of material fact exist as to what a disability claimant’s regular occupation was when he became disabled and whether the claimant’s hand tremors prevented him from performing the duties of his regular occupation (William A. Lemons Jr., M.D. v. Principal Life Insurance Co., No. 18-1040, N.D. Ala., 2020 U.S. Dist. LEXIS 198554).

  • October 27, 2020

    Higher Degree Of Skepticism Must Be Applied To Disability Insurer’s Decision

    PORTLAND, Ore. — The Ninth Circuit U.S. Court of Appeals on Oct. 26 reversed and remanded a district court’s ruling in favor of a disability insurer after determining that the lower court should have applied a “higher degree of skepticism” based on the conflicting medical evidence and the disability insurer’s structural conflict of interest as both the claims administrator and payer (Alison Gary v. Unum Life Insurance Company of America, No. 19-35439, 9th Cir., 2020 U.S. App. LEXIS 33636).

  • October 27, 2020

    Judge:  Additional Discovery In Disability Benefits Dispute Is Not Warranted

    ST. LOUIS — A Missouri federal judge on Oct. 23 denied a disability claimant’s request to depose a claims administrator’s employee and corporate representative regarding the denial of a short-term disability (STD) benefits claim because the claimant failed to provide good cause for conducting the depositions (Kevin Nauss v. Sedgwick Claims Management Services Inc., No. 20-304, E.D. Mo., 2020 U.S. Dist. LEXIS 197491).

  • October 26, 2020

    Insurer’s Termination Of Disability Benefits Was Reasonable, Judge Determines

    ABERDEEN, Miss. — A disability insurer did not abuse its discretion in terminating a claimant’s long-term disability (LTD) benefits under the plan’s any-reasonable-occupation standard because the termination of benefits was reasonable based on the medical evidence, a Mississippi federal judge said Oct. 23 (Jeffrey E. Crump v. Aetna Inc., No. 19-109, N.D. Miss., 2020 U.S. Dist. LEXIS 197375).

  • October 26, 2020

    Disability Insurer Must Produce Documents Related To Training Guidelines

    NEW YORK — A disability insurer must produce documents pertaining to its training guidelines that are applicable to the denial of a disability claimant’s long-term disability (LTD) benefits claim, a New York federal judge said Oct. 21 in partially granting the claimant’s motion to compel (David Smith v. First Unum Life Insurance, et al., No. 19-298, S.D. N.Y., 2020 U.S. Dist. LEXIS 196394).

  • October 22, 2020

    Disability Claimant Failed To Exhaust Administrative Remedies, Panel Says

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Oct. 21 affirmed a district court’s ruling that a disability claimant’s suit must be dismissed for failure to exhaust all administrative remedies because the claimant clearly failed to timely file an administrative appeal of the insurer’s termination of her long-term disability (LTD) benefits claim (Patricia D. White v. Anthem Life Insurance Co., No. 19-16954, 9th Cir., 2020 U.S. App. LEXIS 33213).

  • October 20, 2020

    Disability Claimant Awarded Attorney Fees; Judgment Stayed To Allow Insurer’s Appeal

    DALLAS — A Texas federal judge on Oct. 19 awarded a disability claimant more than $84,000 in attorney fees after determining that the award is warranted based on the claimant’s success on the merits; however, the judge allowed the insurer to post a bond and stayed the execution of the judgment to permit the insurer to file an appeal (Jose Chavez v. Standard Insurance Co., No. 18-2013, N.D. Texas, 2020 U.S. Dist. LEXIS 192877).

  • October 19, 2020

    Federal Judge Grants Stipulation To File Disability Record Under Seal

    TACOMA, Wash. — A Washington federal judge on Oct. 16 granted a joint stipulation to file the administrative record in a disability dispute under seal, agreeing with the parties that the need to protect the disability claimant’s privacy is a compelling reason to file the record under seal (Randolff Scott Ruffell Westover v. Life Insurance Company of North America, No. 20-5606, W.D. Wash., 2020 U.S. Dist. LEXIS 192304).

  • October 16, 2020

    Disability Claimant’s LTD Claim Remanded To Plan Administrator

    PHOENIX — An Arizona federal judge on Oct. 13 granted a disability claimant’s motion to supplement the administrative record and to remand to the plan administrator for reconsideration of its termination of long-term disability benefits after determining that the claimant would have submitted the information had she known that she could do so as part of the administrative appeal process (Ramina Johal v. United States Life Insurance Company in the City of New York, No. 20-204, D. Ariz., 2020 U.S. Dist. LEXIS 190796).

  • October 16, 2020

    Bad Faith Claim To Proceed Against Disability Insurer, Oklahoma Federal Judge Says

    TULSA, Okla. — An Oklahoma federal judge on Oct. 15 determined that a bad faith claim will proceed in a disability benefits dispute because genuine issues of material fact exist on the reasonableness of the disability insurer’s actions in its investigation of the claim (Jody Fees v. American Family Life Insurance Company of Columbus [Aflac], No. 19-476, N.D. Okla., 2020 U.S. Dist. LEXIS 190797).

  • October 16, 2020

    Panel Says Plan Abused Its Discretion In Calculating NFL Player’s Disability Award

    ATLANTA — The 11th Circuit U.S. Court of Appeals on Oct. 15 determined that a district court erred in granting a disability plan’s motion for judgment on the administrative record because the plan abused its discretion in failing to consider relevant evidence and in failing to consider the cumulative effects of the former National Football League (NFL) player’s ailments (Darren Mickell v. Bert Bell/Pete Rozelle NFL Players Retirement Plan, No. 19-10651, 11th Cir., 2020 U.S. App. LEXIS 32516).

  • October 08, 2020

    Disability Claimant Is Not Entitled To Attorney Fees, Federal Judge Says

    PHOENIX — An Arizona federal judge on Sept. 4 denied a disability claimant’s motion for attorney fees after determining that the claimant failed to prove that the remand of his claim for long-term disability benefits warrants an award of attorney fees (Michael Woolsey v. Aetna Life Insurance Co., et al., No. 18-578, D. Ariz., 2020 U.S. Dist. LEXIS 182455).

  • October 07, 2020

    Disability Pension Plan Should Have Considered Social Security Award, Judge Says

    CAPE GIRARDEAU, Mo. — A Missouri federal judge on Oct. 6 denied a disability pension plan’s motion to dismiss after determining that the plan should have considered the claimant’s evidence of a favorable Social Security Administration disability award even if the claimant submitted the award beyond the plan’s 180-day period for making an initial determination (Adam Ruessler v. Boilermakers-Blacksmiths National Pension Trust Board of Trustees, No. 20-128, E.D. Mo., 2020 U.S. Dist. LEXIS 184681).

  • October 06, 2020

    Disability Insurer's Termination Of LTD Benefits Was Not Arbitrary, Capricious

    CHATTANOOGA, Tenn. — A disability insurer's termination of long-term disability benefits was not arbitrary and capricious because the insurer reasonably interpreted its policy and provided reasoned explanations for its decision to terminate the claimant's benefits, a Tennessee federal judge said Oct. 2 (Boyd Lewis v. Unum Life Insurance Company of America, No. 18-127, E.D. Tenn., 2020 U.S. Dist. LEXIS 183165).

  • October 01, 2020

    Disability Claimant Failed To Exhaust All Administrative Remedies Before Filing Suit

    MONTGOMERY, Ala. — An Alabama federal judge on Sept. 30 dismissed a disability claimant's suit with prejudice after determining that the claimant failed to exhaust all administrative remedies under the disability plan and failed to prove that exhaustion of the administrative remedies would be futile (Daniel Castleberry v. The Lincoln National Life Insurance Co., No. 19-1025, M.D. Ala., 2020 U.S. Dist. LEXIS 180498).

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