Mealey's Disability Insurance

  • January 15, 2019

    Panel Denies Disability Claimant’s Motion To Transfer Attorney Fee Question

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Jan. 14 denied a disability claimant’s motion to transfer consideration of attorney fees to the district court, which will be considering the source of a claimant’s disability on remand, because the claimant has not yet achieved any degree of success on the merits (Miae Decovich v. Anthem Life Insurance Co., No. 17-15324, 9th Cir., 2019 U.S. App. LEXIS 1218).

  • January 15, 2019

    Disability Insurer Reasonably Applied Pre-Existing Condition Limitation To Deny Benefits

    BOSTON — A disability insurer’s denial of long-term disability (LTD) benefits based on the policy’s pre-existing condition limitation was reasonable because the insurer offered a reasonable interpretation of the policy that clearly precludes coverage for LTD benefits if the claimant was treated for the same sickness during the 90 days prior to the effective date of coverage, a Massachusetts federal judge said Jan. 14 (William Holzman v. The Hartford Life and Accident Insurance Co., No. 17-11436, D. Mass., 2019 U.S. Dist. LEXIS 6049).

  • January 11, 2019

    LTD Benefits Must Be Reinstated, New York Federal Judge Determines

    NEW YORK — A disability claimant’s long-term disability (LTD) benefits must be reinstated because the claimant met her burden of proving that she is disabled from performing the duties of any occupation, a New York federal judge said Dec. 11 in granting the claimant’s motion for judgment on the administrative record (Christine Thoma v. The Fox Long Term Disability Plan, et al., No. 17-4389, S.D. N.Y., 2018 U.S. Dist. LEXIS 209077).

  • January 11, 2019

    Florida Federal Judge Says It Is Not Clear If Preemption Applies In Disability Suit

    FORT MYERS, Fla. — A Florida federal judge on Dec. 12 denied a motion to dismiss state law claims alleged against two disability insurers because it is not clear from the pleadings that the policies are governed by the Employee Retirement Income Security Act and that the state law claims would therefore be preempted (Marcus Allen, M.D. v. First Unum Life Insurance Co., et al., No. 18-69, M.D. Fla., 2018 U.S. Dist. LEXIS 209454).

  • January 11, 2019

    Panel Denies Rehearing, Allows Ruling In Disability Insurer’s Favor To Stand

    CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Jan. 9 refused to reconsider its ruling that a district court did not err in concluding that a disability claimant was not disabled from his own occupation as an anesthesiologist because the medical evidence supported the insurer’s finding that the claimant could perform the duties of his own occupation with appropriate accommodations (Timothy O’Neill D.O. v. Unum Life Insurance Company of America, No. 18-1382, 6th Cir., 2019 U.S. App. LEXIS 817).

  • January 11, 2019

    Claimant Met Burden; Additional LTD Benefits Owed, Federal Judge Says

    SALT LAKE CITY — A disability claimant is entitled to an additional eight months of long-term disability (LTD) payments because the claimant proved by a preponderance of the evidence that his disability prevents him from working in his occupation as an attorney, a Utah federal judge said Dec. 10 (Ralph Dewsnup v. Unum Life Insurance Company of America, No. 17-126, D. Utah, 2018 U.S. Dist. LEXIS 208688).

  • January 10, 2019

    Federal Judge Permits Limited Extra Discovery In Disability Benefits Dispute

    BIRMINGHAM, Ala. — An Alabama federal judge on Jan. 9 granted a disability claimant’s motion to conduct discovery as it pertains to the insurer’s conflict of interest because additional discovery will help the court in its review of the insurer’s denial of a claim for waiver-of-life-premium (Carol H. Stewart v. Hartford Life & Accident Insurance Co., No. 17-1423, N.D. Ala., 2019 U.S. Dist. LEXIS 3647).

  • January 10, 2019

    Insurer Reasonably Found That Disability Was Caused By Depression, Anxiety

    ST. LOUIS — A disability insurer reasonably concluded that a claimant’s disability was caused by depression and anxiety rather than fibromyalgia because the objective medical records did not support the claimant’s complaints of physical pain, the Eighth Circuit U.S. Court of Appeals said Jan. 9 (Marianne Thiry v. United of Omaha Life Insurance Co., et al., No. 17-3288, 8th Cir., 2019 U.S. App. LEXIS 613).

  • January 09, 2019

    Florida Federal Judge Says Termination Of LTD Benefits Not Arbitrary, Capricious

    JACKSONVILLE, Fla. — A Florida federal judge on Jan. 8 adopted a magistrate judge’s recommendation to grant a disability insurer’s motion for summary judgment after determining that the insurer’s termination of benefits was not arbitrary and capricious (Rebecca McCook v. Aetna Life Insurance Co., No. 17-823, M.D. Fla., 2019 U.S. Dist. LEXIS 2946).

  • January 08, 2019

    Final Denial Of Disability Claim Never Issued, Federal Judge Says

    SAN FRANCISCO — A disability insurer did not issue a final denial of a claim for total disability benefits, a California federal judge said Jan. 4 in granting the insurer’s motion for summary judgment in a breach of contract and bad faith suit filed by an insured (Sunil Srinivasan, DDS v. Continental Assurance Co., et al., No. 18-4371, N.D. Calif., 2019 U.S. Dist. LEXIS 1894).

  • January 08, 2019

    District Court Failed To Address All Alleged Procedural Irregularities

    SAN FRANCISCO — A majority of a Ninth Circuit U.S. Court of Appeals panel on Jan. 4 reversed and remanded a district court’s ruling in favor of a disability plan and the plan administrator after determining that the district court failed to address all of the procedural irregularities that allegedly occurred during the claim review process (Leslie Hoffman v. Screen Actors Guild Producers Pension Plan, No. 16-56663, 9th Cir., 2019 U.S. App. LEXIS 284).

  • January 08, 2019

    Disability Suit Remanded; Wrong Standard Of Review Applied, Panel Says

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Jan. 4 reversed and remanded a judgment entered in favor of a disability insurer after determining that a district court erred in applying the abuse of discretion standard of review rather than the de novo standard of review (Robert Gordon v. Metropolitan Insurance Co., No. 17-16821, 9th Cir., 2019 U.S. App. LEXIS 292).

  • January 07, 2019

    Disability Claimant Fails To Allege Plan Was Improperly Amended, Panel Says

    CINCINNATI — A district court did not err in granting judgment in favor of a disability insurer and a plan administrator because the claimant failed to allege in the district court that the plan was improperly amended, the Sixth Circuit U.S. Court of Appeals said Jan. 3 (David Moore v. Metropolitan Life Insurance Co., et al., No. 18-5325, 6th Cir., 2019 U.S. App. LEXIS 239).

  • January 04, 2019

    Disability Claimant Cannot Supplement Record To Include Letter Awarding Benefits

    BAY CITY, Mich. — A disability claimant cannot supplement the administrative record to include a letter from the disability insurer awarding her benefits because the letter was issued after the district court determined that the claimant is not entitled to an award for attorney fees and costs, a Michigan federal judge said Dec. 10 in denying  the claimant’s motion (Kimberly J. Guest-Marcotte v. Life Insurance Company of North America, et al., No. 15-10738, E.D. Mich., 2018 U.S. Dist. LEXIS 208252).

  • January 04, 2019

    Disability Insurer Did Not Abuse Discretion In Denying STD Benefits, Panel Says

    SAN FRANCISCO — A disability insurer did not abuse its discretion in terminating a claimant’s short-term disability benefits because none of the claimant’s treating physicians found that the claimant was functionally impaired from performing the duties of his own occupation, the Ninth Circuit U.S. Court of Appeals said Dec. 10 (Daniel Johnson v. Aetna Life Insurance Co., et al., No. 17-55501, 9th Cir., 2018 U.S. App. LEXIS 34657).

  • January 04, 2019

    Bad Faith Claim Barred By Statute Of Limitations, Federal Judge Determines

    SAN DIEGO — A California federal judge on Dec. 10 dismissed a disability claimant’s bad faith claim after determining that the claim is barred by the applicable two-year statute of limitations because accrual of the bad faith claim began when the insurer issued its initial benefits determination and not when the insurer issued its decision on appeal (Frank L. Pavel v. Unum Life Insurance Company of America, et al., No. 18-1778, S.D. Calif.,  2018 U.S. Dist. LEXIS 209019).

  • December 07, 2018

    Insured’s Breach Of Contract Claim Against Disability Insurer To Proceed

    CHICAGO — An insured adequately alleged facts in support of a breach of contract claim against a disability insurer but failed to support a claim that the insurer acted vexatiously and unreasonably in refusing to renew the insured’s disability policies, an Illinois federal judge said Nov. 21 (Donald Astar v. Northwestern Mutual Life Insurance Co., No. 18-4895, N.D. Ill., 2018 U.S. Dist. LEXIS 198434).

  • December 07, 2018

    Termination Of Disability Benefits Was Unreasonable, Federal Judge Determines

    JOPLIN, Mo. — A disability claimant is entitled to long-term disability (LTD) benefits under a plan’s any-occupation standard because the plan’s termination of benefits was unreasonable based on the fact that only one doctor, who performed a file review, determined that the claimant was not disabled under the any-occupation standard, a Missouri federal judge said Dec. 6 (Jamie S. Flanagan v. Lincoln National Life Insurance Co., No. 17-5060, W.D. Mo., 2018 U.S. Dist. LEXIS 206031).

  • December 07, 2018

    Plan’s Termination Of Benefits Was Not Abuse Of Discretion, Panel Says

    ST. LOUIS — A district court did not err in granting summary judgment in favor of a disability plan because the plan’s termination of benefits was not an abuse of discretion and was reasonable based on the medical evidence, the Eighth Circuit U.S. Court of Appeals said Dec. 6 (Gary Leirer v. The Proctor & Gamble Disability Benefit Plan, et al., No. 17-3426, 8th Cir., 2018 U.S. App. LEXIS 34406).

  • December 06, 2018

    Denial Of Disability Benefits Not Supported By Medical Evidence, Judge Says

    OAKLAND, Calif. — A California federal judge on Dec. 5 granted a disability claimant’s motion for summary judgment after determining that the disability insurer’s denial of long-term disability (LTD) benefits is not supported by the medical evidence (Dale Holmgren v. Sun Life and Health Insurance Co., No. 17-3028, N.D. Calif., 2018 U.S. Dist. LEXIS 205649).

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