COLUMBUS, Ohio — A bad faith claim cannot stand because the insured failed to prove that the defendant insurers acted in bad faith in classifying the insured’s disability as being caused by a sickness rather than an injury, an Ohio federal judge said Feb. 19 (Mukesh R. Shah, M.D. v. Metropolitan Life Insurance Co., et al., No. 16-1124, S.D. Ohio, 2019 U.S. Dist. LEXIS 25695).
ST. LOUIS — A disability insurer did not abuse its discretion in terminating a claimant’s long-term disability benefits because the insurer’s termination was supported by substantial evidence that the claimant may have been attempting to appear more cognitively impaired than he actually was during the medical examinations ordered by the insurer, the Eighth Circuit U.S. Court of Appeals said Feb. 25 (John Johnston v. Prudential Insurance Company of America, No. 17-3415, 8th Cir., 2019 U.S. App. LEXIS 5407).
NEW ORLEANS — A Louisiana federal judge on Feb. 21 granted a disability insurer’s motion for summary judgment after determining that the insurer did not abuse its discretion in finding that the claimant was not disabled from performing the duties of her own occupation as an attorney because the objective medical evidence clearly supports the insurer’s finding (Anne Wittmann v. Unum Life Insurance Company of America, No. 17-9501, E.D. La., 2019 U.S. Dist. LEXIS 27510).
BOSTON — The First Circuit U.S. Court of Appeals on Feb. 20 affirmed a federal district court's ruling in favor of a disability plan, rejecting a claimant’s contention that the plan was not prejudiced by a 47-day delay in the filing of her appeal (Theresa Fortier v. Hartford Life and Accident Insurance Company, No. 18-1752, 1st Cir., 2019 U.S. App. LEXIS 4917).
NEW YORK — A New York federal judge on Feb. 15 remanded the determination of a Morgan Stanley employee’s long-term disability (LTD) benefits to Metropolitan Life Insurance Co., noting that it “is time for MetLife to do its job” by providing a “full and fair review” of the employee’s claim that his benefits eligible earnings (BEE) is too low (Vincent Ricciardi v. Metropolitan Life Insurance Company, et al., No. 16-3805, S.D. N.Y., 2019 U.S. Dist. LEXIS 25240).
SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Feb. 12 denied a long-term disability (LTD) plan administrator’s motion to reconsider its decision that the plan administrator abused its discretion in denying LTD benefits under the plan’s any-occupation standard because the plan administrator failed to properly consider restrictions placed on the claimant's ability to stand (Jennifer Kott v. Agilent Technologies Inc. Disability Plan, No. 17-16584, 9th Cir., 2019 U.S. App. LEXIS 4235).
OKLAHOMA CITY — An Oklahoma federal judge on Feb. 8 denied a disability claimant’s motion for reconsideration after determining that the claimant presented no new evidence that would warrant reconsideration of a judgment entered in favor of the disability insurer (Alison Smith v. The Standard Insurance Co., No. 16-953, W.D. Okla., 2019 U.S. Dist. LEXIS 20784).
CINCINNATI — A federal district court did not abuse its discretion in sua sponte dismissing an insured’s bifurcated tort claims against his long-term disability insurance provider because the insured failed to submit all of his evidence in support of his claims in responding to the insurer’s motion for summary judgment on the insurer’s breach of contract claim, a Sixth Circuit U.S. Court of Appeals panel affirmed Feb. 7 (James H. Pogue v. Northwestern Mutual Life Insurance Co., No. 18-5291, 6th Cir., 2019 U.S. App. LEXIS 3943).
ATLANTA — A woman’s request for a declaration from her life insurance company that she is entitled to future total disability benefits under a policy governed by the Employee Retirement Income Security Act was properly dismissed by a federal judge in Florida, an 11th Circuit U.S. Court of Appeals panel ruled Feb. 8, holding that there is no ripe claim without an adverse determination by the insurer (Theresa Peer v. Life Liberty Assurance Co., No. 18-13173, 11th Cir., 2019 U.S. App. LEXIS 3956).
PHILADELPHIA — A disability insurer was required to consider the actual duties of a claimant’s occupation rather than the duties of the occupation as performed in the national economy because the plan clearly defined the term “own occupation” as the work the claimant was performing immediately before the onset of the disability, the Third Circuit U.S. Court of Appeals said Feb. 7 in affirming a district court’s opinion (Christopher Patterson v. Aetna Life Insurance Co., No. 17-3566, 3rd Cir., 2019 U.S. App. LEXIS 3902).
KANSAS CITY, Kan. — A disability insurer’s termination of long-term disability (LTD) benefits based on its determination that the claimant was capable of performing a number of identified gainful occupations was reasonable and supported by substantial evidence, a Kansas federal judge said Feb. 5 in granting the insurer’s motion for summary judgment (Andrew Scott v. Union Security Insurance Co., No. 17-2686, D. Kan., 2019 U.S. Dist. LEXIS 17853).
PHOENIX — A disability insurer did not breach its contract or act in bad faith by denying a claim for benefits because the evidence supports a finding that the claimant was not totally disabled, an Arizona federal judge said Jan. 30 (Cynthia Cheney v. United States Life Insurance Company in the City of New York, et al., No. 17-0004, D. Ariz., 2019 U.S. Dist. LEXIS 14742).
LOS ANGELES — A California federal judge on Feb. 1 remanded a long-term disability (LTD) claim to the plan administrator to recalculate a claimant’s monthly benefits to include the claimant’s commissions and monthly and quarterly bonuses after determining that the plan is ambiguous as to what constitutes monthly earnings (Remy Renault v. Unum Life Ins. Co. of America, et al., No. 16-7078, C.D. Calif., 2019 U.S. Dist. LEXIS 17622).
BALTIMORE — A Maryland federal judge on Feb. 1 partially granted a plan administrator’s motion to reconsider after determining that the administrator’s denial of long-term disability (LTD) benefits for one of two periods of time was justified based on the plan’s elimination period, which neither party addressed when the judge initially ruled against the plan (Leslie R. Vetter v. American Airlines Inc., et al., No. 16-2833, D. Md., 2019 U.S. Dist. LEXIS 15550).
WASHINGTON, D.C. — A disability insurer did not wrongfully terminate a claimant’s long-term disability (LTD) benefits because the claimant failed to prove that she was incapable of performing the duties of any occupation, a District of Columbia federal judge said Feb. 1 (Josephine Kemathe v. Reliance Standard Life Insurance Co., No. 17-903, D. D.C., 2019 U.S. Dist. LEXIS 16248).
NEW ORLEANS — A Louisiana federal judge on Jan. 29 denied an insurer’s motion to strike a disability claimant’s untimely demand for a jury trial after determining that the untimely demand will cause no disruption to the court’s calendar and will not cause any prejudice to the insurer (Jeffrey Avena v. Massachusetts Mutual Life Insurance Co., No. 18-9406, E.D. La., 2019 U.S. Dist. LEXIS 13902).
CINCINNATI — After noting that it is clear that a disability claimant has no intention of defending himself against a disability plan’s lawsuit seeking to recover an overpayment of disability benefits, an Ohio federal judge on Jan. 29 entered a default judgment against the claimant for more than $7,500 that is owed to the plan (P&G Health & Longterm Disability Plan v. Javier Molinary, No. 18-283, S.D. Ohio, 2019 U.S. Dist. LEXIS 13667).
BOSTON — A disability claimant is entitled to an award of attorney fees based on the claimant’s success in having the claim remanded to the administrator for further review; however, the amount of attorney fees to which the claimant is entitled cannot be calculated until after the claimant’s administrative appeal is resolved, a Massachusetts federal judge said Jan. 28 (Brian Host v. First Unum Life Insurance Co., et al., No. 13-11578, D. Mass., 2019 U.S. Dist. LEXIS 12832).
CINCINNATI — A disability claimant is not entitled to long-term disability (LTD) benefits because the plan’s decision to terminate his benefits was reasonable based on a review of the medical evidence, the Sixth Circuit U.S. Court of Appeals said Jan. 22 in affirming a district court’s decision in favor of the plan (Marc Jackson v. Blue Cross Blue Shield of Michigan Long Term Disability Program, No. 18-1542, 6th Cir., 2019 U.S. App. LEXIS 1978).
SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Jan. 22 reversed a district court’s ruling in favor of a disability plan after determining that the insurer failed to carry its burden of proving that the plan’s pre-existing condition exclusion applied to bar a claim for long-term disability (LTD) benefits (Fadi G. Haddad, M.D. v. SMG Long Term Disability Plan, et al., No. 17-16729, 9th Cir., 2019 U.S. App. LEXIS 2003).