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Mealey's Disability Insurance

  • December 6, 2018

    Disability Insurer Conducted Full, Fair Review, Judge Says Following Bench Trial

    LOS ANGELES — Following a bench trial in a short-term disability (STD) benefits dispute, a California federal judge on Nov. 26 granted judgment in favor of the disability insurer after determining that the insurer conducted a full and fair review of the disability claim and did not abuse its discretion in denying the claim for benefits (Yvette Williby v. Aetna Life Insurance Co., No. 14-4203, C.D. Calif., 2018 U.S. Dist. LEXIS 201708).

  • December 6, 2018

    Short-Term Disability Plan Did Not Constitute Contract Between Claimant, Employer

    ST. LOUIS — A Missouri federal judge on Dec. 3 dismissed a disability claimant’s breach of contract and bad faith claims after determining that the short-term disability (STD) plan under which the claimant seeks benefits did not constitute a contract between the claimant and the employer (Anne C. Hart v. Ascension Health Alliance, No. 18-1548, E.D. Mo., 2018 U.S. Dist. LEXIS 203974).

  • December 5, 2018

    Statute Of Limitations Bars Breach Of Contract, Bad Faith Claims In Disability Suit

    SAN FRANCISCO — A disability claimant cannot maintain claims for breach of contract and bad faith based on a 2013 denial of benefits because the applicable statute of limitations for breach of contract and bad faith allegations bars the claims, a California federal judge said Dec. 4 (Theresa Hong v. AXA Equitable Life Insurance Co., No. 18-4039, N.D. Calif., 2018 U.S. Dist. LEXIS 205336).

  • December 4, 2018

    9th Circuit Remands Disability Suit To Reconsider Source Of Disability

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Dec. 3 remanded a disability claimant’s suit after determining that the district court must determine the whether the source of a claimant’s disability is physical or mental (Miae Decovich v. Anthem Life Insurance Co., No. 17-15324, 9th Cir., 2018 U.S. App. LEXIS 33890).

  • December 3, 2018

    Disability Claimant Argues Plan Was Not Prejudiced By Delay In Filing Appeal

    BOSTON — The First Circuit U.S. Court of Appeals should reverse a district court’s ruling in favor of a disability plan because the plan was not prejudiced by a 47-day delay in the filing of the disability claimant’s appeal, the claimant argues in a Nov. 28 appellant brief (Theresa Fortier v. Hartford Life and Accident Insurance Co., No. 18-1752, 1st Cir.).

  • November 28, 2018

    3rd Circuit: Coverage Barred For Disability Stemming From Pre-Existing Depression

    PHILADELPHIA — A Pennsylvania federal judge correctly determined that the administrative record in a disability coverage dispute supports the insurer’s conclusion that a plan’s pre-existing condition exclusion bars coverage for the claimant’s disability, which stems from her pre-existing depression, the Third Circuit U.S. Court of Appeals said Nov. 26 (Yvonne Hilbert v. The Lincoln National Life Insurance Co., 17-2583, 3rd Cir., 2018 U.S. App. LEXIS 33133).

  • November 21, 2018

    District Court Did Not Err In Finding Claimant Was Not Disabled From Own Occupation

    CINCINNATI — 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 disability insurer’s conclusion that the claimant could perform the duties of his own occupation with appropriate accommodations, the Sixth Circuit U.S. Court of Appeals said Nov. 19 (Timothy O’Neill D.O. v. Unum Life Insurance Company of America, No. 18-1382, 6th Cir., 2018 U.S. App. LEXIS 32781).

  • November 20, 2018

    Disability Claimant’s Objections Rejected; Judgment Entered For Disability Plan

    DETROIT — Finding no support for a disability claimant’s objections to a magistrate judge’s recommendation that judgment should be granted in favor of the disability plan defendant, a Michigan federal judge on Nov. 13 adopted the magistrate judge’s report of recommendation (Marcie McConnell v. Nationwide Insurance Company Benefits Administrative Committee, No. 17-12869, E.D. Mich., 2018 U.S. Dist. LEXIS 192789).

  • November 19, 2018

    Disability Suit Remanded; Insurer Failed To Prove Damages Exceed $75,000

    LONDON, Ky. — A Kentucky federal judge on Nov. 15 remanded a disability claimant’s breach of contract and bad faith suit after determining that the disability insurer failed to prove by a preponderance of the evidence that the claimant’s damages will exceed the federal jurisdictional minimum of $75,000 (Connie L. Hacker v. Aetna Life Insurance Co., No. 18-30, E.D. Ky., 2018 U.S. Dist. LEXIS 194961).

  • November 16, 2018

    California Federal Judge Grants Parties’ Request To Dismiss Disability Suit

    SANTA ANA, Calif. — A California federal judge on Nov. 6 dismissed a disability claimant’s suit against a long-term disability (LTD) insurer after the parties notified the court that they reached an agreement to dismiss the suit (Karen Compton v. Life Insurance Company of North America, et al., No. 18-184, C.D. Calif., 2018 U.S. Dist. LEXIS 192680).

  • November 9, 2018

    Disability Insurer Ordered To Produce Information Related To Reviewing Physicians

    NEW YORK — A disability insurer must produce the salaries paid to its reviewing physicians in addition to the curriculum vitae for each reviewing physician because the information is relevant to the determination of whether the insurer’s denial of a long-term disability claim was reasonable, a New York federal magistrate judge said Nov. 6 (Michele Weinberg v. Unum Life Insurance Company of America, No. 17-8976, S.D. N.Y., 2018 U.S. Dist. LEXIS 189792).

  • November 9, 2018

    Medical Evidence Supports Disability Plan’s Limitation Of Benefits, Judge Says

    WASHINGTON, D.C. — A disability insurer’s conclusion that a claimant suffered from chronic fatigue syndrome, which limited long-term disability benefits to 24 months, and not from symptoms of Lyme disease was not unreasonable based on the medical evidence in the administrative record, a District of Columbia federal judge said Nov. 7 (Wesley Loucka v. Lincoln National Life Insurance Co., No. 17-1375, D. D.C., 2018 U.S. Dist. LEXIS 190935).

  • November 7, 2018

    Termination Of Disability Benefits Did Not Amount To Bad Faith, Judge Says

    WILLIAMSPORT, Pa. — A Pennsylvania federal judge on Nov. 2 granted a motion for summary judgment filed by the insurers in a disability dispute after determining that the claimant failed to prove that the termination of his benefits was unreasonable and made in bad faith (Dr. Robert Brugler v. Unum Group, et al., No. 15-1031, M.D. Pa., 2018 U.S. Dist. LEXIS 187836).

  • November 5, 2018

    Issue Of Fact Exists As To Whether Disability Insurer’s Determination Was Reasonable

    PHOENIX — A disability claimant’s bad faith claim and request for punitive damages can proceed because the claimant presented an issue of fact as to whether the insurer’s termination of disability benefits was reasonable, an Arizona federal judge said Nov. 1 in denying the insurer’s motion for summary judgement (Kelly Ann Tyler v. United States Life Insurance Co., et al., No. 16-939, D. Ariz., 2018 U.S. Dist. LEXIS 187001).

  • November 2, 2018

    Judge Grants Motion To Exclude Documents Filed After Claimant Initiated Suit

    NEW ORLEANS — A Louisiana federal judge on Oct. 31 granted a disability claimant’s motion to exclude documents generated after a lawsuit was filed against the disability insurer because the administrative record closed after the claimant filed suit (Anne Wittmann v. Unum Life Insurance Company of America, No. 17-9501, E.D. La., 2018 U.S. Dist. LEXIS 186064).

  • November 2, 2018

    Disability Suit Must Be Transferred From New Jersey To Tennessee Federal Court

    NEWARK, N.J. — A disability claimant’s suit alleging wrongful denial of long-term disability (LTD) benefits must be transferred from New Jersey federal court to Tennessee federal court because the alleged breach of the terms of the plan occurred in Tennessee and the parties’ interests weigh in favor of transfer to Tennessee federal court, a New Jersey federal magistrate judge said Oct. 31 (Wesley Gonce v. Prudential Insurance Company of America, No. 18-8662, D. N.J., 2018 U.S. Dist. LEXIS 186905).

  • October 31, 2018

    Disability Insurer Did Not Breach Policy Terms, Judge Says In Dismissing Complaint

    UTICA, N.Y. — A disability claimant’s breach of contract suit must be dismissed because the disability insurer did not breach the terms of the long-term disability (LTD) policy when it terminated the claimant’s benefits at age 65, a New York federal judge said Oct. 30, noting that the insurer paid the maximum period of payment per the terms of the policy (Vincent J. Krocka v. Mutual of New York Insurance Co., No. 18-830, N.D. N.Y., 2018 U.S. Dist. LEXIS 185173).

  • October 30, 2018

    Supplemental Plan Is Governed By ERISA, 3rd Circuit Determines

    PHILADELPHIA — A supplemental disability plan offered by a disability claimant’s former employer is governed under the Employee Retirement Income Security Act because the claimant failed to prove that a reasonable employee would view the supplemental plan as a third-party offering not affiliated with the employer, the Third Circuit U.S. Court of Appeals said Oct. 5 (Kevin M. McCann, M.D. v. Unum Provident, et al., No. 16-2014, 3rd Cir., 2018 U.S. App. LEXIS 29638).

  • October 25, 2018

    Judge Strikes Claimant’s Exhibit, Says Letter Is Not Part Of Administrative Record

    CAPE GIRARDEAU, Mo. — A Missouri federal judge on Oct. 24 granted a disability insurer’s motion to strike a letter offered as an exhibit to a claimant’s complaint after determining that the letter, which states that the claimant’s disability was not caused by a pre-existing condition, is not part of the administrative record because the claimant failed to provide the letter to the insurer during the administrative appeal process (Stacey Waite v. Sun Life Assurance Co., No. 18-208, E.D. Mo., 2018 U.S. Dist. LEXIS 182354).

  • October 25, 2018

    Federal Judge Remands LTD Claim To Administrator For New Determination

    LITTLE ROCK, Ark. — A disability insurer must reconsider a long-term disability (LTD) claim after reviewing the claimant’s Social Security disability benefits records because the insurer represented to the claimant that the Social Security records would be considered as part of the review of the claimant’s appeal, an Arkansas federal judge said Oct. 18 in remanding the claim to the administrator (Michael Buquoi v. United States Life Insurance Co., No. 18-093, E.D. Ark., 2018 U.S. Dist. LEXIS 179172).