Mealey's Disability Insurance

  • March 25, 2020

    Disability Claimant Entitled To Benefits, California Federal Judge Says

    SACRAMENTO,  Calif. — A California federal judge on March 24 determined that a disability claimant is entitled to long-term disability (LTD) benefits under the plan’s own-occupation standard and remanded the claim to the plan administrator to determine if the claimant is disabled from performing the duties of any gainful occupation (Renee Johnson Monroe v. Metropolitan Life Insurance Co., No. 15-2079, E.D. Calif., 2020 U.S. Dist. LEXIS 51075).

  • March 24, 2020

    Substantial Evidence Supports Disability Insurer’s Termination Of LTD Benefits

    WHITE PLAINS, N.Y. — A New York federal judge on March 20 granted a disability insurer’s motion for summary judgment after determining that substantial evidence supported the disability  insurer’s termination of long-term disability (LTD) benefits after paying the claimant benefits for six years (Joseph J. Hinchey v. First Unum Life Insurance Co. et al., No. 17-08034, S.D. N.Y., 2020 U.S. Dist. LEXIS 49703).

  • March 18, 2020

    9th Circuit Finds No Error In District Court’s Judgment For Disability Insurer

    PASADENA, Calif. — A district court did not err in entering judgment for a disability insurer following a bench trial because the disability insurer’s termination of benefits is supported by the medical evidence, the Ninth Circuit U.S. Court of Appeals said March 17 (Lonny R. Western v. Unum Life Insurance Company of America, No. 18-56039, 9th Cir., 2020 U.S. App. LEXIS 8362).

  • March 18, 2020

    Jury Verdict For Disability Claimant Was Reasonable, Panel Says In Affirming

    DENVER — The 10th Circuit U.S. Court of Appeals on March 17 affirmed a jury verdict in favor of a disability claimant after determining that based on the policy language, it was reasonable for the jury to conclude that the claimant was entitled to disability benefits (Brenda Sandoval v. Unum Life Insurance Company of America, Nos. 19-1047, 19-1164, 10th Cir., 2020 U.S. App. LEXIS 8398).

  • March 17, 2020

    LTD Insurer’s Termination Of Benefits Supported By Substantial Evidence

    BOSTON — A Massachusetts federal judge on March 12 granted a disability insurer’s motion for summary judgment after determining that the insurer’s decision to terminate a claimant’s long-term disability benefits was reasonable because substantial evidence supports the insurer’s finding that the claimant was psychologically, but not physically, disabled from working (Karen Gammon v. Reliance Standard Life Insurance Co., No. 18-11665, D. Mass., 2020 U.S. Dist. LEXIS 43022).

  • March 17, 2020

    Denial Of LTD Claim Was Reasonable Based On Pre-Existing Condition

    COLUMBUS, Ohio — A disability insurer’s denial of a long-term disability (LTD) benefits claim based on the plan’s pre-existing condition exclusion was proper because the medical records support the conclusion that the claimant’s inability to work was caused by a pre-existing condition, an Ohio federal judge said March 3 in granting a disability insurer’s motion for judgment on the administrative record (Angela Harrison v. Life Insurance Company of North America, No. 18-1077, S.D. Ohio, 2020 U.S. Dist. LEXIS 36932).

  • March 11, 2020

    LTD Claim Remanded; Plan Administrator Did Not Consider Psychiatric Conditions

    SAN FRANCISCO — A California federal judge on March 6 remanded a disability plan participant’s long-term disability (LTD) claim to the plan administrator after determining that the plan administrator failed to consider the claimant’s psychiatric conditions before terminating her LTD benefits (Lisa Schwarz v. Hartford Life & Accident Insurance Co., No. 19-2370, N.D. Calif., 2020 U.S. Dist. LEXIS 39581).

  • March 11, 2020

    Insurance Agent’s Declaration Excluded From Administrative Record In Disability Suit

    NEW ORLEANS — A Louisiana federal judge on March 6 determined that the declaration of an insurance agent cannot be considered by the court in a long-term disability (LTD) benefits dispute because the agent’s declaration was not made available to the disability insurer before the disability claimant filed suit (Michael G. Miller v. Reliance Standard Insurance Co., No. 18-10028, E.D. La., 2020 U.S. Dist. LEXIS 39005).

  • March 05, 2020

    Limited Discovery Allowed On Dual-Role Conflict Of Interest In Disability Case

    TOPEKA, Kan. — A federal magistrate judge in Kansas on Feb. 28 granted a disability claimant’s motion for discovery to determine whether her insurer’s dual role as plan administrator and payer affected its decision to deny her long-term disability (LTD) benefits, finding that the claimant met her burden to prove that limited discovery on the issue is appropriate (Jodie L. Bribiesca v. Metropolitan Life Insurance Company, No. 19-1339, D. Kan., 2020 U.S. Dist. LEXIS 34929).

  • March 05, 2020

    De Novo Standard Of Review Applies Where Disability Insurer Violated New DOL Regs

    MOBILE, Ala. — A federal judge in Alabama on Feb. 26 denied a motion to reconsider a ruling that a de novo standard of review applied in a dispute over the termination of disability benefits because recent amendments to the Department of Labor (DOL) regulations requiring the insurer to provide the claimant with new evidence that the denial on review was based on governed the claim (Brian McConnell v. American General Life Insurance Co., No. 19-0174, S.D. Ala., 2020 U.S. Dist. LEXIS 32724).

  • March 05, 2020

    Disability Insurer Properly Considered Federal Benefits In Calculation Of LTD Benefits

    CENTRAL ISLIP, N.Y.  — A federal judge in New York on Feb. 26 adopted a magistrate judge’s report and recommendation that a disability insurer’s motion for summary judgment be granted after determining that the insurer properly considered federal disability benefits in calculating a claimant’s monthly long-term disability (LTD) benefits (Jason Brand v. Narco Freedom Inc., et al., No. 15-5021, E.D. N.Y., 2020 U.S. Dist. LEXIS 32078).

  • March 05, 2020

    NFL Player, Disability Plan Dispute Discovery Of Doctors’ Pay In Coverage Suit

    SAN FRANCISCO — In a Feb. 11 joint discovery letter brief, a former National Football League (NFL) player and an NFL benefits plan argue over whether the player is entitled to conduct discovery from physicians used by the plan to determine whether the doctors had a financial incentive to recommend denial of disability benefits (Charles Dimry v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 3:19-cv-05360, N.D. Calif.).

  • March 04, 2020

    9th Circuit Panel Affirms Verdict For Bad Faith Disability Benefit Termination

    PHOENIX — There was sufficient evidence to support a jury’s conclusion that two defendants in a suit alleging bad faith termination of disability benefits were engaged in a joint venture and to support a separate punitive damages award against one of the defendants, a Ninth Circuit U.S. Court of Appeals panel ruled Feb. 27 in a partially divided unpublished opinion (Benjamin McClure v. Country Life Insurance Company, et al., No. 18-16661, 9th Cir., 2020 U.S. App. LEXIS 6566).

  • March 04, 2020

    Pension Plan Applied Wrong Causation Standard In Denying Disability Benefits

    SPRINGFIELD, Ill. — A federal judge in Illinois on Feb. 28 ruled that a pension plan trustees’ application of the “substantially responsible” causation standard in denying disability benefits was arbitrary and capricious, and the judge ruled that an award of benefits was the appropriate remedy (William R. Sharp v. Trustees of the UMWA 1974 Pension Trust, No. 18-cv-03056, C.D. Ill., 2020 U.S. Dist. LEXIS 34194).

  • March 04, 2020

    Denial Of Disability Benefits Based On Medical Records Review Was Not Arbitrary, Judge Rules

    LONDON, Ky. — The insurer of an Employee Retirement Income Security Act disability plan did not act arbitrarily or capriciously in denying benefits under the plan’s any-occupation standard, even though it had granted them under the earlier own-occupation standard and despite conflicting medical opinions, because the insurer relied on a medical records reviewer who considered the opinions and medical records of other physicians when determining the claimant’s restrictions, a federal judge in Kentucky ruled March 2 (Gina Young v. Hartford Life & Accident Insurance. Co., et al., No. 6:19-61-KKC, E.D. Ky., 2020 U.S. Dist. LEXIS 35385).

  • March 03, 2020

    Judge Finds Nurse Anesthetist Disabled Before Termination, Remands To Administrator

    JEFFERSON CITY, Mo. — A nurse anesthetist’s relapse into addiction rendered him disabled before his employer terminated him for using drugs at work, a federal judge in Missouri ruled Feb. 28, finding that the insurer erred in denying him short- and long-term disability benefits (Ronald Bernard v. Kansas City Life Insurance Co., No. 19-4043, W.D. Mo., 2020 U.S. Dist. LEXIS 34344).

  • March 03, 2020

    3rd Circuit: Termination Of LTD Benefits Is Reasonable Despite 1 Medical Opinion

    PHILADELPHIA — An insurer’s decision to deny long-term disability (LTD) benefits despite the medical opinion of one “outlier” was not unreasonable under the Employee Retirement Income Security Act, and the federal district court reasonably denied discovery regarding the possible conflict of interest of the insurer’s in-house reviewer, the Third Circuit U.S. Court of Appeals affirmed Feb. 24 in an unpublished opinion (Giovanna Reichard v. United of Omaha Life Insurance Co., No. 18-2952, 3rd Cir.; 2020 U.S. App. LEXIS 5548).

  • February 28, 2020

    Arizona Disability Claimant Denied Discovery Into Alleged Conflicts Of Interest

    PHOENIX — A federal judge in Arizona on Feb. 25 denied a disability claimant’s request for discovery to supplement the administrative record in her suit alleging that her claim for long-term disability (LTD) was wrongfully denied, finding that she failed to demonstrate that the insurer’s alleged structural conflict of interest demands additional discovery or that information she sought about its medical reviewers’ alleged conflicts would be necessary for the court to conduct a de novo review (Leslie DeMarco v. Life Insurance Company of North America, et al., No. CV-19-02385, D. Ariz., 2020 U.S. Dist. LEXIS 31723).

  • February 20, 2020

    3rd Circuit Upholds Ruling For Disability Plan Administrator In Benefits Denial Suit

    PHILADELPHIA — The administrator of a short-term disability (STD) and a long-term disability (LTD) plan did not abuse its discretion in violation of the Employee Retirement Income Security Act when it denied both types of benefits to a employee who claimed that she couldn’t work due to headaches but was found by the administrator’s doctors and her own to be able to control her symptoms with medication, a Third Circuit U.S. Court of Appeals panel ruled Feb. 18 (Anna Ackaway v. Aetna Life Insurance Company, No. 16-3969, 3rd Cir., 2020 U.S. App. LEXIS 4946).

  • February 14, 2020

    Attorney Fees, Costs Awarded To Disability Claimant Who Achieved Some Success On Merits

    NEW HAVEN, Conn. — A Connecticut federal judge on Feb. 5 awarded a disability claimant more than $100,000 in attorney fees after determining that the award is warranted because the claimant achieved some success on the merits when her claim was remanded to the disability plan administrator for a full and fair review (Patricia Hughes v. Hartford Life and Accident Insurance Co., No. 17-1561, D. Conn., 2020 U.S. Dist. LEXIS 18812).

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