HOUSTON — A federal judge in Texas on April 8 dismissed an insured’s claims against his long-term disability insurer stemming from the insurer’s denial of benefits, ruling that the insured failed to sufficiently plead the necessary elements of his breach of contract claim.
BROOKLYN, N.Y. — A New York federal judge on April 21 granted a disability insurer’s motion for judgment on the administrative record after determining that the insurer’s finding that the claimant was not disabled from performing the duties of any reasonable occupation is supported by substantial evidence in the administrative record.
LOS ANGELES — A California federal judge on April 20 remanded a disability benefits suit filed by residents of Kosovo who performed work for a United States-based company in Afghanistan after determining that the Employee Retirement Income Security Act does not preempt the plaintiffs’ claims because the plaintiffs’ complaint does not present a permissible domestic application of ERISA.
SEATTLE — A Washington federal judge on April 21 granted a disability claimant’s motion for summary judgment after determining that the insurer failed to prove that the claimant’s hip injury was caused by a prior injury and, therefore, barred by the policy’s preexisting condition exclusion.
CINCINNATI — The Sixth Circuit U.S. Court of Appeals on April 19 affirmed a district court’s ruling that a disability insurer owes no long-term disability (LTD) benefits to a claimant because the plan’s preexisting condition limitation clearly bars coverage for the claimant’s disability that was caused by her preexisting conditions of depression and anxiety.
LOS ANGELES — A California federal judge on April 15 awarded a disability claimant past and future long-term disability (LTD) benefits after determining that an award of benefits, rather than remand to the plan administrator, is the appropriate remedy.
NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on April 16 affirmed a district court’s ruling that the denial of line of duty (LOD) disability benefits to a former National Football League player was not an abuse of discretion, agreeing with the lower court’s finding that the appeals committee’s interpretation of the plan was not unreasonable.
NEW ORLEANS — A Louisiana federal judge on April 14 denied a disability insurer’s motion for summary judgment after determining that a question of fact exists as to whether an attorney was totally disabled and whether the attorney’s activities following the date of disability support a finding of total disability under the policy at issue.
NEW ORLEANS — A Louisiana federal judge on April 14 denied a disability insurer’s motion for summary judgment on the applicable standard of review after determining that a question of fact exists as to whether the insurer actually mailed a final denial letter to the disability claimant.
OKLAHOMA CITY — An Oklahoma federal judge on March 26 dismissed claims for breach of contract and bad faith against a disability income insurer after determining that the insured failed to show that the insurer breached its contract or acted in bad faith in denying a claim for benefits; however, the judge allowed a fraud claim based on alleged misrepresentations made by the insurer’s agent to proceed.
ST. LOUIS — A district court properly found that a disability insurer abused its discretion in denying claims for short-term disability and long-term disability benefits because no reasonable person could conclude that the claimant, a nurse anesthetist who was addicted to fentanyl, was able to safely administer anesthesia to patients, the Eighth Circuit U.S. Court of Appeals said April 5.
PASADENA, Calif. — The Ninth Circuit U.S. Court of Appeals on April 2 affirmed a district court’s ruling in favor of a disability insurer after determining that the district court did not err in finding that the claimant failed to prove by a preponderance of the evidence that he is disabled under the disability plan’s any-occupation standard.
ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on April 1 affirmed a district court’s ruling that a disability insurer did not abuse its discretion in denying a claim for disability benefits because the insurer reasonably concluded that the claimant was capable of performing sedentary work.
NEW YORK — A disability insurer did not abuse its discretion in finding that a claim was not physically disabled from performing the duties of any occupation, a New York federal judge said March 24, noting that the insurer was not obligated to defer to the opinions of the claimant’s treating physician regarding her ability to work.
SEATTLE — A disability claimant is entitled to long-term disability benefits because the claimant met his burden of proving by a preponderance of the evidence that he was unable to work in his own occupation as a result of anxiety, depression, insomnia and other cognitive impairments, a Washington federal judge said March 22 in granting the claimant’s motion for judgment on the administrative record.
WILMINGTON, Del. — A disability insurer acted arbitrarily and capriciously in terminating a disability claimant’s benefits because the insurer wrongfully reclassified the claimant’s occupation as an internal medical specialist after more than 10 years of correctly classifying the claimant’s occupation as a gastroenterologist, a Delaware federal judge said March 19 in granting judgment in favor of the claimant.
BOWLING GREEN, Ky. — A disability claimant is entitled to short-term disability (STD) and long-term disability (LTD) benefits because the disability insurer’s denial of benefits is not supported by the medical evidence, a Kentucky federal judge said March 18 in granting the claimant’s motion for judgment.
PASADENA, Calif. — The Ninth Circuit U.S. Court of Appeals on March 18 reversed a district court’s ruling denying a disability claimant’s motion to reopen one of two cases filed against a disability plan and plan administrator because the district court wrongfully assumed that the disability plan and plan administrator will eventually decide whether the claimant is totally disabled.
WASHINGTON, D.C. — Review of the 10th Circuit U.S. Court of Appeals’ ruling on a disability plan’s choice-of-law provision is not warranted because no circuit split exists on how choice-of-law provisions are interpreted in policies governed by the Employee Retirement Income Security Act and because choice-of-law provisions are uniformly honored by circuit courts, a disability insurer says in a March 18 response to a disability claimant’s petition for writ of certiorari filed in the U.S. Supreme Court.
ALEXANDRIA, Va. — A disability insurer’s termination of long-term disability benefits must be remanded because the claimant was not afforded the opportunity to administratively appeal the insurer’s final determination that the claimant was not disabled as the result of a mental condition, a Virginia federal judge said March 11.