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).
SAN FRANCISCO — A long-term disability (LTD) 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, a Ninth Circuit U.S. Court of Appeals panel majority said Jan. 18 (Jennifer Kott v. Agilent Technologies Inc. Disability Plan, No. 17-16584, 9th Cir., 2019 U.S. App. LEXIS 1768).
FORT SMITH, Ark. — A disability insurer did not abuse its discretion in terminating a claimant’s long-term disability(LTD) benefits under the plan’s any-occupation standard because there is substantial evidence supporting the insurer’s termination of benefits, an Arkansas federal judge said Jan. 16 (Dwight W. Phelan v. Unum Life Insurance Company of America, No. 18-2049, W.D. Ark., 2019 U.S. Dist. LEXIS 7699).
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).
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).
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).
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).
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).