SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on March 12 denied a disability claimant’s motion to supplement the record on appeal with documents from her Social Security Disability Insurance (SSDI) claim because the Social Security Administration’s (SSA) award of benefits was based on a different definition of disability than the “any occupation” definition relied on by the plan (Alice McBurnie v. Life Insurance Company of North America, No. 17-55915, 9th Cir., 2019 U.S. App. LEXIS 7254).
GULFPORT, Miss. — Reconsideration of the denial of a disability claimant’s motion for summary judgment is not warranted because the disability plan clearly requires applicants to provide evidence of good health to obtain coverage if they failed to enroll in the disability plan within 31 days of eligibility, a Mississippi federal judge said March 11 in denying the disability claimant’s motion for reconsideration (Jason Ward v. Aetna Life Insurance Co., No. 17-331, S.D. Miss., 2019 U.S. Dist. LEXIS 38196).
DETROIT — A disability plan administrator did not act arbitrarily or capriciously in denying a claim for long-term disability (LTD) benefits because the plan administrator reviewed all of the medical evidence before reasonably concluding that the claimant was not totally or permanently disabled, the Michigan Court of Appeals said Feb. 21 (Amy Clements v. University of Michigan Regents, No. 341114, Mich. App., 2019 Mich. App. LEXIS 323).
LITTLE ROCK, Ark. — The denial of a claim for long-term disability (LTD) benefits was not an abuse of discretion because the plan’s independent medical experts and the claimant’s treating physicians all determined that the claimant was capable of performing work that would pay at least half of the claimant’s pre-disability earnings, an Arkansas federal judge said Feb. 20 (Spencer L. Davis v. AT&T Umbrella Benefit Plan No. 3, No. 18-341, E.D. Ark., 2019 U.S. Dist. LEXIS 26655).
SEATTLE — A Washington federal judge on March 6 granted a disability claimant’s motion to compel additional discovery after determining that additional discovery into the credibility of the disability insurer’s previous and current medical reviewers is necessary because the insurer relied on a fake doctor’s report in denying the initial claim for benefits (Penelope Benis v. Reliance Standard Health Insurance Co., No. 18-164, W.D. Wash., 2019 U.S. Dist. LEXIS 36008).
NASHVILLE, Tenn. — A Tennessee federal judge on March 5 reinstated a disability claimant’s benefits after determining that the insurer acted arbitrarily and capriciously in terminating the benefits because the evidence does not support a finding that the claimant is capable of earning 50 percent of his pre-disability salary as required by the plan (Gary Carty v. Metropolitan Life Insurance Co., et al., No. 15-1186, M.D. Tenn., 2019 U.S. Dist. LEXIS 35992).
ST. LOUIS — A disability claimant’s suit alleging wrongful denial of short-term disability (STD) benefits must be dismissed because the claimant failed to file the suit within 180 days after the denial of her appeal as required by the plan, a Missouri federal judge said March 4 (Tiffany Ausler v. Aetna Life Insurance Co., No. 18-315, E.D. Mo., 2019 U.S. Dist. LEXIS 33486).
SAN DIEGO — A disability plan’s termination of short-term disability (STD) benefits was an abuse of discretion because the plan failed to consider the claimant’s subjective reports of pain related to her diagnosis of multiple sclerosis and erroneously concluded that the claimant’s symptoms had improved, a California federal judge said March 4 in remanding for an award of STD benefits and for a determination on the claimant’s entitlement to long-term disability (LTD) benefits (Lizbeth Valdez v. AT&T Umbrella Benefit Plan No. 1, No. 16-2613, S.D. Calif., 2019 U.S. Dist. LEXIS 34159).
PHILADELPHIA — A district court did not err in finding that a disability claimant is not entitled to long-term disability (LTD) benefits under a plan’s any-occupation standard because the medical evidence supports the plan’s determination that the claimant was capable of performing full-time sedentary work, the Third Circuit U.S. Court of Appeals said Feb. 28 (Thomas P. Kelly Jr. v. The Penn Mutual Life Insurance Co., et al., No. 18-1162, 3rd Cir., 2019 U.S. App. LEXIS 6199).
CLEVELAND — A disability insurer’s denial of short-term disability (STD) benefits was not arbitrary and capricious because the denial was supported by substantial evidence, an Ohio federal judge said Feb. 21 (Christopher Draper v. Aetna Life Insurance Co., No. 18-1321, N.D. Ohio, 2019 U.S. Dist. LEXIS 27672).
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).