Mealey's Disability Insurance

  • June 26, 2019

    Disability Insurer Abused Its Discretion In Terminating Benefits, Panel Says

    RICHMOND, Va. — A disability insurer abused its discretion in terminating a claimant’s long-term disability (LTD) benefits because a wealth of medical evidence supports a finding that the claimant was not capable of working in a sedentary position and was totally disabled under the terms of the disability plan, the Fourth Circuit U.S. Court of Appeals said  June 20 (Fredrick E. Smith, et al. v. Reliance Standard Life Insurance Co., No. 18-2225, 4th Cir., 2019 U.S. App. LEXIS 18518).

  • June 26, 2019

    Substantial Compliance Doctrine Does Not Apply To Deadlines Imposed By ERISA

    CHICAGO — The Seventh Circuit U.S. Court of Appeals on June 25 vacated and remanded a district court’s ruling in favor of a disability insurer after determining that the district court erred in applying the doctrine of substantial compliance to excuse the insurer’s failure to issue an administrative appeal decision by the imposed deadline and to justify the use of the arbitrary and capricious standard of review because the substantial compliance doctrine does not apply to regulatory deadlines imposed by the Employee Retirement Income Security Act (Donald Fessenden v. Reliance Standard Life Insurance Co., et al., No. 18-1346, 7th Cir., 2019 U.S. App. LEXIS 18885).

  • June 26, 2019

    Denial Of Disability Benefits Was Not Wrong, 11th Circuit Panel Says

    ATLANTA — A district court did not err in granting a disability insurer’s motion for judgment on the pleadings because the disability claimant did not exhaust all administrative remedies under the long-term disability (LTD) plan and the disability claimant was not entitled to short-term disability (STD) benefits as he already was receiving workers’ compensation benefits, the 11th Circuit U.S. Court of Appeals said June 24 (Lionel Garcon v. United Mutual of Omaha Insurance Co., No. 18-12220, 11th Cir., 2019 U.S. App. LEXIS 18713).

  • June 24, 2019

    Disability Claimant’s LTD Benefits Reinstated; Insurer’s Termination Not Supported

    ATLANTA — A disability insurer acted arbitrarily and capriciously in terminating a claimant’s long-term disability (LTD) benefits because the evidence does not support the insurer’s finding that the claimant was capable of performing the duties of his job as a software engineer, a Georgia federal judge said June 4 (Arthur F. Lesser IV v. Reliance Standard Life Insurance Co., No. 18-824, N.D. Ga., 2019 U.S. Dist. LEXIS 99418).

  • June 21, 2019

    Federal Judge Says Fraud Claims Against Disability Insurer Cannot Proceed

    MIAMI — A disability claimant’s fraud claims against a disability insurer cannot stand because the claimant failed to allege any facts in support of the claims, a Florida federal judge said June 18 in partially granting the insurer’s motion to dismiss (Douglas Shapiro, M.D. v. Unum Life Insurance Company of America et al., No. 18-23454, S.D. Fla., 2019 U.S. Dist. LEXIS 102631).

  • June 20, 2019

    Disability Insurer Did Not Act Arbitrarily, Capriciously In Denying Benefits Claim

    CLEVELAND — A disability insurer did not act arbitrarily and capriciously in denying a lawyer’s long-term disability (LTD) benefits claim, an Ohio federal judge said June 18, noting that the insurer was entitled to conduct a file-only review of the plan participant’s claim  (Drew A. Carson v. Unum Life Insurance Company of America, No. 18-1225, N.D. Ohio, 2019 U.S. Dist. LEXIS 101676).

  • June 18, 2019

    Disability Insurer Is Entitled To Reimbursement For Overpayment, Judge Says

    HARRISBURG, Pa. — A disability insurer is entitled to judgment on its claim for reimbursement following an overpayment of disability benefits; however, the amount of reimbursement owed to the insurer is unclear, a Pennsylvania federal judge said June 17 in partially granting the insurer’s motion for judgment on its counterclaims for reimbursement (Jamie Eberhard v. United of Omaha Life Insurance Co., No. 18-536, M.D. Pa., 2019 U.S. Dist. LEXIS 100502).

  • June 13, 2019

    Disability Insurer Failed To Properly Address Claimant’s Mental Limitations, Panel Says

    CHICAGO — The Seventh Circuit U.S. Court of Appeals on June 12 reversed a district court’s ruling in favor of a disability insurer after determining that the court and the insurer failed to properly address the disability claimant’s mental limitations and failed to properly classify her occupation under the Dictionary of Occupational Titles (DOT) (Shirley Lacko v. United of Omaha Life Insurance Co., No. 18-2155, 7th Cir., 2019 U.S. App. LEXIS 17518).

  • June 12, 2019

    Pre-Existing Condition Exclusion Does Not Apply To Bar LTD Benefits, Panel Says

    NEW ORLEANS — A disability insurer’s denial of long-term disability (LTD) benefits was arbitrary and capricious because the claimant’s treatment for a symptom that later turned out to be caused by ovarian cancer cannot be considered the condition that caused her disability, the Fifth Circuit U.S. Court of Appeals said June 11 in rejecting the insurer’s argument that the plan’s pre-existing condition exclusion barred the claim for LTD benefits (Marcia L. Smith v. United of Omaha Life Insurance Co., et al., No. 18-60753, 5th Cir., 2019 U.S. App. LEXIS 17367).

  • June 11, 2019

    Oregon Federal Judge Says Claimant’s LTD Benefits Must Be Reinstated

    PORTLAND, Ore. — A disability claimant is entitled to reinstatement of long-term disability (LTD)  benefits because the claimant provided sufficient evidence that his disability was ongoing and that the insurer’s termination of benefits was an abuse of discretion, an Oregon federal judge said June 10 (David Black v. Hartford Life Insurance Co., No. 17-1785, D. Ore., 2019 U.S. Dist. LEXIS 96711).

  • June 11, 2019

    Disability Claimant Entitled To Reduced Attorney Fees, Colorado Federal Judge Says

    DENVER — A disability claimant is entitled to more than $65,000 in attorney fees, a Colorado federal judge said June 10 after determining that the claimant, who prevailed in a dispute over benefits for West Nile virus, cannot collect attorney fees that were expended on independent doctors who were consulted during the administrative phase before the claimant filed suit (Michael J. Paquin v. Prudential Insurance Company of America, No. 16-02142, D. Colo., 2019 U.S. Dist. LEXIS 96798).

  • June 10, 2019

    High Court Denies Disability Claimant’s Petition To Review Termination Of Benefits Ruling

    WASHINGTON, D.C. — The U.S. Supreme Court on June 10 denied a disability claimant’s petition for writ of certiorari, refusing to review the 11th Circuit Court of Appeals’ finding that a disability insurer had a reasonable basis for terminating the claimant’s disability benefits (Timothy P. O’Leary v. Aetna Life Insurance Co., No. 18-1266, U.S. Sup.).

  • June 10, 2019

    ERISA Preempts State Law Claims; Disability Suit Barred By Plan’s Suit Limitation

    CHICAGO — A district court did not err in finding that the Employee Retirement Income Security Act preempts a disability claimant’s state law claims and that the claimant’s complaint is barred by the disability plan’s three-year suit limitation, the Seventh Circuit U.S. Court of Appeals said June 7 (Teresa Di Joseph v. Standard Insurance Co., et al., No. 18-2178, 7th Cir., 2019 U.S. App. LEXIS 17127).

  • June 07, 2019

    NFL Player’s Disability Benefits Award Supported By Evidence, Plan Argues

    ATLANTA — A district court did not err in granting a disability plan’s motion for judgment on the administrative record because the plan’s award of disability benefits to a former National Football League (NFL) player was reasonable and supported by substantial evidence, the plan argues in its June 5 brief to the 11th Circuit U.S. Court of Appeals (Darren Mickell v. Bert Bell/Pete Rozelle NFL Players Retirement Plan, No. 19-10651, 11th Cir.).

  • June 05, 2019

    Disability Insurer, Claimant Reach Agreement In Dispute Over Calculation Of Benefits

    SAN FRANCISCO — Following the settlement of a long-term disability (LTD) benefits dispute, the Ninth Circuit U.S. Court of Appeals on June 3 dismissed the disability insurer’s appeal of a district court decision to remand the claim to the plan administrator to recalculate the claimant’s monthly benefits to include the claimant’s commissions and monthly and quarterly bonuses (Remy Renault v. Unum Life Ins. Co. of America, et al., No. 19-55254, 9th Cir., 2019 U.S. App. LEXIS 16740).

  • June 05, 2019

    Disability Claimant’s Bad Faith, Breach Of Contract Suit Dismissed As Untimely

    FORT LAUDERDALE, Fla. — A Florida federal judge on May 31 dismissed a disability claimant’s complaint after determining that the claimant’s breach of contract and bad faith allegations are barred by the policy’s three-year limitations provision and Delaware’s applicable three-year statute of limitations (Douglas Kuber v. The Prudential Insurance Company of America, No. 19-80151, S.D. Fla., 2019 U.S. Dist. LEXIS 92468).

  • June 04, 2019

    Evidence Supports Insurer’s Termination Of Disability Benefits, Panel Affirms

    SEATTLE — A district court did not err in entering judgment in favor of a disability insurer because the insurer’s termination of benefits is supported by sufficient evidence, the Ninth  Circuit U.S. Court of Appeals said May 31 (Todd J. Mickel v. Unum Group, dba Paul Revere Life Insurance Co., No. 18-35178, 9th Cir., 2019 U.S. App. LEXIS 16354).

  • June 04, 2019

    Federal Magistrate Recommends Dismissal Of Disability Claimant’s Bad Faith Suit

    MIAMI — A Florida federal magistrate judge on May 31 recommended that a disability insurer’s motion to dismiss be granted after determining that the claimant failed to state a claim for breach of contract and cannot allege a bad faith claim until a determination of liability is made (Rodolfo Molina v. Provident Life & Accident Co., No. 18-24413, S.D. Fla., 2019 U.S. Dist. LEXIS 92479).

  • June 03, 2019

    Issues Of Fact Exist As To Whether Claimant Is Owed Total Disability Benefits

    WEST PALM BEACH, Fla. — A Florida federal judge on May 30 denied a disability income insurer’s motion for summary judgment and referred the disability claimant’s suit to a federal magistrate judge for a settlement conference after determining that questions of fact exist as to whether the claimant was entitled to total disability benefits under the policy (Joseph J. Thomas v. The Northwestern Mutual Life Insurance Co., No. 18-14166, S.D. Fla., 2019 U.S. Dist. LEXIS 90543).

  • May 29, 2019

    Overpayment Claim In NFL Disability Benefits Dispute Will Proceed

    TAMPA, Fla. — A Florida federal judge on May 28 allowed a former National Football League player’s claim regarding overpayment of disability benefits to proceed after determining that the overpayment issue is separate and distinct from the issue of whether the plan abused its discretion in terminating the player’s benefits (Tyrone Keys v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 18-2098, M.D. Fla., 2019 U.S. Dist. LEXIS 88486).

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