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Mealey's Disability Insurance

  • June 5, 2018

    Former Newspaper Reporter Entitled To Retroactive Disability Benefits, Judge Says

    NEWARK, N.J. — A New Jersey federal judge on May 31 determined that a former newspaper reporter is entitled to short-term disability and long-term disability benefits under a disability plan issued by his employer because the wealth of medical evidence supports a finding that the claimant is disabled as a result of chronic fatigue syndrome under the terms of the plan and unable to perform the duties of his own occupation (Brian Vastag v. Prudential Insurance Company of America, No. 15-6197, D. N.J., 2018 U.S. Dist. LEXIS 91458).

  • June 4, 2018

    District Court Correctly Dismissed Disability Claimant’s Suit, Panel Says

    SAN FRANCISCO — A district court did not abuse its discretion in dismissing a disability claimant’s amended complaint because the prelitigation costs and attorney fees sought by the claimant are not available as equitable relief under the Employee Retirement Income Security Act, the Ninth Circuit U.S. Court of Appeals said May 31 (Larry A. Benson v. Life Insurance Company of North America, No. 17-55253, 9th Cir., 2018 U.S. App. LEXIS 14367).

  • June 4, 2018

    Issues Of Fact Exist As To Whether Disability Insurer Properly Denied Claim

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on May 31 reversed a district court’s ruling in favor of a disability insurer after determining that genuine issues of fact exists regarding whether the insurer improperly denied the claim before the amount of time to submit additional materials had expired (Narciso Cuaresma Jr. v. Farmers Group Disability Income Plan, et al., No. 16-16946, 9th Cir., 2018 U.S. App. LEXIS 14368).

  • May 31, 2018

    Cause Of Disability Incorrectly Classified As Sickness Rather Than Injury

    PHOENIX — An Arizona federal judge on May 29 granted an insured’s motion for summary judgment after determining that a disability insurer incorrectly classified the insured’s disability as resulting from a sickness rather than from an accidental injury because the insured was not totally disabled by a pre-existing degenerative disc disease until after the accidental injury occurred (Thomas Scott Wood v. Provident Life and Accident Insurance Co., No. 17-2330, D. Ariz., 2018 U.S. Dist. LEXIS 89056).

  • May 30, 2018

    Termination Of LTD Benefits Based On Policy Limitation Was Reasonable

    ALEXANDRIA, Va. — A Virginia federal judge on May 29 granted a disability insurer’s motion for summary judgment after determining that the insurer’s termination of benefits based on the policy’s mental and nervous disorder limitation was reasonable and not an abuse of discretion (Roger D. Shepard v. Liberty Life Assurance Company of Boston, No. 17-1055, E.D. Va., 2018 U.S. Dist. LEXIS 89241). 

  • May 30, 2018

    High Court’s Review Of 9th Circuit’s Offset Ruling Not Warranted, Plan Says

    WASHINGTON, D.C. — The U.S. Supreme Court should deny a disability claimant’s petition for writ of certiorari in a dispute over the offsetting of a claimant’s long-term disability (LTD) benefits to account for Social Security disability income (SSDI) benefits received on behalf of the claimant’s dependents because the plan administrators applied the language of the LTD plan as written, the defendants maintain in a May 25 response brief (Susan Rene Jones v. Merck Sharpe & Dohme Corp., et al., No. 17-1478, U.S. Sup.).

  • May 24, 2018

    Former NFL Player Files Class Action, Alleges Plan Breached Fiduciary Duties

    NEW YORK — A former National Football League player on May 22 filed suit in New York federal court, alleging that the NFL’s retirement plan and its fiduciaries duty violated the Employee Retirement Income Security Act by refusing to reclassify players’ disability benefits as football degenerative (FD) benefits despite evidence showing that the disabilities suffered by players were caused by numerous hits to the head and concussions sustained while playing in the NFL (Christopher Hudson, et al., v. National Football League Management Council, et al., No. 18-4483, S.D. N.Y.).

  • May 17, 2018

    Disability Claimant Alleges Denials Were Based On Profit-Making Motive

    CHATTANOOGA, Tenn. — A disability insurer breached its contract and acted in bad faith when it terminated a claimant’s short-term disability (STD) benefits and denied a claim for long-term disability (LTD) benefits because the decisions were based on a profit-making motive rather than the evidence of the claimant’s disability, the claimant alleges in a May 14 complaint filed in Tennessee federal court (Janet Mitchell v. Unum Life Insurance Company of America, et al., No. 18-94, E.D. Tenn.).

  • May 16, 2018

    Disability Insurer’s Denial Of Claims Was Reasonable, Federal Judge Determines

    CHICAGO — A disability insurer’s denial of short-term disability (STD) and long-term disability (LTD) benefits was reasonable as the insurer undertook a thorough review of the claims for benefits, an Illinois federal judge said May 15 in granting the insurer’s motion for summary judgment (Shirley Lacko v. United of Omaha Life Insurance Co., No. 17-2100, N.D. Ill., 2018 U.S. Dist. LEXIS 81117).

  • May 14, 2018

    Disability Claimant Capable Of Performing Sedentary Work, Judge Determines

    OAKLAND, Calif. — A California federal judge on May 11 determined that a disability insurer properly denied a claimant long-term disability benefits under a plan’s any-occupation standard because the evidence supports the insurer’s finding that the claimant was capable of performing sedentary work (Dave Nagy v. Hartford Life and Accident Insurance Co., et al., No. 16-5309, N.D. Calif., 2018 U.S. Dist. LEXIS 80278).

  • May 11, 2018

    Disability Insurer Has Standing To Enforce Separation Agreement

    PHILADELPHIA — A Pennsylvania federal judge on May 8 denied a disability claimant’s motion to dismiss a disability insurer’s breach of contract counterclaim after determining that the insurer was included as a released party in a separation agreement signed by the claimant and his employer and, therefore, has standing to enforce the terms of the separation agreement (Roger Michael Thomas v. Prudential Insurance Company of America, No. 17-4522, E.D. Pa., 2018 U.S. Dist. LEXIS 77732).

  • May 8, 2018

    Disability Claimant Does Not Have Standing To File Suit Against Insurer

    OAKLAND, Calif. — A California federal judge on May 7 granted a disability insurer’s motion for summary judgment after determining that the claimant does not have standing to bring suit against the insurer because she was actually not a participant in the long-term disability plan (Brenda Spies v. Life Insurance Company of North America, No. 17-2012, N.D. Calif., 2018 U.S. Dist. LEXIS 76987).

  • May 7, 2018

    Disability Claimant Seeks High Court’s Review Of 9th Circuit’s Offset Ruling

    WASHINGTON, D.C. — A disability claimant filed a petition for writ of certiorari on April 24 in the U.S. Supreme Court, urging the high court to review the Ninth Circuit U.S. Court of Appeals’ finding that a disability plan administrator did not abuse its discretion in offsetting a claimant’s long-term disability (LTD) benefits to account for Social Security disability income (SSDI) benefits received on behalf of the claimant’s dependents (Susan Rene Jones v. Merck Sharpe & Dohme Corp., et al., No. 17-1478, U.S. Sup., 2018 U.S. S. Ct. Briefs LEXIS 1725).

  • May 7, 2018

    Insurer’s Reserves Data Deemed Relevant, Discoverable In Long-Term Disability Suit

    NEW ALBANY, N.Y. — An Indiana federal judge on May 2 partly sustained an insured’s objection to a magistrate’s decision not to compel certain documents from her long-term disability insurance provider, concluding that information about the insurer’s reserves was relevant to contractual claims over termination of benefits (Lanisa Kelly v. Lincoln National Life Insurance Co., No. 4:15-cv-00126, S.D. Ind., 2018 U.S. Dist. LEXIS 74741).

  • May 4, 2018

    Disability Benefits Must Be Reinstated; Evidence Supports Claimant’s Inability To Work

    CINCINNATI — A disability claimant’s benefits must be reinstated because the disability insurer failed to give sufficient weight to the opinions of the claimant’s treating physicians, who stated that the claimant was unable to return to work after a leg injury, the Sixth Circuit U.S. Court of Appeals said May 3 in reversing a district court’s judgment in favor of the insurer (Richard Wagner v. American United Life Insurance, No. 17-4072, 6th Cir., 2018 U.S. App. LEXIS 11477).

  • May 4, 2018

    Claimant Met Burden Of Proving Radiculopathy Is Cause Of Disability

    OAKLAND, Calif. — A California federal judge on May 1 determined that a disability claimant is entitled to long-term disability benefits because the claimant provided ample evidence that he suffers from radiculopathy, an exception to the plan’s two-year limitation for disabilities caused by neuromuscular, musculoskeletal or soft tissue disorder (David Do v. Metropolitan Life Insurance Co., No. 16-5097, N.D. Calif., 2018 U.S. Dist. LEXIS 73712).

  • May 3, 2018

    Disability Claimant Is Not Permitted To Depose Insurer’s Employee, Judge Says

    BOSTON — A Massachusetts federal judge on May 2 denied a disability claimant’s motion to reopen the administrative record to conduct additional discovery because the claimant failed to present sufficient evidence that would justify reopening the administrative record (Amy Scolnick v. Prudential Insurance Company of America, No. 17-11430, D. Mass., 2018 U.S. Dist. LEXIS 73976).

  • May 1, 2018

    9th Circuit Panel Denies Disability Plan’s Motion For Attorney Fees

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeal on April 27 denied a motion for attorney fees filed by a disability plan and its insurer following the appeals panel’s recent finding that a work incentive benefit in a disability policy’s summary plan description does not violate the disclosure requirements of the Employee Retirement Income Security Act (Howard Lyle Abrams v. Life Insurance Company of North America, et al., No. 16-55858, 9th Cir., 2018 U.S. App. LEXIS 10919).

  • April 30, 2018

    Disability Claimant’s Suit Dismissed With Leave To Refile Complaint

    CHARLESTON, S.C. — A South Carolina federal judge on April 26 dismissed a disability claimant’s suit but said that the claimant could refile the complaint to include the facts and arguments raised for the first time in the claimant’s response to the insurer’s motion to dismiss (Cheryl Deas v. Prudential Insurance Company of America, No. 17-3016, D. S.C., 2018 U.S. Dist. LEXIS 70659).

  • April 30, 2018

    LTD Benefits Were Properly Denied Under Plan, Michigan Federal Judge Concludes

    DETROIT — A disability claimant is not entitled to long-term disability benefits because he failed to present objective evidence of any functional limitations that would entitle him to benefits under the plan, a Michigan federal judge concluded April 26 (Marc Jackson v. Blue Cross Blue Shield of Michigan Long Term Disability Program, No. 17-12537, E.D. Mich., 2018 U.S. Dist. LEXIS 70191).