GRAND RAPIDS, Mich. — A disability insurer’s termination of a claimant’s benefits pursuant to the disability plan’s 24-month mental health limitation is supported by the evidence in the administrative record, a Michigan federal judge said March 19 in granting judgment in favor of the insurer (Timothy O’Neill v. Unum Life Insurance Company of America, No. 16-1061. W.D. Mich., 2018 U.S. Dist. LEXIS 43878).
PORTLAND, Ore. — A disability claimant is permitted to supplement the administrative record with evidence in support of her disability because the disability insurer failed to provide the claimant with the opportunity for a full and fair review when it issued a new basis for its decision on appeal, an Oregon federal judge said March 12 (Alison Gary v. Unum Life Insurance Company of America, No. 17-1414, D. Ore., 2018 U.S. Dist. LEXIS 40672).
CHICAGO — An Illinois federal judge on March 14 determined that a disability claimant is not entitled to disability benefits because the claimant failed to prove by a preponderance of the evidence that he is disabled from his own occupation as a plan administrator (Jonas Daniliauskas v. Reliance Standard Life Insurance Co., No. 16-9278, N.D. Ill., 2018 U.S. Dist. LEXIS 42805).
SAN FRANCISCO — A California federal judge on March 12 remanded a former National Football League player’s claim for disability benefits after determining that the plan failed to provide support for its denial of the player’s claim (Charles Dimry v. The Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 16-1413, N.D. Calif., 2018 U.S. Dist. LEXIS 41359).
LOUISVILLE, Ky. — The denial of a claim for disability benefits must be reviewed under the arbitrary and capricious standard of review because the disability plan at issue clearly grants the insurer the discretionary authority to construe the terms of the plan and to make benefit eligibility decisions, a Kentucky federal judge said March 7 (Jack Ritter Jr. v. Liberty Life Assurance Company of Boston, No. 17-445, W.D. Ky., 2018 U.S. Dist. LEXIS 36932).
AKRON, Ohio — Discovery pertaining to a potential conflict of interest between a disability plan and the plan’s claims administrator is not warranted because the disability claimant failed to provide any factual support for the allegation that a conflict of interest influenced the termination of her long-term disability benefits, an Ohio federal judge said March 12 (Kristina L. Alekna v. The AT&T Service Inc. et al., No. 17-400, N.D. Ohio, 2018 U.S. Dist. LEXIS 40063).
WORCESTER, Mass. — A Massachusetts federal judge on March 12 transferred a disability claimant’s suit to the U.S. District Court for the District of Kansas after determining that Kansas has a greater interest in resolving the claim and that Kansas is the more convenient forum for the parties and witnesses (Anne R. Rosenthal, M.D. v. Unum Group, et al., No. 17-40064, D. Mass., 2018 U.S. Dist. LEXIS 40025).
BRIDGEPORT, Conn. — A disability claimant exhausted all administrative remedies under a disability plan by appealing the insurer’s initial termination of benefits and was not required to file an additional appeal after the insurer granted the claimant an additional two days of disability benefits following the review of the claimant’s appeal, a Connecticut federal judge said March 9 in denying the insurer’s motion to dismiss (Gary Tuttle v. Prudential Insurance Company of America, No. 17-100, D. Conn., 2018 U.S. Dist. LEXIS 38830).
SAN FRANCISCO — A work incentive benefit included in a disability policy’s summary plan description does not violate the disclosure requirements of the Employee Retirement Income Security Act and was properly applied to offset a disability claimant’s monthly benefits, the Ninth Circuit U.S. Court of Appeal said March 7 (Howard Lyle Abrams v. Life Insurance Company of North America, et al., No. 16-55858, 9th Cir., 2018 U.S. App. LEXIS 5780).
ST. LOUIS — A panel of the Eighth Circuit U.S. Court of Appeals on Feb. 13 affirmed a district court’s ruling that a woman’s Employee Retirement Security Act claim for long-term benefits from a disability insurance plan was barred by the limitations period on the policy (Estelean Jeannette Dodge v. Hartford Life and Accident Insurance Company, No. 17-1417, 8th Cir., 2018 U.S. App. LEXIS 3310).
BALTIMORE — A plan administrator’s denial of long-term disability benefits for two periods of time was not supported by substantial evidence and must be remanded to the plan administrator for a determination of the date of the claimant’s onset of disability, a Maryland federal judge said March 6 (Leslie R. Vetter v. American Airlines Inc., et al., No. 16-2833, D. Md., 2018 U.S. Dist. LEXIS 36057).
CENTRAL ISLIP, N.Y. — A New York federal magistrate judge on Feb. 28 recommended that a disability claimant be awarded attorney fees and costs of approximately $168,000, rather than more than $500,000 requested by the claimant, because the billing hours submitted by the claimant’s attorneys appeared to be excessive (Janet Solnin v. Sun Life and Health Insurance Co., et. al., No. 08-2759, E.D. N.Y., 2018 U.S. Dist. LEXIS 33823).
NEW YORK — After determining that a de novo standard of review applies in a disability benefits dispute, a New York federal judge on March 5 found that the insurer’s initial denial of long-term disability (LTD) benefits was justified but said that a question of fact exists as to whether the insurer properly denied the claimant’s administrative appeal (Alexander Sigal v. Metropolitan Life Insurance Co., No. 16-3397, S.D. N.Y., 2018 U.S. Dist. LEXIS 35534).
By Ian S. Linker
YOUNGSTOWN, Ohio — An Ohio federal judge on Feb. 28 remanded a long-term disability (LTD) claim to a plan administrator after determining that the plan administrator acted arbitrarily and capriciously by failing to consider the treating physician’s opinion that the claimant was disabled as a result of emotional lability following the death of her son (Shelley Westfall v. Liberty Life Assurance Company of Boston, No. 16-2921, N.D. Ohio, 2018 U.S. Dist. LEXIS 32641).
SALT LAKE CITY — A disability claimant is judicially estopped from pursuing a claim for long-term disability benefits because the claimant failed to disclose her interest in the disability policy as an asset in her bankruptcy filings, a Utah federal judge said Feb. 28 in granting the disability insurer’s motion to dismiss (Dawna Lane v. Prudential Insurance Co., No. 17-998, D. Utah, 2018 U.S. Dist. LEXIS 33646).
NEW YORK — The Second Circuit U.S. Court of Appeals on Feb. 21 affirmed a district court’s ruling in favor of a disability insurer, noting that the insurer’s decision to terminate a claimant’s long-term disability (LTD) benefits was reasonable in light of the substantial evidence supporting the termination (Marybeth M. Donlick v. Standard Insurance Co., No. 17-1593, 2nd Cir., 2018 U.S. App. LEXIS 4348).
PASADENA, Calif. — A woman proved that her multiple sclerosis (MS) caused debilitating fatigue, rendering her totally disabled under the Employee Retirement Income Security Act, the Ninth Circuit U.S. Court of Appeals ruled Feb. 13, reversing and remanding a federal court’s conclusion that Aetna Life Insurance Co. properly denied benefits (Margueritte Kibel v. Aetna Life Insurance Company, No. 16-56169, 9th Cir., 2018 U.S. App. LEXIS 3367).
SEATTLE — A Washington federal judge on Feb. 12 granted a motion jointly filed by both parties to seal the entire administrative record of a disability insurance dispute, finding that the plaintiff’s right to medical privacy and the inability to redact portions of the record outweigh the public’s right to access the information (David Alan Anderson v. Unum Life Insurance Company of America, No. C17-0659-JCC, W.D. Wash., 2018 U.S. Dist. LEXIS 22661).
SAN DIEGO — Dismissal of an insured’s insurance breach of contract and bad faith lawsuit is necessary because her claims were not brought within the applicable statute of limitations and she has failed to show that the limitations period was tolled by the discovery rule, a federal judge in California ruled Feb. 20 in granting an insurer’s motion to dismiss (Laurel Davis v. Liberty Life Assurance Company of Boston, No. 17-0738, S.D. Calif., 2018 U.S. Dist. LEXIS 27045).