Mealey's Disability Insurance

  • March 08, 2019

    Additional Discovery Is Warranted In Disability Benefits Suit, Judge Says

    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).

  • March 07, 2019

    Disability Benefits Reinstated; Termination Was Arbitrary, Capricious, Judge Says

    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).

  • March 05, 2019

    Disability Claimant’s Suit Dismissed For Failure To File Within 180 Days

    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).

  • March 05, 2019

    Denial Of STD Benefits Was An Abuse Of Discretion, Federal Judge Determines

    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).

  • March 01, 2019

    Disability Claimant Is Not Entitled To Benefits Under Any-Occupation Standard

    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).

  • February 28, 2019

    Denial Of Short-Term Disability Benefits Was Not Arbitrary, Capricious

    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).

  • February 28, 2019

    Bad Faith Claim Dismissed; Classification Of Disability Was Not Made In Bad Faith

    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).

  • February 27, 2019

    Termination Of LTD Benefits Supported By Substantial Evidence, Panel Determines

    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).

  • February 26, 2019

    Evidence Supports Finding That Claimant Was Not Disabled From Own Occupation

    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).

  • February 22, 2019

    1st Circuit Affirms Ruling In Favor Of Disability Plan In ERISA Dispute

    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).

  • February 21, 2019

    Judge: MetLife’s LTD Determination Was ‘Made In Arbitrary And Capricious Manner’

    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).

  • February 14, 2019

    9th Circuit Denies Rehearing In Abuse Of Discretion Disability Benefits Dispute

    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).

  • February 12, 2019

    Reconsideration Not Warranted In Disability Benefits Suit, Judge Says

    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).

  • February 11, 2019

    Summary Judgment Ruling On Tort Claims In Bad Faith Dispute Upheld

    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).

  • February 11, 2019

    11th Circuit Upholds Ruling Finding Woman’s Claim For Future Benefits Premature

    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).

  • February 08, 2019

    Disability Insurer Must Consider Actual Duties Of Claimant’s Own Occupation

    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).

  • February 07, 2019

    Termination Of LTD Benefits Was Reasonable Based On Evidence, Judge Says

    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).

  • February 07, 2019

    Evidence Supports Insurer’s Finding That Claimant Was Not Totally Disabled

    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).

  • February 06, 2019

    Federal Judge Remands LTD Claim To Administrator For Recalculation Of Benefits

    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).

  • February 05, 2019

    Plan Administrator’s Motion To Reconsider Partially Granted Based On Elimination Period

    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).

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