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Mealey's Disability Insurance

  • July 16, 2019

    Disability Claimant Exhausted Lifetime Maximum For Partial Disability Benefits

    BOSTON — A Massachusetts federal judge on July 11 granted summary judgment in favor of a disability plan after determining that the plan’s termination of partial disability benefits was not arbitrary and capricious because the claimant exhausted the plan’s lifetime maximum for partial disability benefits and the medical evidence supported the plan’s finding that the claimant was not totally disabled (Donald Hammond v. Procter & Gamble Health and Long Term Disability Plan, No. 18-11343, D. Mass., 2019 U.S. Dist. LEXIS 115105).

  • July 15, 2019

    Federal Magistrate Judge Orders Discovery On Overpayment Of Benefits Issue

    BOSTON — A Massachusetts federal judge on July 11 granted a disability claimant’s motion to dismiss a disability insurer’s counterclaim seeking to recover an alleged overpayment of benefits after determining that discovery on the issue of the overpayment is necessary (Karen Jette v. United of Omaha Life Insurance Co., No. 18-11650, D. Mass., 2019 U.S. Dist. LEXIS 115973).

  • July 12, 2019

    Question Of Fact Exists As To Whether Claimant Can Perform Other Occupations

    BRIDGEPORT, Conn. — A Connecticut federal judge on July 9 determined that a trial must be scheduled in a disability benefits suit because a question of fact exists as to whether the claimant can become qualified for the occupations identified by the disability insurer (Jeff Schuman v. Aetna Life Insurance Co., et al, No. 15-1006, D. Conn., 2019 U.S. Dist. LEXIS 113375).

  • July 10, 2019

    Disability Insurer’s Denial Of Benefits Was Not Abuse Of Discretion, Panel Says

    ST. LOUIS — A district court did not err in granting a disability insurer’s motion for summary judgment because the insurer’s denial of benefits is supported by the medical evidence in the administrative record, the Eighth Circuit U.S. Court of Appeals said July 3 (David C. Nicholson v. Standard Insurance Co., et al., No. 18-1848, 8th Cir., 2019 U.S. App. LEXIS 19909).

  • June 28, 2019

    Substantial Evidence Supports Disability Plan’s Denial Of Benefits, Judge Says

    CAPE GIRARDEAU, Mo. — A Missouri federal judge on June 20 granted summary judgment in favor of a disability plan after determining that substantial evidence supports the plan’s denial of total disability benefits to a claimant who exhausted the maximum amount of partial disability benefits available under the plan (Charlie Craig Hounihan v. The Proctor & Gamble Disability Committee, et al., No. 18-010, E.D. Mo., 2019 U.S. Dist. LEXIS 103248).

  • June 28, 2019

    Termination Of Disability Benefits Was Reasonable, W.Va. Federal Judge Says

    CHARLESTON, W.Va.— The termination of a claimant’s disability benefits was not unreasonable because an insurer properly concluded that the claimant was no longer disabled from his own occupation as an attorney based on his decision to accept a full-time position as an attorney after resigning from his former law firm, a West Virginia federal judge said June 26 (Vaughn  T. Sizemore v. Northwestern Mutual Life Insurance Co., No. 17-789, S.D. W.Va., 2019 U.S. Dist. LEXIS 106972).

  • June 27, 2019

    Disability Benefits Suits Remanded; ERISA Does Not Apply Extraterritorially

    PHILADELPHIA — A Pennsylvania federal judge on June 24 remanded 12 separate lawsuits filed by foreign nationals alleging claims for breach of contract and bad faith against a disability insurer after determining that federal jurisdiction does not exist because Congress has not clearly expressed that the Employee Retirement Income Security Act applies extraterritorially (In re Reliance Standard Life Insurance Co. et. al., Nos. 19-331; 19-332; 19-333; 19-334; 19-335; 19-336; 19-338; 19-339; 19-340; 19-341; 19-342; 19-343, E.D. Pa., 2019 U.S. Dist. LEXIS 104922).

  • 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).