DETROIT — A Michigan federal judge on Sept. 29 denied a disability claimant’s motion for summary judgment and granted a disability insurer’s motion for summary judgment after determining that the disability insurer’s finding that the claimant was not disabled under the plan’s any-occupation standard was not arbitrary and capricious.
NEW YORK — A district court erred in dismissing a disability claimant’s suit alleging that a disability insurer failed to exhaust all administrative remedies in violation of the Employee Retirement Income Security Act because the insurer’s decision to remand a claim to its claim department for reconsideration does not constitute a “benefit determination on review,” the U.S. Secretary of Labor says in an Oct. 5 amicus curiae brief filed in the Second Circuit U.S. Court of Appeals in support of the claimant’s appeal.
PHILADELPHIA — A disability claimant’s breach of contract suit against a disability insurer must be dismissed because the claimant failed to file the suit within the applicable four-year statute of limitations or within the three years provided for in the policy’s suit limitation provision, a Pennsylvania federal judge said Oct. 4.
NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on Oct. 5 reversed a district court’s ruling that a disability insurer waived its right to contest an award of disability benefits under the plan’s any-occupation standard because the insurer’s determination that the claimant’s disability was subject to a plan limitation made an analysis of whether any-occupation benefits were owed unnecessary.
COLUMBUS, Ohio — A disability insurer did not act arbitrarily and capriciously in calculating a claimant’s disability benefits because the insurer followed the disability plan’s terms and provisions in calculating the claimant’s benefits, an Ohio federal judge said Sept. 24.
ALBUQUERQUE, N.M. — A disability claimant failed to show by a preponderance of the evidence that he is owed disability benefits under a plan’s any-occupation standard, a New Mexico federal judge said Sept. 22 in granting the disability insurer’s motion for judgment on the administrative record.
JACKSON, Miss. — A Mississippi federal judge on Sept. 30 granted a disability claimant’s motion for summary judgment after determining that the disability insurer abused its discretion in terminating a claimant’s benefits because the insurer failed to consider the material and substantial duties of the claimant’s actual occupation of a legal secretary.
SAN JOSE, Calif. — A California federal judge on Sept. 30 denied a disability claimant’s motion for attorney fees because the claimant failed to show that his lawsuit, filed before the disability insurer made a decision on the claimant’s appeal, was a contributing factor in the disability insurer’s decision to reinstate his disability benefits.
NEW YORK — A federal judge in New York on Sept. 29 accepted a federal magistrate judge’s report and recommendation and issued an order granting declaratory judgment in favor of a disability income insurer in an insurance fraud dispute, ruling that “[e]nough ink has been spilled, effort expended, and resources consumed” in the litigation.
NEW YORK — The Second Circuit U.S. Court of Appeals on Oct. 1 affirmed a trial court’s ruling that a National Football League (NFL) player’s claims alleging violations of the Employee Retirement Income Security Act are time-barred because the player knew in 2000, the year he applied for disability benefits, that the plan failed to provide him with a copy of the summary plan description (SPD).
MIAMI — A Florida federal judge on Sept. 22 granted a disability insurer’s motion for summary judgment, finding that the insurer reasonably denied the insured’s anxiety and depression disability claim and that the insured failed to provide records from a treating psychologist or psychiatrist to make a showing of disability under the plan.
BOSTON — A disability insurer’s termination of long-term disability (LTD) benefits based on the plan’s self-reported symptom limitation provision was not arbitrary and capricious, the First Circuit U.S. Court of Appeals said Sept. 22, noting that it also was reasonable for the insurer to require the claimant to provide objective evidence of her functional limitations.
FORT MYERS, Fla. — An expert retained by a doctor arguing that his insurer erroneously rescinded his disability policy cannot testify, a Florida federal judge ruled Sept. 17, agreeing with the insurer that his testimony constitutes improper legal conclusions.
CAMDEN, N.J. — A disability insurer and reinsurer wrongfully terminated a claimant’s long-term disability (LTD) benefits after determining that the claimant was capable of returning to work in his own occupation, a claimant alleges in a Sept. 8 complaint filed in New Jersey federal court.
MEMPHIS, Tenn. — A disability claimant alleges in a Sept. 7 complaint that he was denied a full and fair review of his short-term disability benefits claim under Employee Retirement Income Security Act because the claims administrator refused to provide him with additional time to file an appeal despite the U.S. Department of Labor’s emergency regulation, issued in response to the COVID-19 pandemic, which extended the amount of time to appeal an adverse benefits decision.
SAN JOSE, Calif. — A California federal judge on Sept. 7 partially granted a disability claimant’s motion for judgment on the administrative record after determining that the claimant proved by a preponderance of the evidence that she was disabled for a period of time from performing the duties of her own occupation.
CINCINNATI — A disability plan’s denial of disability benefits was not arbitrary and capricious because the plan’s denial was reasonable based on the available medical evidence, the Sixth Circuit U.S. Court of Appeals said Sept. 3 in affirming a district court’s ruling in favor of the plan.
NEW YORK — The Second Circuit U.S. Court of Appeals on Aug. 12 affirmed a district court’s ruling in favor of a disability insurer after determining that the lower court properly applied an arbitrary and capricious standard of review because California’s law banning the inclusion of discretionary authority provisions does not apply as the claimant is a resident of New York and not California.
UTICA, N.Y. — A disability insurer’s decision to terminate a claimant’s long-term disability benefits based on its finding that the claimant was capable of performing the duties of his own occupation was reasonable and supported by substantial evidence, a New York federal judge said Sept. 1 in entering judgment for the disability insurer.
DENVER — The 10th Circuit U.S. Court of Appeals on Sept. 1 affirmed a district court’s ruling in favor of a disability insurer and rejected the disability claimant’s argument that a jury trial on the insurer’s denial of benefits decision is warranted.