Mealey's Disability Insurance

  • December 7, 2017

    Federal Magistrate Judge Says ERISA Preempts Intentional Inducement Claim

    PITTSBURGH — A Pennsylvania federal magistrate judge on Nov. 28 recommended the dismissal a claim alleging intentional inducement to breach a contract of confidentiality against a disability plan administrator and one of its case managers after determining that the claim is preempted by the Employee Retirement Income Security Act because the claim relates to the claimant’s denial of benefits under an ERISA plan (Gregory Addington v. Senior Vice President – Human Resources, Consol Energy Inc., No. 17-444, W.D. Pa., 2017 U.S. Dist. LEXIS 196020).

  • December 7, 2017

    Federal Judge Dismisses Disability Benefits Suit After Parties Reach Settlement

    LOS ANGELES — A California federal judge on Nov. 29 dismissed a disability claimant’s suit after the parties reached a settlement following remand of the suit from the Ninth Circuit U.S. Court of Appeals (Sonia Cruz-Baca v. Edison International Long Term Disability Plan, No. 14-7887, C.D. Calif., 2017 U.S. Dist. LEXIS 197347).

  • December 6, 2017

    Federal Judge Says Claimant Cannot Perform Material Duties Of Any Occupation

    SEATTLE — A plaintiff who is receiving long-term disability (LTD) benefits is entitled to waiver of premium (WOP) benefits under a life insurance policy because the plaintiff cannot perform the material duties of any occupation as she is unable to perform the material duties of any occupation on a full-time basis, a Washington federal judge said Dec. 4 in vacating the insurer’s denial of WOP benefits (Adasha Turner v. Life Insurance Company of North America, No. 17-1, W.D. Wash., 2017 U.S. Dist. LEXIS 199004).

  • December 5, 2017

    Department Of Labor Delays Change For Disability Plan Claims Procedures

    WASHINGTON, D.C. — The U.S. Department of Labor’s Employee Benefits Security Administration on Nov. 29 published a notification in the Federal Register of a 90-day delay in the applicability of a final rule amending the claims procedure requirements that are applicable to employee disability benefit plans governed by the Employee Retirement Income Security Act.

  • December 5, 2017

    Disability Insurer Says 2nd Circuit Incorrectly Found Offset Is Barred

    WASHINGTON, D.C. — Review of the Second Circuit U.S. Court of Appeals’ ruling that New York law bars the offset of a claimant’s disability benefits with the proceeds of the claimant’s settlement of a personal injury suit is warranted because the Employee Retirement Income Security Act preempts the New York law at issue, a disability insurer argues in a Nov. 17 reply brief filed in the U.S. Supreme Court (Aetna Life Insurance Co. v. Salvatore Arnone, No. 17-416, U.S. Sup., 2017 U.S. S. Ct. Briefs LEXIS 4511).

  • December 5, 2017

    Pennsylvania Federal Judge Says ERISA Applies To Subrogation Dispute

    SCRANTON, Pa. — A Pennsylvania federal judge on Dec. 1 denied a plaintiff’s motion to remand a suit seeking a declaration that a recovery service company hired by a disability insurer is not entitled to collect reimbursement for paid disability benefits because the Employee Retirement Income Security Act applies to the dispute and, therefore, federal subject matter jurisdiction exists (Denise Wingo v. Trover Solutions Inc., No. 17-846, M.D. Pa., 2017 U.S. Dist. LEXIS 197751).

  • December 5, 2017

    Rhode Island Federal Judge Determines That De Novo Standard Of Review Applies

    PROVIDENCE, R.I. — A Rhode Island federal judge on Dec. 1 determined that de novo standard of review must be applied in a dispute alleging wrongful termination of disability benefits because the plan in effect when the benefits claim was filed did not grant discretionary authority to the plan insurer (Nancy A. Tullie v. The Prudential Life Insurance Company of America, No. 16-662, D. R.I., 2017 U.S. Dist. LEXIS 198365).

  • December 1, 2017

    Negligence Claim For Practice Of Medicine Without License Is Preempted By ERISA, Judge Says

    LEXINGTON, Ky. — A Kentucky federal judge on Nov. 28 determined that a plaintiff’s claim for negligence per se for the practice of medicine without a license based on a defendant’s certification of information about the plaintiff’s disability without approval from the plaintiff’s doctor is preempted by the Employee Retirement Income Security Act and must be dismissed (Mark Morcus v. Medi-Copy Services Inc., et al., No. 17-229, E.D. Ky., 2017 U.S. Dist. LEXIS 195485).

  • November 28, 2017

    Disability Income Insurer Must Produce Documents Pertaining To Claims Decision

    COLUMBUS, Ohio — Following an in camera review, an Ohio federal magistrate judge on Nov.  27 granted an insured’s motion to compel the production of seven documents after determining that the documents will help to determine whether the insurer acted in bad faith in its handling of the insured’s disability income claim (Mukesh R. Shah, M.D. v. Metropolitan Life Insurance Co., et al., No.  16-1124, S.D. Ohio, 2017 U.S. Dist. LEXIS 194347).

  • November 28, 2017

    Discovery Outside Of Administrative Record Is Not Warranted, Judge Says

    BALTIMORE — A disability claimant is not permitted to conduct discovery outside of the administrative record because the claimant failed to identify any specific need for extra-record discovery, a Maryland federal judge said Nov. 16 (Amy Silverstone v. Reliance Standard Life Insurance Co., No. 17-0111, D. Md., 2017 U.S. Dist. LEXIS 189528).

  • November 21, 2017

    Offset Was Not Abuse Of Discretion, 9th Circuit Panel Says In Affirming

    SAN FRANCISCO — 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 that she receives for her dependents, the Ninth Circuit U.S. Court of Appeals said Nov. 17 in affirming a district court’s ruling for the plan (Susan Rene Jones v. Life Insurance Company of North America, et al., No. 16-16172, 9th Cir., 2017 U.S. App. LEXIS 23244).

  • November 21, 2017

    Fact Issues Exist On Cause Of Claimant’s Disability, 11th Circuit Panel Says

    ATLANTA — The 11th Circuit U.S. Court of Appeals on Nov. 17 remanded a disability claimant’s suit after determining that a district court erred in granting summary judgment in favor of the insurer because genuine issues of material fact exist regarding the cause of the claimant’s disability and whether the plan’s pre-existing conditions exclusion applies (Kristian Horneland v. United of Omaha Insurance Co., No. 16-16935, 11th Cir., 2017 U.S. App. LEXIS 23129).

  • November 17, 2017

    California Federal Judge Transfers Disability Suit To New Jersey Federal Court

    SAN FRANCISCO — A California federal judge on Nov. 16 granted a disability insurer’s motion to transfer a disability claimant’s suit to New Jersey federal court after determining that New Jersey is the more convenient forum for the parties and for the witnesses (Ernest Tarasovsky v. The Guardian Life Insurance Company of America, No. 17-03464, N.D. Calif., 2017 U.S. Dist. LEXIS 189926).

  • November 17, 2017

    Disability Claimant Says 2nd Circuit Properly Found Offset Is Barred

    WASHINGTON, D.C. — The U.S. Supreme Court should deny a disability insurer’s petition for writ of certiorari because the Second Circuit U.S. Court of Appeals did not err in finding that New York law bars the offset of the claimant’s disability benefits in light of the claimant’s settlement of a personal injury suit and properly applied the relevant test to determine if the New York law is preempted by the Employee Retirement Income Security Act, a disability claimant states in a Nov. 6 response to the insurer’s petition (Aetna Life Insurance Co. v. Salvatore Arnone, No. 17-416, U.S. Sup., 2017 U.S. S. Ct. Briefs LEXIS 4336).

  • November 16, 2017

    Termination Of LTD Benefits Supported By Medical Evidence, Appeals Panel Says

    PHILADELPHIA — A district court did not err in finding that a disability insurer’s termination of long-term disability benefits under the plan’s any-occupation standard was not arbitrary and capricious because the termination is supported by substantial evidence, the Third Circuit U.S. Court of Appeals held Nov. 13 (Kristen Ann Davies v. First Reliance Standard Life Insurance Co., No. 17-1782, 3rd Cir., 2017 U.S. App. LEXIS 22656).

  • November 15, 2017

    Denial Of LTD Claim Supported By Evidence, Pennsylvania Federal Judge Says

    PHILADELPHIA — A Pennsylvania federal judge on Nov. 13 denied a disability claimant’s motion for summary judgment and granted a disability plan’s motion for summary judgment after determining that the plan’s denial of the claim for long-term disability benefits was not arbitrary and capricious because the denial is supported by the evidence (Karen O’Conner v. The PNC Financial Services Group Inc. et al., No. 15-5051, E.D. Pa., 2017 U.S. Dist. LEXIS 186692).

  • November 9, 2017

    Washington Federal Judge Denies Disability Claimant’s Motion To Supplement Record

    SEATTLE — A Washington federal judge on Nov. 8 denied a disability claimant’s motion to supplement the administrative record with a disability benefits decision made by the Social Security Administration because the claimant failed to establish the existence of any exceptional circumstances to warrant supplementing the record (Kristen Reetz v. Hartford Life and Accident Insurance Co., No. 17-84, W.D. Wash., 2017 U.S. Dist. LEXIS 185362).

  • November 7, 2017

    Missouri Federal Judge Dismisses Disability Suit On Preemption Basis

    CAPE GIRARDEAU, Mo. — A Missouri federal judge on Nov. 3 granted a disability insurer’s motion to dismiss a claimant’s suit alleging that the insurer acted in bad faith in denying a claim for disability benefits because the claimant’s state law claims are preempted by the Employee Retirement Income Security Act and the claimant alleged no ERISA claims that can withstand dismissal (Patricia Carmack v. Liberty Life Assurance Company of Boston, No. 17-121, E.D. Mo., 2017 U.S. Dist. LEXIS 182319).

  • November 3, 2017

    Disability Insurer Erred In Applying Pre-Existing Condition Exclusion

    FLINT, Mich. — A Michigan federal judge on Nov. 2 granted judgment in favor of a disability claimant after rejecting the disability insurer’s argument that the plan’s pre-existing condition exclusion barred coverage for the claimant’s disability (Cheryl L. Wallace v. Beaumont Healthcare Employee Welfare Benefit Plan, et al., No. 16-10625, E.D. Mich., 2017 U.S. Dist. LEXIS 182028).

  • November 2, 2017

    Denial Of Appellate Attorney Fees In Disability Dispute Was An Abuse Of Discretion

    SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals on Oct. 31 reversed a district court’s denial of attorney fees to a disability plan acting on behalf the plan participant after determining that the plan is entitled to collect the attorney fees it incurred as result of the disability insurer’s appeal and that the district court’s denial of attorney fees was an abuse of discretion (John Paul Micha M.D., v. Sun Life Assurance Of Canada, Inc., No. 16-55053, 9th Cir., 2017 U.S. App. LEXIS 21800).