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Mealey's Disability Insurance

  • September 20, 2018

    Arbitrary, Capricious Standard Of Review Applies, Federal Judge Determines

    PIKEVILLE, Ky. — An arbitrary and capricious standard of review applies in disability suit because the disability plan delegates discretionary authority to the insurer for the administration of claims made under the plan, a Kentucky federal judge said Sept. 18 (Regina Hurd v. Life Insurance Company of North America, No. 18-67, E.D. Ky., 2018 U.S. Dist. LEXIS 158595).

  • September 20, 2018

    Federal Judge Says Disability Insurer Must Determine If Claimant Was ‘Made Whole’

    COLUMBUS, Ohio — An Ohio federal judge on Sept. 18 remanded a claim to a disability insurer for further fact finding on the issues of whether a disability claimant was made whole by a settlement she received following injuries sustained in a car accident and whether the disability claimant’s benefits can be offset based on the settlement (Sepanta Jalali v. Unum Life Insurance Company of America, No. 16-512, S.D. Ohio, 2018 U.S. Dist. LEXIS 159015).

  • September 18, 2018

    Disability Claimant Failed To Challenge District Court’s Ruling, Panel Says

    CINCINNATI — The Sixth Circuit U.S. Court of Appeal on Sept. 11 affirmed a district court’s ruling in favor of a retirement benefits plan because the appellant, seeking retirement disability benefits, failed to challenge the district court’s finding that the retirement plan was properly amended to delete a provision stating that a claimant would be considered totally disabled if the Social Security Administration (SSA) declared the claimant disabled (Patsy Saylor v. Appalachian Regional Hospital, No. 17-6266, 6th Cir., 2018 U.S. App. LEXIS 25828).

  • September 18, 2018

    Supplemental Disability Policy Not Part Of Employee Welfare Benefit Plan, Judge Says

    MINNEAPOLIS — A breach of contract claim is not preempted by the Employee Retirement Income Security Act because the supplemental disability policy at issue is not part of an employee welfare benefit plan under ERISA, a Minnesota federal judge said Sept. 14 in adopting a magistrate judge’s recommendation to deny the insurer’s motion for summary judgment (Matthew J. Christoff v. Paul Revere Life Insurance Co., No. 17-3515, D. Minn., 2018 U.S. Dist. LEXIS 157107).

  • September 18, 2018

    Evidence Supports Finding That Claimant Was Not Disabled From Any Occupation

    NEW YORK — A disability insurer’s denial of a claimant’s long-term disability benefits claim was not arbitrary and capricious because substantial medical evidence supports the insurer’s determination that the claimant was not disabled from any occupation, a New York federal judge said Sept. 14 (Lazer Wagschal v. Principal Life Insurance Co., No. 16-1029, S.D. N.Y., 2018 U.S. Dist. LEXIS 157319).

  • September 17, 2018

    Termination Of Disability Benefits Was Arbitrary And Capricious, Majority Says

    CHICAGO — A disability insurer acted arbitrarily and capriciously when it failed to consider the opinions of four doctors in favor of one doctor who determined that a disability claimant was not disabled as a result of radiculopathy, a majority of the Seventh Circuit U.S. Court of Appeals said Sept. 14 reversing a district court’s opinion and remanding the claim to the plan administrator (Susan Hennen v. Metropolitan Life Insurance Co., No. 17-3080, 7th Cir., 2018 U.S. App. LEXIS 26114).

  • September 13, 2018

    Disability Insurer’s Summary Judgment Motion Should Be Granted, Magistrate Judge Says

    WASHINGTON, D.C. — A District of Columbia federal magistrate judge on Sept. 11 recommended that a disability’s claimant’s motion for summary judgment be denied and the disability insurer’s motion for summary judgment be granted after determining that the evidence supports the insurer’s denial of benefits (Elaine Arabaitzis v. Unum Life Insurance Company of America, No. 16-1273, D. D.C.).

  • September 13, 2018

    Denial Of Disability Benefits Was Not Arbitrary, Capricious, Federal Judge Says

    LEXINGTON, Ky. — A disability insurer’s denial of long-term disability benefits was not arbitrary and capricious because substantial evidence in the record supports the insurer’s denial, a Kentucky federal judge said Sept. 11 in granting the insurer’s motion for summary judgment (Susan Card v. Principal Life Insurance Co., No. 15-139, E.D. Ky., 2018 U.S. Dist. LEXIS 154563).

  • September 12, 2018

    Bad Faith Claim Against Disability Income Insurer Is Premature, Judge Says

    TAMPA, Fla. — A Florida federal judge on Sept. 11 dismissed an insured’s bad faith claim without prejudice after determining that the claim arising out of a disability income insurer’s termination of benefits is premature (Susan Welsh v. General American Life Insurance Co., No. 18-1227, M.D. Fla., 2018 U.S. Dist. LEXIS 154487).

  • September 11, 2018

    2nd Circuit Affirms Denial Of Benefits Based On Plan’s Mental Illness Provision

    NEW YORK — The Second Circuit U.S. Court of Appeals on Sept. 7 affirmed a district court’s ruling that a disability insurer did not act arbitrarily and capriciously in relying on the American Psychiatric Association's definition of mental illness when determining that bipolar disorder is a mental illness and subject to the plan's 24-month cap on disability benefits for a mental illness (Marry Kim v. The Hartford Life Insurance Co., No. 17-2122, 2nd Cir., 2018 U.S. App. LEXIS 25389).

  • September 7, 2018

    Claimant Was Not Disabled From Any Occupation, Federal Judge Determines

    ALLENTOWN, Pa. — A disability insurer’s termination of long-term disability benefits was not arbitrary and capricious because substantial evidence supports the insurer’s determination that the claimant was not disabled from performing the duties of any gainful occupation, a Pennsylvania federal judge said Aug. 13 (Giovanna Reichard v. United of Omaha Life Insurance Co., No. 17-2885, E.D. Pa., 2018 U.S. Dist. LEXIS 136050).

  • September 7, 2018

    Disability Plan Is Ambiguous As To Exhaustion Requirement, Federal Judge Says

    BRIDGEPORT, Conn. — A Connecticut federal judge on Aug. 28 denied a disability insurer’s motion to dismiss after determining that the disability plan does not include an express exhaustion provision and that it is possible for a plan participant to interpret the plan as not requiring exhaustion prior to filing suit (Annuziata Germana, et al. v. Reliance Standard Life Insurance Co., No. 16-1611, D. Conn., 2018 U.S. Dist. LEXIS 146074).

  • September 7, 2018

    Claimant Is Entitled To Reinstatement Of LTD Benefits, Federal Judge Says

    TULSA, Okla. — An Oklahoma federal judge on Aug. 17 determined that a claimant’s long-term disability (LTD) benefits must be reinstated because the denial of benefits is not supported by substantial evidence and was arbitrary and capricious (Shirley Kathy Redden v. Aetna Life Insurance Co., No. 12-16, N.D. Okla., 2018 U.S. Dist. LEXIS 139733).

  • September 6, 2018

    Disability Insurer Properly Terminated Benefits, Federal Judge Determines

    PHILADELPHIA — A Pennsylvania federal judge on Aug. 23 determined that a disability insurer’s termination of long-term disability (LTD) benefits was proper because the claimant failed to prove that she was disabled under the plan’s any-occupation standard and because the claimant collected the maximum amount of available benefits available under the plan’s mental health limitation (Kristy M. Keller-Smith v. Reliance Standard Life Insurance Co., No. 17-1549, E.D. Pa., 2018 U.S. Dist. LEXIS 144425).

  • September 6, 2018

    Information Challenging Administrative Record In Disability Suit Is Discoverable

    NEW ORLEANS — A Louisiana federal magistrate judge on Aug. 16 determined that a disability claimant is entitled to some discovery as some of the claimant’s requests challenge the completeness of the administrative record and some of the requests seek discoverable information regarding the insurer’s retention of third-party medical professionals (Jeanne Sirey v. Metropolitan Life Insurance Co., No. 18-197, E.D. La., 2018 U.S. Dist. LEXIS 138732).

  • September 5, 2018

    Evidence Supports Finding That Claimant Was Not Disabled From Own Occupation

    NEW YORK — A New York federal judge on Aug. 30 determined that the termination of a disability claimant’s long-term disability (LTD) benefits was not arbitrary and capricious because the evidence supports the plan’s finding that the claimant’s hearing loss and tinnitus did not prevent the claimant from performing the duties of her own occupation (Susan Shahgholi v. Aetna Inc. Long Term Disability Benefits Plan, No. 17-963, S.D. N.Y., 2018 U.S. Dist. LEXIS 148400).

  • September 4, 2018

    Claimant Failed To Show Insurer Acted In Bad Faith In Terminating LTD Benefits

    DENVER — A Colorado federal judge on Aug. 29 granted a disability insurer’s motion for summary judgment on a disability plan participant’s claims for common-law bad faith and statutory bad faith after determining that the participant failed to prove that the insurer acted unreasonably in handling a claim for long-term disability benefits (Brenda Sandoval v. Unum Life Insurance Company of America, No. 17-644, D. Col., 2018 U.S. Dist. LEXIS 147184).

  • September 4, 2018

    Minnesota Federal Judge Says Claims Against LTD Insurer Are Not Duplicative

    MINNEAPOLIS — A Minnesota federal judge on Aug. 29 denied a disability insurer’s motion for judgment on the pleadings after determining that a breach of fiduciary claim seeking attorney fees and health care costs as remedies for the breach is not duplicative of the breach of fiduciary claim seeking benefits under a long-term disability (LTD) plan (Michael J. Christoff v. Unum Life Insurance Company of America, No. 17-3512, D. Minn., 2018 U.S. Dist. LEXIS 147188).

  • August 29, 2018

    Termination Of Disability Benefits Supported By Evidence, Federal Judge Says

    DETROIT — A disability insurer properly terminated a claimant’s long-term disability (LTD) benefits because the evidence obtained by the insurer, which includes surveillance video and multiple independent medical reviews, supports the finding that the claimant was not disabled from any occupation, a Michigan federal judge said Aug. 20 (Jill Brown v. Hartford Insurance Co., No. 17-10868, E.D. Mich., 2018 U.S. Dist. LEXIS 140541).

  • August 27, 2018

    Disability Insurer Reasonably Relied On Independent Physicians’ Opinions

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on Aug. 23 reversed a district court’s ruling in favor of a disability claimant after determining that the insurer did not abuse its discretion in relying on the opinions of two independent medical reviewers when it denied the claim for benefits (Damon Zaeske v. Liberty Life Assurance Company of Boston, No. 17-2496, 8th Cir., 2018 U.S. App. LEXIS 23768).