Mealey's Disability Insurance : Mealey's : Legal News & Analysis

Mealey's Disability Insurance

August 22, 2022
Mental Health Diagnoses Do Not Prevent Claimant From Working In Own Occupation

MINNEAPOLIS — A Minnesota federal judge on Aug. 19 granted a disability insurer’s motion for summary judgment and denied a disability claimant’s motion for summary judgment after determining that the insurer’s denial of long-term disability (LTD) benefits was not arbitrary and capricious because a reasonable person could have concluded that the claimant’s mental health diagnoses do not prevent the claimant from performing the duties of her own occupation.
August 22, 2022
Breach Of Contract Claim Can Proceed, Bad Faith Claim Fails In Disability Suit

SAN FRANCISCO — A disability claimant’s breach of contract claim can proceed because a question of fact exists as to whether the claimant can perform the material duties of a general and pediatric anesthesiologist; however, the claimant’s bad faith claim cannot proceed because the claimant failed to show that the disability insurer’s investigation was unreasonable, a California federal judge said Aug. 19.
August 22, 2022
Discovery Permitted In Denial Of Disability Benefits Suit, Magistrate Judge Says

ST. LOUIS — A disability claimant is entitled to conduct limited discovery on claims of breach of fiduciary duty and wrongful denial of disability benefits because the claimant has shown that good cause exists to determine whether the disability insurer operated under a conflict of interest and committed procedural irregularities in the handling of the claim, a Missouri federal magistrate judge said Aug. 15.
August 17, 2022
Panel: Denial Of LTD Benefits For Failure To Provide Medical Records Was Reasonable

RICHMOND, Va. — A disability insurer’s denial of long-term disability (LTD) benefits based on a claimant’s failure to provide requested medical documentation in support of his disability was reasonable because the policy at issue specifically states that failure to provide any requested materials could result in the denial of a claim, the Fourth Circuit U.S. Court of Appeals said Aug. 16 in affirming a district court’s opinion.
August 16, 2022
Disability Claimant’s Suit Dismissed Without Prejudice; No Support For Agent Theory

SAN FRANCISCO — A California federal judge on Aug. 12 granted a disability insurer’s motion to dismiss a breach of contract and bad faith lawsuit after determining that the claimant, who sought disability benefits under a policy issued to a bone marrow donor program, failed to show that that the program was acting as an agent for the disability insurer when his claim for benefits was denied.
August 15, 2022
Prior Plan Exclusion Applies; No LTD Benefits Owed, 11th Circuit Panel Affirms

BIRMINGHAM, Ala. — The 11th Circuit U.S. Court of Appeals on Aug. 10 affirmed a district court’s finding that a disability insurer’s decision to deny a long-term disability (LTD) benefits claim based on the plan’s prior plan exclusion was not wrong because the insurer’s interpretation of the exclusion as a bar to coverage was reasonable.
August 11, 2022
Parties File Stipulation Of Dismissal In Long COVID, Disability Benefits Suit

SAN FRANCISCO — A disability insurer and a disability claimant suffering from symptoms of long COVID following a battle with COVID-19 have settled the claimant’s suit seeking a reinstatement of short-term disability (STD) benefits and a finding that she is entitled to long-term disability (LTD) benefits, according to an Aug. 8 stipulation of dismissal filed by the parties in California federal court.
August 04, 2022
Disability Claimant Achieved Some Success On Merits; Attorney Fee Award Warranted

CONCORD, N.H. — Because a disability claimant achieved some success on the merits when a disability insurer agreed to remand a long-term disability (LTD) benefits claim for reconsideration after the claimant filed suit, the claimant is entitled to attorney fees of $17,312, a New Hampshire federal judge said July 28.
August 04, 2022
LTD Claim Remanded To Plan Administrator For Full, Fair Review

GREEN BAY, Wis. — A Wisconsin federal judge on July 29 remanded a long-term disability (LTD) benefits claim to a plan administrator after determining that the denial of the claim was arbitrary and capricious based on the claims administrator’s finding that the medical evidence did not support the claimant’s disability.
August 04, 2022
Termination Of Benefits Was Not Arbitrary, Capricious, Federal Judge Determines

NEWARK, N.J. — A disability insurer’s decision to terminate a claimant’s long-term disability benefits was not arbitrary and capricious because the claimant was paid the maximum amount of benefits for a mental illness under the plan and failed to show that she was physically disabled from performing the duties of her own occupation, a New Jersey federal judge said July 29 in granting the disability insurer’s motion for summary judgment and in denying the claimant’s motion for summary judgment.
August 02, 2022
Judge Allows Disability Insurer To Stay A Portion Of Judgment Reinstating Benefits

SEATTLE — A Washington federal judge on July 25 granted a disability insurer’s motion to stay a portion of a judgment reinstating a claimant’s past long-term disability (LTD) benefits upon the posting of a bond while the insurer’s appeals the judgment but denied the insurer’s motion to stay the portion of the judgment ordering the insurer to pay ongoing LTD benefits because the portion of the judgment related to the ongoing benefits qualifies as injunctive relief that is not subject to an automatic stay.
August 01, 2022
Court Erred In Not Allowing Disability Claimant To Present Additional Evidence

ATLANTA — The 11th Circuit U.S. Court of Appeals on July 29 reversed and remanded a district court’s ruling that a disability claimant was not permitted to submit additional evidence in support of his claim that a disability insurer wrongfully terminated his claim because 11th Circuit precedent allows evidence outside of the administrative record to be presented when a de novo standard of review applies.
July 29, 2022
No Ambiguity Exists In Disability Policy, 5th Circuit Panel Says In Affirming

NEW ORLEANS — A district court did not err in finding that a disability insurer properly terminated a claimant’s benefits after five years because the policy phrase “any gainful occupation” is not ambiguous, the Fifth Circuit U.S. Court of Appeal said July 27.
July 27, 2022
Disability Insurer Properly Rescinded Policy, Federal Judge Says In Adopting Report

CENTRAL ISLIP, N.Y. — In a July 22 docket order, a New York federal judge adopted a magistrate judge’s recommendation to grant a disability insurer’s motion for summary judgment, agreeing with the magistrate judge’s conclusion that the insurer properly rescinded the disability policy based on fraudulent and material misrepresentations made by the insured regarding a preexisting neck condition and that the insurer did not act in bad faith in handling the insured’s claim.
July 21, 2022
Amount In Controversy Not Met In Disability, Bad Faith Suit, Magistrate Judge Says

AUGUSTA, Ga. — A disability claimant’s breach of contract and bad faith suit should be remanded to Georgia state court because the disability insurer failed to prove by a preponderance of the evidence that the amount in controversy exceeds the federal jurisdictional minimum of $75,000, a Georgia federal magistrate judge recommended June 27.
July 21, 2022
Disability Insurer Did Not Abuse Its Discretion In Terminating LTD Benefits

HOUSTON — A disability insurer did not abuse its discretion in determining that a disability claimant was not disabled from performing the duties of any gainful occupation because the record shows that the insurer conducted multiple peer-to-peer reviews with the claimant’s treating physicians and that the claimant did not suffer from functional limitations as a result of her physical and mental health ailments, a Texas federal judge said July 18.
July 20, 2022
Judge Awards Enhanced Lodestar, Conditional Attorney Fees In NFL Disability Row

DALLAS — Saying “David took on Goliath and prevailed,” a Texas federal judge on July 18 awarded enhanced attorney fees of $1,232,058.75 and conditional appellate attorney fees of $600,000 in a former National Football League player’s suit for disability benefits under the Employee Retirement Income Security Act.
July 19, 2022
Denial Of Benefits Was Not Arbitrary, Capricious, Federal Judge Says

LOUISVILLE, Ky. — A disability insurer’s denial of a long-term disability benefits claim was not arbitrary and capricious because the insurer thoroughly considered the claimant’s restrictions before concluding that the claimant was not disabled from performing the duties of her own occupation, a Kentucky federal judge said July 18.
July 19, 2022
4th Circuit Affirms Finding That Claimant Did Not Suffer From Physical Disability

RICHMOND, Va. — A disability insurer did not abuse its discretion in terminating a claimant’s long-term disability benefits based on its finding that the claimant did not suffer from a physical disability that precluded him from performing the duties of any occupation, the Fourth Circuit U.S. Court of Appeals said July 18 in affirming a district court’s ruling.
July 14, 2022
Termination Of Benefits Supported By Substantial Evidence, Judge Says

LEXINGTON, Ky. — A disability claimant failed to show that she is disabled from working in any occupation, a Kentucky federal judge said July 12 in determining that the medical evidence shows that the claimant is capable of performing some gainful activity.
July 14, 2022
Termination Of LTD Benefits Based On Policy Limitation Supported By Medical Evidence

NEW ORLEANS — A disability insurer’s termination of long-term disability (LTD) benefits based on the policy’s 12-month limitation for neuromuscular disorders was not arbitrary and capricious because the claimant failed to show that he suffered from a disability that was not subject to the policy’s limitation, a Louisiana federal judge said July 11 in granting the insurer’s motion for judgment on the administrative record.
July 14, 2022
Transfer Of Disability Suit From New York To Virginia Federal Court Is Appropriate

NEW YORK — A disability claimant’s suit must be transferred to Virginia federal court because the convenience of the parties and witnesses weigh in favor of transferring the suit, a New York federal magistrate judge said July 12 in granting the disability insurer’s motion to transfer venue.
July 08, 2022
Disability Insurer Properly Rescinded Policy Based On Insured’s Misrepresentations

CENTRAL ISLIP, N.Y. — A New York federal magistrate judge on June 30 recommended granting summary judgment in favor of a disability insurer after determining that the insurer properly rescinded a disability policy based on fraudulent and material misrepresentations made by the insured regarding a preexisting neck condition and that the insurer did not act in bad faith in handling the insured’s claim.
July 08, 2022
Judge Adopts Recommendation To Grant Judgment In Favor Of Disability Insurer

TAMPA, Fla. — A Florida federal judge on June 23 adopted a magistrate judge’s report and recommendation to grant summary judgment in favor of a disability insurer, agreeing with the magistrate judge that the insurer’s decision to deny a claim for long-term disability (LTD) benefits and to terminate a claim for short-term disability (STD) benefits was not arbitrary and capricious and was supported by the evidence in the administrative record.
July 08, 2022
Evidence Supports Finding That Disability Claimant Not Disabled From Any Occupation

GREEN BAY, Wis. — A disability insurer did not act arbitrarily and capriciously in terminating a claimant’s long-term disability benefits based on its determination that the claimant was no longer disabled from performing the duties of any occupation because the insurer’s termination was rational and supported by the evidence, a Wisconsin federal judge said June 27 in denying the claimant’s motion for summary judgment.