Mealey's Disability Insurance
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January 27, 2022
Disability Claimant Claims Benefits Owed For Long COVID Symptoms
SAN FRANCISCO — A disability claimant suffering from symptoms of long COVID following a battle with COVID-19 asks a California federal court in a Jan. 19 complaint to order a disability insurer to reinstate her short-term disability (STD) benefits and approve her long-term disability (LTD) benefits claim because she remains unable to perform the duties of her own occupation.
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January 27, 2022
Disability Claimant Entitled To Award Of More Than $120K For Attorney Fees, Costs
MINNEAPOLIS — A Minnesota federal judge on Jan. 13 granted a disability claimant’s motion for attorney fees and costs and awarded the claimant, who prevailed on her claim seeking long-term disability (LTD) benefits, more than $120,000 in attorney fees and costs after determining that the amount sought by the claimant was reasonable.
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January 27, 2022
Disability Plan Did Not Accurately Describe Available Benefits, Judge Says
GREENEVILLE, Tenn. — A Tennessee federal judge on Jan. 24 determined that a plan sponsor breached its fiduciary duty because the employer’s long-term disability plan description did not accurately describe the amount of benefits available to an employee if an employee elected the buy-up coverage for additional benefits.
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January 21, 2022
Judge: 3 Of 4 Fraud Elements Of Disability Insurer’s Rescission Claim Pass Muster
FORT MYERS, Fla. — A federal judge in Florida on Jan. 11 substantially granted an insurer’s motion for summary judgment in a lawsuit seeking to rescind a doctor’s disability policy based on material misrepresentations the doctor made in his policy application, ruling that the insurer partially pleaded certain elements of its rescission claim.
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January 14, 2022
2nd Circuit Affirms Dismissal Of Claimant’s Disability Suit Under ERISA
NEW YORK — Concluding that there was no clear error in the factual findings and declining to apply a less deferential standard of review, the Second Circuit U.S. Court of Appeals in a Jan. 11 summary order affirmed the judgment of a New York federal court that dismissed a disability claimant’s suit under the Employee Retirement Income Security Act of 1974 following determination on the papers.
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January 12, 2022
Policy’s Other Limited Conditions Limitation Properly Applied To Disability Claim
MADISON, Wis. — A disability insurer did not act arbitrarily or capriciously in terminating a claimant’s long-term disability (LTD) benefits because the claimant failed to show that his disability was not subject to the plan’s other limited conditions limitations, a Wisconsin federal magistrate judge said Dec. 27.
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January 12, 2022
Bad Faith Claim Against Disability Insurer Cannot Proceed, Judge Says
SAN FRANCISCO — A California federal judge on Dec. 21 granted a disability insurer’s motion for summary judgment on a bad faith claim after determining that there is no evidence showing that the insurer’s investigation was unreasonable and after determining that a question of fact exists as to whether the claimant’s disability was caused by sickness or injury.
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January 12, 2022
Judgment Entered In Favor Of Disability Claimant; Attorney Fees, Costs Awarded
SANTA ANA, Calif. — In a Jan. 3 amended judgment, a California federal judge entered judgment in favor of a disability claimant and awarded the claimant approximately $226,097 in attorney fees and $4,489 in costs after he prevailed on a claim for long-term disability benefits.
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January 12, 2022
Disability Policy’s 3-Year Limitations Provision Is Enforceable, Judge Says
BALTIMORE — A three-year limitations provision in a disability policy is enforceable and bars a disability claimant’s lawsuit seeking a declaration that he is entitled to additional long-term disability benefits, a Maryland federal judge said Jan. 4.
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January 12, 2022
Termination Of Disability Benefits Was Not Arbitrary, Capricious, Judge Says
DETROIT — A disability insurer’s decision to terminate a claimant’s benefits was not arbitrary and capricious because the insurer properly found that the claimant was able to perform the duties of a sedentary occupation, a Michigan federal judge said Dec. 28 in granting the insurer’s motion to affirm its decision.
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January 12, 2022
Disability Claim Remanded To Determine If Pre-Existing Condition Exclusion Applied
NEW ORLEANS — A Louisiana federal judge on Dec. 29 upheld a disability insurer’s determination that a disability claimant is not entitled to long-term disability benefits for migraine headaches but remanded the disability insurer’s determination that the plan’s pre-existing condition exclusion barred benefits for other medical ailments because there is a discrepancy as to when the claimant was hired and whether the pre-existing condition exclusion applied.
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January 12, 2022
Disability Plan Is Not Church Plan; Claimant’s Suit To Remain In Federal Court
COVINGTON, Ky. — A Kentucky federal judge on Jan. 11 denied a disability claimant’s motion to remand after determining that federal jurisdiction exists because the plan at issue is governed by the Employee Retirement Income Security Act and does not qualify as an exempted church plan under ERISA.
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January 11, 2022
District Court Properly Found Claimant Not Disabled From Any Occupation
CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Dec. 13 affirmed a district court’s ruling in favor of a disability insurer after determining that the lower court correctly found that the disability claimant failed to prove by a preponderance of the evidence that he is disabled from performing the duties of any occupation.
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January 10, 2022
District Court Erred In Entering Judgment For Disability Insurer, Panel Says
ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on Dec. 27 reversed a district court’s judgment entered in favor of a disability insurer after determining that the insurer failed to show that there was any new information or evidence to support its decision to terminate benefits after almost 10 years.
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January 07, 2022
Panel Says Any-Occupation Ruling Not Supported; Remand Necessary
PASADENA, Calif. — The Ninth Circuit U.S. Court of Appeal on Dec. 27 affirmed a district court’s finding that a disability claimant is entitled to own-occupation benefits but reversed and remanded the lower court’s ruling that the claimant is entitled to any-occupation benefits because the evidence in the administrative record did not conclusively show that the claimant was disabled from performing the duties of any occupation.
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January 06, 2022
Insurer Waives Right To Respond To Petition Seeking Review Of Disability Ruling
WASHINGTON, D.C. — A disability insurer on Jan. 5 waived its right to respond to a disability claimant’s petition for writ of certiorari filed in the U.S. Supreme Court seeking a “uniform rule enforcing an ERISA plan’s choice of law and applying the chosen law to all plan participants” and a ruling that the Employee Retirement Income Security Act does not preempt state law prescribing de novo judicial review for challenged benefit determinations.
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January 04, 2022
Federal Judge Finds Attorney Fees Reasonable In Physician’s ERISA Disability Suit
WILMINGTON, Del. — A Delaware federal judge on Dec. 17 granted a disability claimant’s request for attorney fees, finding that the claimant met the burden of showing that the fees were not excessive.
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December 22, 2021
High Court Review Sought In Disability Benefits Case Over Discretionary Authority
WASHINGTON, D.C. — In a Dec. 9 petition to the U.S. Supreme Court for a writ of certiorari regarding judgment in favor of a disability insurer, a beneficiary seeks a “uniform rule enforcing an ERISA plan’s choice of law and applying the chosen law to all plan participants” and a ruling that the Employee Retirement Income Security Act does not preempt state law prescribing de novo judicial review for challenged benefit determinations.
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December 10, 2021
Connecticut Panel Affirms Decision In Favor Of Insurance Guaranty Association
HARTFORD, Conn. — A Connecticut appeals panel on Dec. 7 held that the Compensation Review Board did not err in affirming the workers' compensation commissioner for the Fourth District’s decision that the Connecticut Insurance Guaranty Association fulfilled its statutory duty regarding a claimant’s retroactive lump-sum cost of living adjustment (COLA) payment arising from a disability claim.
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December 09, 2021
Disability Claimant Permitted To Supplement Record With Therapist’s Letter
CENTRAL ISLIP, N.Y. — A New York federal magistrate judge on Nov. 29 partially granted a disability claimant’s request to supplement the administrative record with a letter from her physical therapist because the letter shows that there may have been some form of bad faith conduct committed by the disability insurer.
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December 09, 2021
Disability Insurer Is Not Entitled To Attorney Fee Award, Judge Says
TACOMA, Wash. — Despite the fact that a disability insurer prevailed on the merits of a long-term disability (LTD) claim, a Washington federal judge on Dec. 3 denied the insurer’s motion for attorney fees after determining that the insurer failed to prove that the disability claimant acted in bad faith in filing suit and failed to prove that the disability claimant has the ability to pay an award for attorney fees.
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December 09, 2021
Disability Insurer Abused Discretion In Denying Benefits, Oregon Federal Judge Says
PORTLAND, Ore. — After applying a “higher degree of skepticism” as instructed by the Ninth Circuit U.S. Court of Appeals, an Oregon federal judge on Nov. 29 determined that a disability insurer abused its discretion in denying a claim for long-term disability (LTD) benefits because the insurer ignored evidence showing that the claimant remain disabled.
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December 08, 2021
Disability Claimant Was Incapable Of Working Full Time, 4th Circuit Panel Says
RICHMOND, Va. — A disability claimant is entitled to a reinstatement of disability benefits because the medical evidence shows that the claimant was incapable of working in a sedentary full-time employment position when his benefits were terminated, the Fourth District U.S. Court of Appeals said Dec. 7 in reversing a district court’s judgment in favor of the disability insurer.
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December 08, 2021
Disability Insurer’s Denial Of Benefits Was Not Arbitrary, Capricious, Judge Says
CHICAGO — A disability insurer’s denial of disability benefits was not arbitrary and capricious because the insurer reasonably construed the disability plan to require proof of ongoing radiculopathy, an Illinois federal judge said Dec. 6 in granting the insurer’s motion for summary judgment.
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December 08, 2021
Doctor Is Disabled From Performing Duties Of Own Occupation, Judge Determines
SEATTLE — A Washington federal judge on Dec. 6 granted judgment in favor of a disability claimant after determining that the medical evidence supports a finding that the claimant is disabled from her own occupation as a medical doctor based on her stage IV breast cancer diagnosis.