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

Mealey's Disability Insurance

December 06, 2021
Breach Of Contract Claim Preempted By ERISA, Kentucky Federal Judge Says

LEXINGTON, Ky. — A breach of contract claim alleged against a disability insurer cannot proceed because the claim is based on a plan governed by the Employee Retirement Income Security Act and, therefore, is preempted by ERISA, a Kentucky federal judge said Dec. 3 in dismissing the breach of contract claim.
December 06, 2021
Disability Claimant Denied Full, Fair Review Under ERISA, 1st Circuit Panel Says

BOSTON — The First Circuit U.S. Court of Appeals on Nov. 10 vacated a district court’s ruling in favor of a disability insurer after finding that a disability plan participant’s claim must be remanded to the plan administrator for a full and fair review because the insurer did not allow the claimant the opportunity to respond to the findings of an independent medical exam.
December 03, 2021
District Court Did Not Err In Finding Claimant Is Disabled From Any Occupation

CHICAGO — While a district court erred in resolving factual disputes on motions for summary judgment, the district court did not err in finding that a disability claimant is unable to perform the duties of any occupation, the Eighth Circuit U.S. Court of Appeals said Nov. 30.
November 30, 2021
Termination Of Benefits Was Arbitrary, Capricious, 3rd Circuit Panel Says

PHILADELPHIA — A disability insurer’s termination of benefits was arbitrary and capricious because the insurer “deviated significantly from its normal eligibility-review processes” by requesting an outside evaluation of the claimant, the Third Circuit U.S. Court of Appeals said Nov. 26 in affirming a district court’s decision to reinstate a disability claimant’s benefits.
November 10, 2021
Judgment Entered For Disability Insurer; Claimant Failed To Exhaust All Remedies

SAN DIEGO — A California federal judge on Nov. 5 entered judgment in favor of a disability insurer after determining that the disability claimant is not entitled to long-term disability benefits because the claimant failed to exhaust her administrative remedies and the medical evidence does not support a finding that the claimant is disabled from performing the duties of her own occupation.
November 10, 2021
Disability Claimant Cannot Perform Sedentary Work, Ohio Federal Judge Says

CINCINNATI — A disability claimant is entitled to long-term disability (LTD) benefits because the medical evidence supports a finding that the claimant is unable to perform any occupation, including sedentary work, an Ohio federal judge said Nov. 5 in granting judgment in favor of the claimant.
November 05, 2021
ERISA Claim Seeking Disability Benefits Can Proceed, Judge Says

MINNEAPOLIS — A Minnesota federal judge on Nov. 3 denied a disability insurer’s motion to dismiss a claim seeking disability benefits under the Employee Retirement Income Security Act because the claimant asserted a plausible claim for benefits; however, the judge granted the disability’s insurer’s motion to dismiss the claimant’s breach of fiduciary claim after finding no support for the claim.
November 05, 2021
Benefits Wrongfully Terminated Based On Request To Reschedule Exam, Claimant Says

FORT MYERS, Fla. — A disability claimant alleges in an Oct. 27 complaint filed in Florida federal court that a disability insurer wrongfully and unreasonably terminated his disability benefits based on his request to reschedule a medical evaluation until after he could receive the COVID-19 vaccine.
November 04, 2021
Termination Of LTD Benefits Was Reasonable Based On Medical Evidence, Panel Says

CHICAGO — A district court properly found that a disability insurer’s termination of long-term disability benefits was reasonable based on the medical evidence, the Seventh Circuit U.S. Court of Appeals said Nov. 3 in rejecting the claimant’s argument that the insurer failed to properly credit the opinion of his treating physician.
November 04, 2021
Termination Of LTD Benefits Supported By Medical Evidence, Texas Federal Judge Says

HOUSTON — The termination of a claimant’s long-term disability (LTD) benefits was not arbitrary or capricious, a Texas federal judge said Nov. 1 in granting the disability plan’s motion for summary judgment, because the medical records support the plan administrator’s finding that the claimant was not disabled from performing any work for compensation or profit.
November 03, 2021
District Court Retained Jurisdiction In Disability Benefits Suit, Panel Says

CINCINNATI — A district court erred in determining that it did not have jurisdiction to hear a disability claimant’s motion for attorney fees and motion to reopen her case because the court retained jurisdiction over the suit even though the Sixth Circuit U.S. Court of Appeals previously remanded the claims to the plan administrator, the Sixth Circuit said Nov. 2 in vacating the lower court’s ruling.
November 03, 2021
Denial Of Disability Benefits Was Not An Abuse Of Discretion, Judge Says

CHARLOTTE, N.C. — A disability plan did not abuse its discretion in denying claims for short-term disability (STD) and long-term disability (LTD) benefits because the plan’s denial was not unreasonable or unsupported by substantial evidence, a North Carolina federal judge said Oct. 27.
November 02, 2021
Offset Of Disability Benefits Permitted Under Disability Plan, Judge Says

OWENSBORO, Ky. — A disability insurer’s decision to offset a claimant’s benefits was not arbitrary and capricious because the claimant’s benefits from the Veterans Administration qualify as other income benefits under the disability plan at issue, a Kentucky federal judge said Oct. 29 in granting the insurer’s motion for judgment.
November 02, 2021
Judge: Disability Insurer’s Decision To Deny LTD Benefits Was Arbitrary, Capricious

BOSTON — A Massachusetts federal judge on Oct. 28 granted a disability claimant’s motion for summary judgment after determining that the disability insurer’s decision to deny long-term disability (LTD) benefits was arbitrary and capricious because the insurer did not rely on any substantial evidence in denying the claim.
November 01, 2021
Disability Claimant Permitted To Conduct Limited Discovery, Federal Judge Says

CAPE GIRARDEAU, Mo. — A Missouri federal judge on Oct. 21 granted a disability claimant’s motion to conduct limited discovery because limited discovery will help to determine whether the plan committed any procedural irregularities in handling the plan participant’s long-term disability (LTD) claim.
November 01, 2021
Disability Claimant Failed To Prove He Was Covered Employee, Judge Says

PORTLAND, Ore. — A disability insurer is entitled to judgment on the administrative record because the disability claimant failed to meet his burden of proving that he was a covered employee under a long-term disability plan, an Oregon federal magistrate judge said Oct. 25.
October 28, 2021
Judge Awards $259,276 In Fees For Remand Of 1 Issue In Long-Term Disability Case

PHOENIX — An Arizona federal judge on Oct. 8 granted in part and denied in part a claimant’s motion for attorney fees in a suit seeking long-term disability benefits, finding that the award should be reduced because the lower hourly rate agreed to in the fee agreement should apply, that the fees requested are “excessive in light of the maximum benefits due in the case” and that some of the billing was related to clerical tasks.
October 21, 2021
Federal Judge Finds Employee’s Disability Continuous, Awards More Than $180,000

SAN DIEGO — A federal judge in California on Oct. 5 ruled that an insurer erred in determining that an employee’s disability due to depression and anxiety stopped for a span of approximately 10 months before starting again and, on Oct. 20, after requesting supplemental briefing, awarded the man past-due benefits of more than $180,000 plus pre- and post-judgment interest.
October 19, 2021
Termination Of LTD Benefits Was Not Arbitrary, Capricious, Judge Says

MILWAUKEE — A disability plan’s termination of long-term disability benefits on the basis that the claimant was not disabled from any occupation was not arbitrary and capricious because the evidence supports the termination of benefits and the claimant’s self-reported symptoms cannot be used to demonstrate a total disability, a Wisconsin federal judge said Oct. 8.
October 18, 2021
Federal Judge Grants Partial Award Of Attorney Fees And Costs In Disability Suit

MINNEAPOLIS— A Minnesota federal judge on Oct. 8 granted in part and denied in part a claimant’s motion for attorney fees in her suit against a disability insurer, finding that the requested fees should be reduced because some of them appear to relate to administrative proceedings and because the claimant did not receive all the relief sought in her complaint.
October 18, 2021
Equitable Relief Claim Alleged Under ERISA Will Proceed, Judge Determines

SACRAMENTO, Calif. — A California federal judge on Oct. 7 denied a disability insurer’s motion to dismiss a portion of a claim seeking equitable relief under the Employee Retirement Income Security Act after determining that the disability claimant sufficiently stated facts in support of the claim.
October 08, 2021
Termination Of LTD Benefits Was Not Arbitrary, Capricious, Federal Judge Says

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.
October 07, 2021
U.S. Secretary Of Labor Says Disability Insurer Failed To Issue Benefit Determination

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.
October 07, 2021
Disability Claimant’s Breach Of Contract Suit Is Untimely, Federal Judge Determines

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.
October 06, 2021
5th Circuit Panel Reverses, Remands Ruling On Any-Occupation Benefits

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.