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

Mealey's Disability Insurance

November 20, 2023
9th Circuit Finds No Error In Judgment Entered In Favor Of Disability Insurer

SAN JOSE, Calif. — The Ninth Circuit U.S. Court of Appeals affirmed a district court’s judgment in favor of a disability insurer, rejecting the disability claimant’s argument that the lower court adopted new rationales that were not included in the administrative record in finding that the insurer’s termination of benefits was reasonable based on the evidence.
November 14, 2023
Disability Claimant’s Suit Cannot Proceed; Panel Says Claims Are Time-Barred

NEW ORLEANS — A district court properly found that a disability claimant’s suit cannot proceed because the claims alleged against the disability insurer are barred by the applicable statutes of limitations, the Fifth Circuit U.S. Court of Appeals said in affirming the lower court’s ruling.
November 10, 2023
Alabama Federal Judge Refuses To Deviate From Precedent In Disability Suit

JASPER, Ala. — An Alabama federal judge denied motions to determine the appropriate standard of review in a disability benefits dispute filed by the disability insurer and disability claimant after determining that neither of the parties persuaded the court to deviate from the precedent set forth in an 11th Circuit U.S. Court of Appeals’ suit when determining the appropriate standard of review.
November 09, 2023
Panel Affirms Disability Insurer’s Benefits Termination Was Arbitrary, Capricious

PHILADELPHIA — The Third Circuit U.S. Court of Appeals on Nov. 8 affirmed a district court’s ruling that a disability insurer acted arbitrarily and capriciously in terminating a disability claimant’s benefits because the insurer wrongfully reclassified the claimant’s occupation as an internal medical specialist after more than 10 years of correctly classifying the claimant’s occupation as a gastroenterologist.
November 09, 2023
Federal Magistrate Judge Strikes Filings Submitted By Disability Claimant

PORTLAND, Maine — A federal magistrate judge in Maine on Nov. 8 granted a disability insurer’s motion to strike two filings submitted by a disability claimant because the claimant did not seek leave of the court before submitting the filings, which were not permitted pursuant to the court’s scheduling order.
November 10, 2023
Panel Refuses To Review District Court Decision In Disability Benefits Dispute

PHILADELPHIA — While acknowledging that a district court’s appointment of an independent medical expert to examine a disability claimant suffering from fibromyalgia and rheumatoid arthritis is “highly unusual,” the Third Circuit U.S. Court of Appeals refused to grant a disability insurer’s petition for a writ of mandamus because the district court indicated that the purpose of the appointment is to reinforce the district court’s belief that remand of the claim is the appropriate form of relief.
November 10, 2023
Airline Pilot Files Complaint Seeking Disability Benefits For Long-Haul COVID-19

PHILADELPHIA — A disability insurer abused its discretion and breached its duty to a commercial airline pilot suffering from the effects of long-haul COVID-19 when it denied the pilot’s claim for long-term disability (LTD) benefits, the pilot claims in a complaint filed in Pennsylvania federal court.
November 09, 2023
Insured’s Disability Income Suit Barred By Policy’s Suit Limitations Provision

ATLANTA — A suit against a disability income insurer is barred by the policy’s three-year suit limitations provision because the insured failed to file the breach of contract and bad faith suit within three years of his claim for benefits being denied, the 11th Circuit U.S. Court of Appeals said in affirming a district court’s ruling.
November 09, 2023
Bad Faith Claim In Disability Suit Cannot Proceed, Judge Says

SAN DIEGO — A bad faith claim alleged against a disability insurer cannot proceed because the insured failed to show that the insurer acted unreasonably and because the insurer showed that a genuine issue of fact existed on the cause of the insured’s disability, a California federal judge said in partly granting the disability insurer’s motion for summary judgment.
November 08, 2023
Parties In Disability Suit Allowed To File Administrative Record Under Seal

CINCINNATI — An Ohio federal judge granted a joint motion to seal the administrative record in a disability benefits suit after determining that the protection of the disability claimant’s private health information outweighs the public’s interest in having access to the records and documents in the administrative record.
November 08, 2023
Magistrate Judge Recommends Disability Insurer’s Motion For Judgment Be Granted

CHATTANOOGA, Tenn. — A disability insurer’s termination of a claimant’s long-term disability (LTD) benefits was not arbitrary and capricious because the medical evidence supported the insurer’s termination of benefits and the insurer “provided a reasoned basis” for its termination, a Tennessee federal magistrate judge said in recommending that the insurer’s motion for judgment as a matter of law (JMOL) be granted and the claimant’s motion for JMOL be denied.
November 08, 2023
Disability Claimant Awarded $42K In Attorney Fees After 9th Circuit’s Remand

SEATTLE — A Washington federal judge determined that a disability claimant is entitled to $42,000 in attorney fees based on the fact that she achieved some success on the merits in her long-term disability (LTD) benefits suit, which was remanded by the Ninth Circuit U.S. Court of Appeals.
November 07, 2023
Disability Insurer’s Benefits Termination Was Not Arbitrary, Capricious, Judge Says

CHATTANOOGA, Tenn. — A disability claimant failed to show that a disability insurer’s reliance on the opinions of its staff physicians was arbitrary and capricious or that the insurer’s conflict of interest affected its decision to terminate the claimant’s benefits, a Tennessee federal judge said Nov. 6 in adopting a magistrate judge’s report and recommendation to grant the insurer’s motion for judgment on the administrative record.
October 18, 2023
Former NBA Player Alleges Disability Insurer Breached Contract, Acted In Bad Faith

CHARLOTTE, N.C. — A former National Basketball Association (NBA) player alleges in a complaint filed in North Carolina federal court that his disability insurer acted in bad faith and breached its contract by denying his disability benefits claim because he was rendered totally and permanently disabled by a diagnosis of myopericarditis, an inflammation of the lining of his heart, following two bouts with COVID-19.
October 10, 2023
5th Circuit Says Former NFL Player Not Entitled To Additional Disability Benefits

NEW ORLEANS — Even though the denial of a claim for additional disability benefits under the National Football League (NFL) plan seems “disturbing,” the Fifth Circuit U.S. Court of Appeals said reversal of a district court’s ruling in favor of an ex-NFL player must be reversed because the former player failed to show that he had any changed circumstances that would entitle him to additional disability benefits under the plan.
October 06, 2023
1st Circuit Panel Says Termination Of Disability Pension Benefits Was Reasonable

BOSTON — The First Circuit U.S. Court of Appeals affirmed a district court’s finding that the termination of disability pension benefits was reasonable because the pension plan made numerous attempts to verify the claimant’s contention that he did not engage in disqualifying employment while receiving the benefits.
October 06, 2023
New York Federal Judge Says Questions Of Fact Exist In Disability Benefits Suit

NEW YORK — A New York federal judge denied motions for summary judgment filed by a disability claimant and a disability insurer after determining that genuine disputes of material fact exist over the claimant’s job duties and the medical opinions regarding the claimant’s disabling conditions.
October 06, 2023
LTD Benefits Reinstated; Claimant Presented Evidence Supporting Disability

PORTLAND, Ore. — A disability claimant’s long-term disability (LTD) benefits were reinstated by an Oregon federal judge because the claimant presented the disability insurer with requested evidence that supports a finding that she was disabled from performing the duties of her occupation.
October 06, 2023
New York Federal Judge Transfers Disability Claimant’s Suit To Utah Federal Court

NEW YORK — A New York federal judge transferred a disability claimant’s wrongful denial of benefits suit to Utah federal court after determining that Utah is the more appropriate venue because the disability claimant and the claimant’s treating physicians are all located in Utah.
October 06, 2023
Disability Plan Is ERISA Plan; Safe Harbor Doesn’t Apply, Judge Rules

CLEVELAND — A disability plan is governed by the Employee Retirement Income Security Act, a federal judge in Ohio ruled, concluding that the plan did not fall under ERISA’s safe harbor exemption because the employer initially paid the plan premiums and those payments were not illusory despite the employer’s issuance of a Form 1099 to the disability claimant.
October 06, 2023
Fees Reduced, Costs Denied In ERISA Disability Case That Settled

MADISON, Wis. — A federal judge in Wisconsin reduced the attorney fees awarded to a disability claimant who sued to have her long-term disability benefits reinstated because the case settled before dispositive motions were filed and found that the issuer of the policy should not be responsible for increased costs resulting from the claimant’s “halting, piecemeal approach to recovering her attorney fees.”
October 04, 2023
Preexisting Conditions Exclusion Applies Based On Prior Treatment, Judge Says

ATLANTA — A disability insurer’s denial of a long-term disability (LTD) claim was reasonable because the policy’s preexisting conditions exclusion bars coverage, a Georgia federal judge said after determining that an actual diagnosis for a sickness for which the claimant was treated prior to becoming an insured under the disability plan is not required for the exclusion to apply.
October 04, 2023
Disability Claimant’s Suit Barred By Applicable Statute Of Limitations, Judge Says

PHOENIX — An Arizona federal judge terminated a disability claimant’s suit after determining that the claimant failed to file suit within three years as required by the policy or within six years as provided under Arizona law for contractual claims.
October 04, 2023
Disability Claimant’s Suit Dismissed Following Settlement Reached During Mediation

SAN FRANCISCO — A California federal judge dismissed a disability claimant’s suit seeking a declaration that she is entitled to long-term disability (LTD) benefits after the claimant and the disability insurer agreed to a settlement during a mediation proceeding.
October 03, 2023
Federal Magistrate Judge Awards Disability Claimant $42,851 In Attorney Fees

MADISON, Wis. — A Wisconsin federal magistrate judge awarded a disability claimant more than $42,000 in attorney fees after determining that a 40% overall reduction in the billed amount of fees was necessary despite the claimant’s success on the merits of his long-term disability (LTD) benefits claim.