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

Mealey's Disability Insurance

July 07, 2023
Denial Of LTD Claim ‘Supported By Substantial Evidence,’ Panel Says

DENVER — A disability insurer’s denial of a long-term disability (LTD) benefits claim was not arbitrary and capricious because the insurer’s decision that the claimant was not disabled from performing the duties of her own occupation was “reasonable and supported by substantial evidence,” the 10th Circuit U.S. Court of Appeals said in affirming a district court’s ruling.
July 07, 2023
Bad Faith Claim In Disability Suit Proceeds; Emotional Distress Claim Dismissed

CAMDEN, N.J. — A New Jersey federal judge on July 6 determined that a disability claimant’s bad faith claim can proceed because the claimant sufficiently stated facts in support of the claim but a claim for intentional and negligent infliction of emotional distress cannot proceed because the claimant failed to show that the disability insurer’s conduct caused her to suffer emotional distress.
July 06, 2023
Termination Of LTD Benefits Was Result Of Deliberate Reasoning Process

CINCINNATI — The termination of a claimant’s long-term disability (LTD) benefits claim was not arbitrary and capricious under New York law because the record supported the denial of benefits and the third-party claims administrator’s decision was the result of a deliberate and principled reasoning process, the Sixth Circuit U.S. Court of Appeals said in affirming a district court’s judgment.
July 06, 2023
Evidence Supports Finding That Claimant Not Disabled From Working In Own Occupation

CHICAGO — A disability insurer’s denial of a long-term disability (LTD) benefits claim was not arbitrary and capricious because the evidence in the administrative record supports the insurer’s conclusion that the claimant was not disabled from performing the duties of her own occupation, an Illinois federal judge said in granted the insurer’s motion for summary judgment.
July 06, 2023
Question Of Fact Exists As To Whether Payments Were Disability Or Workers’ Comp

WASHINGTON, D.C. — A district court erred in granting summary judgment in favor of an employer in a dispute over whether an injured employee’s wages were properly reported as disability payments, which are taxable income, on W-2s filed with the Internal Revenue Service as opposed to workers’ compensation payments, which are nontaxable income, because a question of fact exists regarding what type of payments the employee received, the District of Columbia Circuit U.S. Court of Appeals said in reversing and remanding.
July 06, 2023
Panel Remands Disability Claimant’s Suit On Issue Of Bonus Calculation

SEATTLE — The Ninth Circuit U.S. Court of Appeals remanded a disability claimant’s suit to a district court to allow the court to determine if the claimant’s trimester bonuses should have been pro-rated over the applicable months as part of her benefits calculation.
July 06, 2023
Disability Insurer Did Not Abuse Discretion In Terminating LTD Benefits

RICHMOND, Va. — A disability insurer did not abuse its discretion in terminating a claimant’s long-term disability (LTD) benefits because the insurer’s decision to terminate the benefits was reasonable and based on substantial evidence, the Fourth Circuit U.S. Court of Appeals said in affirming a district court’s decision.
June 23, 2023
Disability Income Insurer Did Not Breach Contract, Act In Bad Faith, Judge Says

TRENTON, N.J. — A disability income insurer did not breach its contract or act in bad faith in denying an insured ophthalmologist’s claim for total disability benefits because the insured’s inability to perform surgery does not render him totally disabled in his occupation as he is still able to see patients, a New Jersey federal judge said in granting the insurer’s motion for summary judgment and denying the insured’s motion for summary judgment.
June 21, 2023
Disability Benefits Suit Transferred To Connecticut Federal Court

SAN FRANCISCO — A disability benefits suit filed by the trustee of the plan participant’s estate must be transferred to Connecticut federal court because Connecticut has a greater interest in the dispute as the plan participant received his medical treatment and plan benefits in Connecticut for 27 years, a California federal judge said in granting the disability plan defendants’ motion to transfer venue.
June 09, 2023
9th Circuit Partly Reverses Dismissal Of Disability Claims Against Insurers

SAN FRANCISCO — A Ninth Circuit U.S. Court of Appeals panel reversed in part and affirmed in part a California federal judge’s grant of summary judgment against an insured who accused two insurers of breach of contract and violation of California’s unfair competition law (UCL) for refusing to find her totally disabled since 1989 when she developed carpal tunnel syndrome and left her primary career, based on a claim she filed in 2020 after leaving a secondary job due to COVID-19-related health concerns.
June 09, 2023
Termination Of LTD Benefits Supported By Medical Evidence, Judge Says

BIRMINGHAM, Ala. — A disability insurer’s termination of benefits was not de novo wrong because the medical evidence supports the insurer’s finding that the claimant is capable of working in a sedentary occupation, an Alabama federal judge said in granting the insurer’s motion for judgment on the administrative record.
June 09, 2023
Denial Of LTD Claim Was Not Arbitrary, Capricious, Wisconsin Federal Judge Says

MILWAUKEE — A disability claimant failed to show that a disability insurer’s denial of a claim for long-term disability (LTD) benefits was not arbitrary and capricious because the record supports a finding that the claimant could perform the duties of his occupation in the national economy even if he was unable to perform the duties of that occupation with his current employer, a Wisconsin federal judge said in granting the disability insurer’s motion for summary judgment.
June 09, 2023
Disability Claimant’s Interpretation Of Plan Requirement Is More Reasonable

NEW YORK — A New York federal judge determined that a disability claimant’s interpretation of a plan’s monthly income loss requirement is more reasonable than the disability insurer’s interpretation and must be applied to calculate the claimant’s long-term disability (LTD) benefits.
June 06, 2023
Claimant Failed To Show She Was Continuously Disabled During Elimination Period

CINCINNATI — A district court did not err in finding that a disability claimant is not entitled to long-term disability (LTD) benefits because the claimant failed to prove that she was continuously disabled throughout the plan’s six-month elimination period, the Sixth Circuit U.S. Court of Appeal said in affirming the lower court’s ruling.
June 06, 2023
Breach Of Fiduciary Duty Claim Against Disability Insurer Not Foreclosed

PASADENA, Calif. — A district court erred in entering judgment in favor of a disability insurer on a breach of fiduciary duty claim because the insurer was acting in a fiduciary function when it miscalculated the claimant’s long-term disability benefits, resulting in a more than $56,000 overpayment to the claimant, the Ninth Circuit U.S. Court of Appeals said in reversing the district court’s judgment.
June 06, 2023
Former NFL Player Alleges NFL Disability Plan Breached Fiduciary Duty

WEST PALM BEACH, Fla. — A former National Football League player alleges in a complaint filed in Florida federal court that the NFL’s disability plan breached its fiduciary duty by failing to consider the former player’s claim for total and permanent disability benefits and by concealing that the player was eligible for the benefits when he submitted an application for disability benefits in 2006.
June 06, 2023
STD Benefits Owed Under Company’s Self-Funded Plan, Disability Claimant Says

CHARLOTTE, N.C. — The denial of a claim for short-term disability (STD) benefits under an employer’s self-funded disability plan was an abuse of discretion, a disability claimant says in a complaint filed in North Carolina federal court seeking a finding that benefits are owed.
June 06, 2023
Disability Claimant Alleges STD Benefits Were Wrongfully Terminated By Plan Insurer

COLUMBUS, Ohio — A disability claimant filed suit in Ohio federal court against his former employer, a disability plan and the plan’s insurer, asking the court to find that the insurer wrongfully terminated his short-term disability (STD) benefits and that he continues to be entitled to STD benefits and long-term disability (LTD) benefits.
May 25, 2023
Disability Claimant Alleges Insurer Violated ERISA, Wrongfully Denied Claim

NEWARK, N.J. — A disability claimant alleges in a complaint filed in New Jersey federal court that a disability insurer wrongfully denied her claim for long-term disability (LTD) benefits and then, violated the requirements of the Employee Retirement Income Security Act by failing to issue a decision on her second-level administrative appeal within 45 days.
May 25, 2023
Disability Suit Not Timely Filed Under Policy’s Suit Limitations Clause, Judge Says

HARRISBURG, Pa. — A Pennsylvania federal judge dismissed a disability claimant’s suit after determining that the suit is time-barred based on the claimant’s failure to file suit within three years of submitting a proof of loss for her disability claim as required by the disability policy.
May 22, 2023
District Court Did Not Err In Finding Disability Plan Misapplied Plan Exclusion

CINCINNATI — A district court did not err in finding that a disability plan misapplied the plan’s mental health exclusion because the claimant was never diagnosed with chronic pain syndrome as required for the exclusion to apply, a panel majority of the Sixth Circuit U.S. Court of Appeals said May 19 in affirming judgment for the claimant.
May 16, 2023
Judgment Properly Entered For Disability Plan, 9th Circuit Panel Determines

SAN FRANCISCO — A district court did not err in granting judgment in favor of a disability plan and against a disability claimant because the claimant failed to show that he is unable to perform the duties of any occupation and the plan identified at least one sedentary occupation that the claimant could become qualified to perform even with his current physical restrictions, the Ninth Circuit U.S. Court of Appeals said.
May 12, 2023
Disability Claimant Is Not Entitled To Information Related To Claims Evaluations

NASHVILLE, Tenn. — A disability claimant is not entitled to information related to long-term disability (LTD) claims evaluated by the same reviewers who evaluated her claim because producing the information would be burdensome to the disability insurer, a Tennessee federal magistrate judge said.
May 12, 2023
Florida Federal Magistrate Judge Denies Disability Claimant’s Motion To Seal

OCALA, Fla. — A Florida federal magistrate judge denied a disability claimant’s motion to seal his complaint after determining that the claimant failed to offer a compelling reason for sealing the complaint.
May 10, 2023
Disability Benefits Suit Dismissed Following Parties’ Notification Of Settlement

SEATTLE — A Washington federal judge on May 9 dismissed a disability suit alleging that a disability insurer breached its contract and acted in bad faith by failing to properly calculate the amount of residual disability benefits available under two long-term disability policies a day after the parties notified the court that they reached a settlement.