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

Mealey's Disability Insurance

May 04, 2023
Claimant Is Entitled To LTD Benefits Under Any-Occupation Standard

SEATTLE — A Washington federal judge found that a disability claimant is entitled to long-term disability (LTD) benefits under a plan’s any-occupation standard because the claimant met her burden of showing that her frequents falls and the side effects from medications preclude her from working full time in a sedentary occupation.
May 03, 2023
De Novo Standard Of Review Applies In Disability Benefits Dispute, Judge Says

NEW YORK — A de novo standard of review applies in a disability benefits dispute because the disability claimant was deprived of a full and fair review under the Employee Retirement Income Security Act based on the disability insurer’s failure to have a medical doctor exam the claimant during an independent medical exam and based on the disability insurer’s failure to decide the claimant’s appeal within 45 days, a New York federal judge said.
May 02, 2023
3rd Circuit Affirms Judgment Against Retiree Who Sought Pension Payments

PHILADELPHIA — Affirming a decision against a retiree seeking pension payments, a Third Circuit U.S. Court of Appeals issued a not precedential per curiam disposition, ruling in part that a New Jersey federal court lacked subject-matter jurisdiction over what the lower court construed as claims asserted under the Employee Retirement Income Security Act and the Labor Management Relations Act (LMRA).
April 26, 2023
Disability Insurer’s Failure To Consider All Ailments Was Arbitrary, Capricious

CHICAGO — A disability insurer acted arbitrarily and capriciously in failing to consider a claimant’s cognitive and psychiatric impairments, an Illinois federal judge said in granting the claimant’s motion for summary judgment and remanding the claim to the plan administrator for further consideration.
April 25, 2023
Disability Claimant’s Benefits Properly Offset According To Plan’s Terms, Judge Says

GREENEVILLE, Tenn. — A disability insurer properly offset a claimant’s disability benefits by prorating the claimant’s lump-sum pension plan payment over a period of five years, a Tennessee federal judge said in finding that the offset was applied according to the terms of the disability plan’s provisions.
April 24, 2023
Stay Of Disability Suit To Allow Appeal Is Not Warranted, Judge Says

WILLIAMSPORT, Pa. — A Pennsylvania federal judge denied a disability insurer’s motion to stay proceedings in a suit pending in Pennsylvania federal court arising out of the insurer’s right to reimbursement from a claimant who recovered damages from a tortfeasor in an auto accident to allow the insurer to file an appeal in the Third Circuit U.S. Court of Appeals because the insurer failed to show that it would be prejudiced absent a stay and failed to make a strong showing that success on the merits is likely.
April 24, 2023
Disability Insurer’s Motion To Dismiss Must Be Granted, Florida Federal Judge Says

WEST PALM BEACH, Fla. — A Florida federal judge granted a disability insurer’s motion to dismiss an amended complaint, agreeing with the insurer that the relief sought by the claimant, which consists of a finding that she is entitled to an additional two years or more of disability benefits and an injunction prohibiting the insurer from contacting her for two years, is relief that is not afforded under the Employee Retirement Income Security Act.
April 21, 2023
Disability Insurer Is Owed Reimbursement; Breach Of Contract, Bad Faith Claims Fail

INDIANAPOLIS — The Indiana Court of Appeal affirmed a trial court’s ruling that a disability insurer did not breach its contract or act in bad faith and is entitled to reimbursement for the overpayment of long-term disability (LTD) benefits because the policy clearly stated that the insurer was entitled to seek reimbursement if an offset of benefits resulted in an overpayment.
April 18, 2023
Exhaustion Of Administrative Remedies Was Not Required Under Disability Plan

SAN FRANCISCO — A disability claimant’s wrongful denial of benefits suit can proceed because the disability plan defendants failed to show that the exhaustion of administrative remedies was required under the plan’s terms before the claimant could file suit, a California federal judge said in denying the plan defendants’ motion for summary judgment.
April 17, 2023
High Court Denies Review On Issue Of Limitations Provision In Disability Suit

WASHINGTON, D.C. — The U.S. Supreme Court on April 17 denied a disability claimant’s petition for writ of certiorari, refusing to review the 11th Circuit U.S. Court of Appeals’ ruling that a district court properly dismissed the claimant’s suit alleging that her long-term disability (LTD) benefits were wrongfully terminated based on the finding that the claimant failed to file her suit within three years as required by the policy’s three-year suit limitations provision and failed to show that she did not have actual notice of the limitations provision.
April 14, 2023
Additional Discovery On Social Security Disability Income Benefits Not Warranted

SACRAMENTO, Calif. — A disability insurer is not entitled to additional discovery regarding a dependent’s monthly Social Security disability payments because the disability claimant provided the insurer with documentation that she has only one dependent who is receiving Social Security benefits based on the claimant’s disability, a California federal judge said.
April 14, 2023
Disability Claimant Appeals Ruling On Reduction Of Disability Income Benefits

SAN FRANCISCO — A disability claimant filed a notice of appeal to the Ninth Circuit U.S. Court of Appeal, seeking review of a California federal judge’s decision to grant a disability income insurer’s motion for judgment on the pleadings based on a finding that the insurer correctly reduced the claimant’s disability income benefits according to the terms of the disability income policy.
April 11, 2023
8th Circuit Finds No Abuse Of Discretion In Disability Pension Ruling

ST. LOUIS — Finding no abuse of discretion, an Eighth Circuit U.S. Court of Appeals panel upheld a ruling against a claimant over disability pension benefits and a fiduciary duty claim — the former on alternative grounds rather than those on which the lower court relied.
April 05, 2023
Judge Denies Request To Refer Parties In Disability Suit To Mediation

BOSTON — A Massachusetts federal judge denied a disability insurer’s motion to refer the remaining issues in a disability benefits suit to mediation, noting in an electronic order that it is not the court’s general practice to force parties to mediation when one of the parties does not agree to mediation.
April 05, 2023
Bad Faith, Fraudulent Misrepresentation Claims Preempted By ERISA

SAN FRANCISCO — Bad faith and fraudulent misrepresentation claims alleged against a disability insurer are preempted by the Employee Retirement Income Security Act because the claims relate to an ERISA plan and the claimant can seek relief for the denial of her long-term disability (LTD) benefits claim under ERISA, a California federal judge said in granting the disability insurer’s motion to dismiss.
April 04, 2023
Breach Of Contract Suit Against Disability Income Insurer Is Time-Barred

FORT LAUDERDALE, Fla. — A disability claimant’s breach of contract suit against its disability income insurers is time-barred because the claimant failed to file suit within five years of the insurer determining that the claimant’s total disability benefits would be payable only through his 65th birthday and not through the remainder of the claimant’s life, a Florida federal judge said in granting the insurer’s motion for judgment on the pleadings.
April 04, 2023
Judge Says Disability Policy’s Mental Condition Limitation Not Exhausted

DETROIT — A disability insurer must continue to pay long-term disability (LTD) benefits to a plan participant until the disability policy’s 24-month maximum benefit duration for mental conditions is exhausted because the insurer failed to show that its initial award of benefits was for a mental disability, a Michigan federal judge said in partially rejecting a magistrate judge’s recommendation to grant judgment in favor of the disability insurer.
April 04, 2023
Disability Claimant’s Suit Time- Barred Per Plan’s Limitations Provision, Judge Says

PITTSBURGH — A disability claimant’s suit must be dismissed as time-barred because the claimant failed to file suit within the three-month limitations period as set forth in the disability plan and failed to demonstrate that extraordinary circumstances prevented filing the suit within the limitations period, a Pennsylvania federal judge said in granting the disability insurer’s motion to dismiss.
April 03, 2023
Preexisting Condition Exclusion Bars Coverage For LTD Claim, Judge Determines

WASHINGTON, D.C. — A disability insurer properly denied a claim for long-term disability (LTD) benefits because the policy’s preexisting condition exclusion applied even if the effective date of the policy was the date on which the claimant argued that the policy was effective, a District of Columbia federal judge said in granting judgment in favor of the disability insurer.
April 03, 2023
Disability Income Insurer Breached Contract In Terminating Benefits

OKLAHOMA CITY — An Oklahoma federal judge denied a disability income insurer’s motion for summary judgment on a breach of contract claim after determining that the insurer breached its contract in terminating a claimant’s residual disability benefits because the policy provided coverage for the claimant’s loss of income.
April 03, 2023
Disability Insurer’s Denial Of Own-Occupation LTD Benefits Was Reasonable

NEW YORK — The Second Circuit U.S. Court of Appeal affirmed a disability insurer’s denial of a claim for long-term disability (LTD) benefits after determining that the denial was reasonable based on the medical evidence and materials in the administrative record.
March 30, 2023
Termination Of LTD Benefits Was Not Arbitrary, Capricious, Judge Says

ORLANDO, Fla. — A disability insurer’s termination of long-term disability (LTD) benefits was not arbitrary or capricious because the disability claimant failed to offer any evidence showing that he was incapable of performing sedentary work as identified by the insurer, a Florida federal judge ruled in granting the insurer summary judgment.
March 30, 2023
Disability Insurer Must Provide Thorough Explanation For Termination Of Benefits

BOSTON — Although a disability insurer’s termination of long-term disability (LTD) benefits was not arbitrary and capricious, the insurer’s failure to provide a thorough explanation of its decision was unreasonable, a Massachusetts federal judge said in remanding the claim to the insurer to provide a thorough explanation for its finding that the claimant is capable of performing the duties of her own occupation as an attorney.
March 29, 2023
Disability Claimant’s Motion To Vacate Ruling On Bad Faith, Negligence Claims Denied

WASHINGTON, D.C. — A District of Columbia federal judge denied a disability claimant’s motion to vacate a prior opinion dismissing negligence and bad faith claims against a physician employed by a disability insurer because the claims are preempted by the Employee Retirement Income Security Act and the claimant failed to provide any legal authority supporting the contention that the bad faith claim should proceed.
March 15, 2023
Disability Insurer Did Not Breach Contract, Act In Bad Faith In Denying Claim

DENVER — A disability insurer did not breach its contract or act in bad faith in denying a claim for disability benefits because the claimant’s disability was excluded from coverage pursuant to a mental disorder rider included in the disability policies, a Colorado federal judge said in granting the insurer’s motion for summary judgment.