Mealey's Disability Insurance
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March 14, 2023
Breach Of Fiduciary Duty Claim Against Disability Insurer Fails As A Matter Of Law
ST. LOUIS — A breach of fiduciary duty claim cannot proceed against a disability insurer because the claimant failed to rely upon the regulations that were in effect at the time he filed his claim for disability benefits, a Missouri federal judge said in determining that the claim fails as a matter of law.
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March 10, 2023
LTD Claim Remanded For Finding On Whether Continued Benefits Are Owed
CHICAGO — An Illinois federal judge granted a disability claimant’s motion for summary judgment and remanded the long-term disability (LTD) claim to the plan administrator to determine if the claimant is eligible for continued LTD benefits based on her medical conditions and despite the fact that the claimant did not meet the plan’s deadline to apply for Social Security Disability Income benefits.
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March 09, 2023
Former NFL Player’s Claims In Disability Suit Must Be Dismissed, Judge Says
DETROIT — A Michigan federal judge determined that a former National Football League (NFL) player cannot maintain a claim seeking disability benefits under the NFL disability plan or a breach of fiduciary duty claim against the plan and other NFL entities because the player’s claim for disability benefits was not timely filed and the player failed to plausibly state a claim for breach of fiduciary duty against any of the defendants.
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March 09, 2023
Dentist Appeals Breach Of Contract, Bad Faith Ruling In Disability Income Suit
SAN FRANCISCO — A dentist filed a notice of appeal to the Ninth Circuit U.S. Court of Appeals, seeking review of a district court’s ruling that a disability insurer did not breach its contract or act in bad faith in terminating the dentist’s disability income benefits because the dentist was not under the care of a doctor as required by the policy at issue.
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March 08, 2023
Disability Suit Barred By Release Signed With Employer, New York Federal Judge Says
NEW YORK — A disability claimant’s suit against a disability insurer is barred by a separation agreement the claimant signed with her former employer because the agreement clearly barred the claimant from filing any claims under the Employee Retirement Income Security Act, a New York federal judge said in granting the disability insurer’s motion for summary judgment.
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March 08, 2023
Federal Judge Grants Summary Judgment In Favor Of Disability Insurer
WASHINGTON, D.C. — A District of Columbia federal judge adopted a magistrate judge’s recommendation to grant summary judgment in favor of a disability insurer, agreeing with the magistrate judge’s conclusion that no reasonable fact finder could return a verdict in favor of the disability claimant.
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March 08, 2023
STD, LTD Benefits Claims Cannot Proceed Against Insurer, Judge Concludes
SANTA ANA, Calif. — Following a one-day bench trial in a disability benefits dispute, a California federal judge determined that claims for short-term disability (STD) and long-term disability (LTD) benefits cannot proceed because the disability insurer was not responsible for paying STD benefit claims under the employer’s self-insured plan and because the disability claimant failed to exhaust all administrative remedies in connection with the LTD benefits claim.
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March 08, 2023
Disability Insurer Acted Arbitrarily, Capriciously In Terminating LTD Benefits
CINCINNATI — A disability insurer acted arbitrarily and capriciously in terminating a disability claimant’s benefits because the insurer failed to consider credible and objective evidence provided by the claimant in support of his disability, an Ohio federal judge said in granting the claimant’s motion for judgment on the administrative record.
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March 07, 2023
Termination Of Disability Benefits Was Arbitrary, Capricious, Judge Says
BOSTON — A disability insurer’s denial of a claimant’s request for an independent medical exam rendered the insurer’s termination of benefits arbitrary and capricious, a Massachusetts federal judge said in denying the insurer’s motion for summary judgment and in remanding the claim to the insurer for further proceedings.
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March 06, 2023
Summary Plan Description In Disability Policy Was Deficient, Judge Says
BATON ROUGE, La. — A Louisiana federal judge found that a summary plan description (SPD) in a disability policy was deficient because the lookback provision in the policy’s preexisting condition exclusion was not included in the SPD and further said that a question of fact exists as to whether the claimant’s long-term disability (LTD) benefits claim would have been approved without applying the lookback provision.
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March 02, 2023
Disability Claimant’s Suit Transferred From New York To Rhode Island Federal Court
NEW YORK — A New York federal judge determined that a disability claimant’s suit must be transferred to Rhode Island federal court because the alleged breach of the disability policy occurred in Rhode Island and all of the potential witnesses are located in Rhode Island.
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March 01, 2023
2nd Circuit Affirms Ruling, Standard Of Review In Disability Pension Case
NEW YORK — In a summary order, a Second Circuit U.S. Court of Appeals panel affirmed a ruling against a beneficiary in a pension disability case involving interpretation of the phrase “secure gainful employment.”
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February 10, 2023
Bad Faith Claim Properly Dismissed; Disability Insurer’s Decision Was Arguable
ATLANTA — The 11th Circuit U.S. Court of Appeals affirmed a district court’s grant of summary judgment on a bad faith claim in a disability benefits dispute after determining that the disability insurer did not act in bad faith because it had an arguable reason to terminate the claimant’s long-term disability benefits.
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February 10, 2023
Adequate Remedy Provided Under Claim For Wrongful Denial Of Benefits, Judge Says
WINSTON-SALEM, N.C. — A disability plan participant’s claims for breach of fiduciary duty and breach of claims procedures are duplicative of the participant’s claim for wrongful denial of benefits and must be dismissed, a North Carolina federal judge said in granted the disability insurer’s motion to dismiss.
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February 09, 2023
Termination Of LTD Benefits Not Abuse Of Discretion, Judge Says
MINNEAPOLIS — A disability insurer did not abuse its discretion in terminating a claimant’s benefits because the termination of benefits was reasonable based on the substantial medical evidence in support of the insurer’s decision, a Minnesota federal judge said.
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February 09, 2023
Only Unredacted Portions Of Administrative Record In Disability Suit Will Be Sealed
PORTLAND, Maine — A Maine federal judge determined that the interest of the public outweighs a disability insurer’s burden of redacting personally identifiable information from the administrative record and said that only the unredacted portions of the administrative record will be sealed.
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February 08, 2023
Disability Claimant Failed To Show Bone Marrow Program Acted As Agent For Insurer
SAN FRANCISCO — A California federal judge granted a disability insurer’s motion to dismiss a breach of contract and bad faith lawsuit and ordered that the claimant’s suit be closed after determining that the claimant, who sought disability benefits under a policy issued to a bone marrow donor program, failed to show in a second amended complaint that the program was acting as an agent for the disability insurer when his claim for benefits was denied.
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February 08, 2023
Termination Of LTD Benefits Was Arbitrary, Capricious, Magistrate Judge Says
JACKSONVILLE, Fla. — A Florida federal magistrate judge recommended denying a long-term disability (LTD) insurer’s motion for summary judgment and granting the disability claimant’s motion for summary judgment after determining that the insurer’s termination of benefits was arbitrary and capricious based on inconsistencies in the insurer’s benefit termination letters.
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February 08, 2023
No Coverage Owed For Medical Practices’ Expenses Under Disability Policies
NEW YORK — A neurosurgeon’s claim for coverage under disability policies that provided overhead expenses coverage for his medical practices fails because the insured’s businesses were not in “continued operation,” as required by the policies at issue, when the claim for coverage was filed, a New York federal judge said in granting the insurer’s motion for summary judgment.
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February 07, 2023
Doctrine Of Issue Preclusion Bars ERISA Claims Under Group Policy, Judge Says
FORT MYERS, Fla. — A Florida federal judge determined that summary judgment in favor of disability insurers is warranted because the doctrine of issue preclusion bars the claimant from arguing that he remains disabled under a group disability policy based on a jury’s verdict on the claimant’s state law claims brought against the same insurers who also issued individual disability policies.
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February 07, 2023
District Court Properly Denied Disability Claimant’s Motion To Reopen Case
RICHMOND, Va. — A district court did not abuse its discretion in denying a disability claimant’s motion to reopen his suit following a settlement because the claimant failed to provide any justification for not filing the motion to reopen within 60 days after the settlement was reached as required, the Fourth Circuit U.S. Court of Appeals said.
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February 02, 2023
Termination Of LTD Benefits Claim Was Not Arbitrary, Capricious, Panel Says
PHILADELPHIA — A district court correctly found that a disability insurer’s termination of a long-term disability (LTD) benefits claim was not arbitrary and capricious because the insurer’s decision was supported by ample evidence in the record, the Third Circuit U.S. Court of Appeals said in affirming the district court’s ruling.
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February 01, 2023
Breach Of Contract Claim Fails; Bad Faith Claim Survives In Disability Suit
COLUMBUS, Ohio — An Ohio federal judge denied a disability claimant’s motion for summary judgment on a breach of contract claim after determining that the complaint fails to state a claim for breach of contract; however, the judge found that the claimant’s bad faith claim related to the appeal of the benefits termination can proceed because the insurer’s failure to follow its policy requirements could support a claim for bad faith.
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January 31, 2023
District Court Properly Found LTD Benefits, Attorney Fees Owed, 9th Circuit Says
SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals affirmed a district court’s rulings that a disability claimant is owed long-term disability (LTD) benefits as an eligible employee under the disability plan and is entitled to an award of attorney fees based on her success on the merits.
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January 26, 2023
Breach Of Fiduciary Claims Dismissed In Disability Benefits Suit
WEST PALM BEACH, Fla. — Breach of fiduciary claims against various employees of a disability insurer and an employer’s human resources director cannot proceed because the claims stem from the wrongful denial of benefits, a Florida federal judge said in noting that the claimant is provided relief wrongful denial of benefits under the Employee Retirement Income Security Act.