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

Mealey's Disability Insurance

March 31, 2022
Breach Of Contract Counterclaim Is Preempted By ERISA, Judge Says

CINCINNATI — A disability insurer’s breach of contract counterclaim arising out of a claimant’s refusal to reimburse the insurer for an overpayment of disability benefits is preempted under the Employee Retirement Income Security Act and must be dismissed, an Ohio federal judge said March 22 in granting the claimant’s motion to dismiss the counterclaim.
March 29, 2022
Denial Of LTD Benefits Was Not Arbitrary, Capricious, Utah Federal Judge Says

SALT LAKE CITY — A disability insurer did not act arbitrarily and capriciously in denying a claim for long-term disability (LTD) benefits because substantial medical evidence supports the insurer’s denial of benefits, a Utah federal judge said March 21 in granting the insurer’s motion for summary judgment.
March 29, 2022
Disability Insurer Breached Fiduciary Duty In Terminating Benefits, Claimant Says

NEW YORK — A disability insurer breached its fiduciary duty in terminating a disability claimant’s long-term disability (LTD) benefits based on its finding that the claimant failed to submit proof of a positive COVID-19 test or proof of COVID-19 antibodies because the insurer failed to request proof of a positive test or antibodies test when it initially approved the claimant’s LTD benefits for COVID-19 long hauler syndrome, the claimant alleges in a March 13 complaint filed in New York federal court.
March 28, 2022
Denial Of LTD Benefits Was Arbitrary, Capricious, Federal Judge Finds

MADISON, Wis. — A Wisconsin federal judge on March 24 granted a disability claimant’s motion for summary judgment and remanded the long-term disability (LTD) claim to the plan administrator after determining that the denial of benefits was not supported by the medical evidence and was arbitrary and capricious.
March 28, 2022
Denial Of LTD Claim Was Not Abuse Of Discretion, 9th Circuit Panel Says

PASADENA, Calif. — A disability plan administrator did not abuse its discretion in denying a claim for long-term disability (LTD) benefits because the medical records did not support a finding that the claimant was disabled from performing the duties of his own occupation or the duties of any occupation, the Ninth U.S. Circuit Court of Appeals said March 10.
March 16, 2022
Breach Of Contract, Bad Faith Claims Properly Dismissed Against Disability Insurer

NEW ORLEANS — A district court did not err in dismissing a disability claimant’s breach of contract and bad faith claims against a disability insurer because the claimant failed to offer sufficient facts in support of the breach of contract and bad faith claims, the Fifth Circuit U.S. Court of Appeals said March 15.
March 11, 2022
Medical Evidence Supports Disability Insurer’s Termination Of LTD Benefits

SACRAMENTO, Calif. — A California federal judge on Feb. 18 denied a disability claimant’s motion for judgment and granted a disability insurer’s motion for judgment after determining that the medical evidence supports the insurer’s termination of benefits based on the conclusion that the claimant was no longer disabled from performing the duties of his own occupation.
March 11, 2022
Disability Plan Did Not State Continued Social Security Benefits Were Necessary

CHICAGO — A disability plan’s termination of long-term disability (LTD) benefits was arbitrary and capricious because the plan did not state that continued Social Security Administration (SSA) disability benefits were necessary in order to continue to receive LTD benefits, an Illinois federal judge said Feb. 28 in granting the claimant’s motion for summary judgment.
March 11, 2022
Disability Benefits Owed Under Plan’s Own-Occupation Standard, Judge Says

SACRAMENTO, Calif. — A disability claimant is entitled to long-term disability (LTD) benefits for the full 24-month period permitted under the plan’s own-occupation standard because the claimant met his burden of proving by a preponderance of the evidence that he was disabled from performing the duties of his own occupation, a California federal judge said Feb. 15.
March 10, 2022
Denial Of LTD Benefits Was Arbitrary, Capricious, Federal Judge Determines

CHATANOOGA, Tenn. — A Tennessee federal judge on March 9 granted a disability claimant’s motion for judgment on the administrative record and remanded the claim to the plan administrator after determining that the disability insurer’s denial of long-term disability (LTD) benefits was arbitrary and capricious because the insurer disregarded the opinion of the claimant’s treating doctor who was the only physician to physically examine the claimant.
March 10, 2022
Administrative Record In Disability Suit To Be Filed Under Seal, Judge Says

SEATTLE — A Washington federal judge on March 9 granted a joint motion to seal the administrative record in a disability benefits suit after determining that protecting the disability claimant’s privacy interests outweighs any public interest in accessing the records.
March 09, 2022
Judge Says Jury Instruction On Disability Insurers’ Burden Of Proof Is Allowed

FORT MYERS, Fla. — A Florida federal judge on Feb. 23 granted a disability claimant’s motion to include a jury instruction stating that defendant disability insurers carry the burden of proving the claimant’s disability under Florida law because the insurers terminated the claimant’s benefits.
March 09, 2022
Medical Evidence Supports Finding That Disability Claimant Was Totally Disabled

CHICAGO — An Illinois federal judge on Feb. 16 granted a disability claimant’s motion for judgment on the administrative record after determining that the medical evidence and the claimant’s deteriorating health condition support a finding that the claimant was totally disabled from performing the duties of her occupation.
March 09, 2022
Judge Rejects Disability Insurer’s Objections To Inclusion Of Therapist’s Letter

CENTRAL ISLIP, N.Y. — Noting that a disability benefits suit has been going on for far too long, a New York federal judge on Feb. 17 denied a disability insurer’s objections to the inclusion in the record of a letter from a physical therapist who completed the claimant’s functional capacity evaluation and encouraged the parties to consider other approaches to bring the suit to finality.
March 07, 2022
Disability Claimant Met Burden Of Showing She Is Disabled From Own Occupation

NEW YORK — A disability claimant met her burden of proving by a preponderance of the evidence that she was disabled from performing the duties of her own occupation under the terms of a disability plan, a New York federal judge said March 3 after determining that subjective and objective medical evidence supports the claimant’s disability.
March 07, 2022
Administrative Record In Disability Benefits Suit To Be Sealed, Judge Says

CINCINNATI — An Ohio federal judge on March 4 granted a disability insurer’s unopposed motion to seal the administrative record after determining that the insurer met its burden of showing that protection of the claimant’s private health information outweighs any public interest in the disclosure of the information.
March 04, 2022
Disability Claimant Failed To Show That Termination Of Benefits Was Incorrect

CINCINNATI — A district court did not err in entering judgment in favor of a disability insurer because the disability claimant failed to show that the lower court erroneously found that the insurer’s termination of benefits was incorrect based on the evidence, the Sixth Circuit U.S. Court of Appeals said Feb. 22.
March 04, 2022
Change In Disability Benefits Was Not Arbitrary, Capricious, 6th Circuit Says

CINCINNATI — A district court did not err in finding that a disability plan and its administrator did not act arbitrarily and capriciously in determining that a plan participant was no longer totally disabled and, instead, only partially disabled because the medical evidence supports the plan’s decision, the Sixth Circuit U.S. Court of Appeals said Feb. 24.
February 22, 2022
District Court Erred In Awarding Disability Benefits, Panel Says In Remanding

NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on Feb. 18 vacated and remanded a district court’s award of almost $195,000 in disability benefits to a disability claimant after determining that the lower court should have remanded the claim to the plan administrator to determine the amount of benefits owed to the claimant.
February 22, 2022
High Court Denies Review Of Disability Claimant’s Petition On Choice Of Law

WASHINGTON, D.C. — The U.S. Supreme Court on Feb. 22 denied a disability claimant’s petition for writ of certiorari seeking a “uniform rule enforcing an ERISA plan’s choice of law” and a ruling that the Employee Retirement Income Security Act does not preempt state law prescribing de novo judicial review for challenged benefit determinations.
February 15, 2022
Question Of Fact Exists As To Disability Claimant’s Medical Specialty, Judge Says

SAN FRANCISCO — A California federal judge on Feb. 10 denied a disability claimant’s motion for summary judgment in a breach of contract and bad faith lawsuit after determining that a question of fact exists as to whether the claimant’s occupation was limited to that of a pediatric anesthesiologist.
February 10, 2022
Disability Claimant’s Suit Not Filed Within 3 Years As Required, Judge Determines

SAN FRANCISCO — A California federal judge on Jan. 12 dismissed a breach of contract and bad faith lawsuit filed against a disability insurer after determining that the claimant’s suit seeking disability benefits for pain following a voluntary bone marrow donation is untimely as it was not filed within three years as required by the policy.
February 10, 2022
Question Of Fact Exists As To Whether Disability Insurer Waived Payment Deadline

PHOENIX — An Arizona federal judge on Jan. 31 determined that questions of fact exists as to whether a disability income insurer waived its right to cancel an insured’s policy based on a late payment because a fact finder could find that the insurer’s prior acceptance of premium payments made after the 31-day grace period is evidence of the insurer’s waiver of the premium payment deadline.
February 10, 2022
Disability Insurers Did Not Act In Bad Faith In Denying LTD Claim

PHILADELPHIA — A Pennsylvania federal judge on Feb. 9 dismissed a bad faith claim alleged against two disability insurers after determining that the insurers had a reasonable basis to deny the insured’s claim for additional long-term disability (LTD) benefits.
February 09, 2022
Good Cause Exists To Extend Discovery Deadline In Disability Benefits Suit

ASHEVILLE, N.C. — A North Carolina federal judge on Feb. 8 granted a disability claimant’s request to extend a discovery deadline after determining that good cause exists for extending the deadline and allowing the disability insurer to respond to the claimant’s discovery requests.