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

Mealey's Disability Insurance

October 18, 2021
Equitable Relief Claim Alleged Under ERISA Will Proceed, Judge Determines

SACRAMENTO, Calif. — A California federal judge on Oct. 7 denied a disability insurer’s motion to dismiss a portion of a claim seeking equitable relief under the Employee Retirement Income Security Act after determining that the disability claimant sufficiently stated facts in support of the claim.
October 08, 2021
Termination Of LTD Benefits Was Not Arbitrary, Capricious, Federal Judge Says

DETROIT — A Michigan federal judge on Sept. 29 denied a disability claimant’s motion for summary judgment and granted a disability insurer’s motion for summary judgment after determining that the disability insurer’s finding that the claimant was not disabled under the plan’s any-occupation standard was not arbitrary and capricious.
October 07, 2021
U.S. Secretary Of Labor Says Disability Insurer Failed To Issue Benefit Determination

NEW YORK — A district court erred in dismissing a disability claimant’s suit alleging that a disability insurer failed to exhaust all administrative remedies in violation of the Employee Retirement Income Security Act because the insurer’s decision to remand a claim to its claim department for reconsideration does not constitute a “benefit determination on review,” the U.S. Secretary of Labor says in an Oct. 5 amicus curiae brief filed in the Second Circuit U.S. Court of Appeals in support of the claimant’s appeal.
October 07, 2021
Disability Claimant’s Breach Of Contract Suit Is Untimely, Federal Judge Determines

PHILADELPHIA — A disability claimant’s breach of contract suit against a disability insurer must be dismissed because the claimant failed to file the suit within the applicable four-year statute of limitations or within the three years provided for in the policy’s suit limitation provision, a Pennsylvania federal judge said Oct. 4.
October 06, 2021
5th Circuit Panel Reverses, Remands Ruling On Any-Occupation Benefits

NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on Oct. 5 reversed a district court’s ruling that a disability insurer waived its right to contest an award of disability benefits under the plan’s any-occupation standard because the insurer’s determination that the claimant’s disability was subject to a plan limitation made an analysis of whether any-occupation benefits were owed unnecessary.
October 06, 2021
Disability Insurer Did Not Act Arbitrarily, Capriciously In Calculating Benefits

COLUMBUS, Ohio — A disability insurer did not act arbitrarily and capriciously in calculating a claimant’s disability benefits because the insurer followed the disability plan’s terms and provisions in calculating the claimant’s benefits, an Ohio federal judge said Sept. 24.
October 06, 2021
Disability Claimant Failed To Show Benefits Owed Under Any-Occupation Standard

ALBUQUERQUE, N.M. — A disability claimant failed to show by a preponderance of the evidence that he is owed disability benefits under a plan’s any-occupation standard, a New Mexico federal judge said Sept. 22 in granting the disability insurer’s motion for judgment on the administrative record.
October 05, 2021
Termination Of Disability Benefits Was Abuse Of Discretion, Judge Says

JACKSON, Miss. — A Mississippi federal judge on Sept. 30 granted a disability claimant’s motion for summary judgment after determining that the disability insurer abused its discretion in terminating a claimant’s benefits because the insurer failed to consider the material and substantial duties of the claimant’s actual occupation of a legal secretary.
October 05, 2021
Attorney Fees Not Warranted; Disability Claimant Failed To Show Success On Merits

SAN JOSE, Calif. — A California federal judge on Sept. 30 denied a disability claimant’s motion for attorney fees because the claimant failed to show that his lawsuit, filed before the disability insurer made a decision on the claimant’s appeal, was a contributing factor in the disability insurer’s decision to reinstate his disability benefits.
October 04, 2021
Federal Judge Puts An End To Overlitigated Insurance Fraud Dispute

NEW YORK — A federal judge in New York on Sept. 29 accepted a federal magistrate judge’s report and recommendation and issued an order granting declaratory judgment in favor of a disability income insurer in an insurance fraud dispute, ruling that “[e]nough ink has been spilled, effort expended, and resources consumed” in the litigation.
October 04, 2021
NFL Player’s ERISA Claims Are Time-Barred, 2nd Circuit Says In Affirming Dismissal

NEW YORK — The Second Circuit U.S. Court of Appeals on Oct. 1 affirmed a trial court’s ruling that a National Football League (NFL) player’s claims alleging violations of the Employee Retirement Income Security Act are time-barred because the player knew in 2000, the year he applied for disability benefits, that the plan failed to provide him with a copy of the summary plan description (SPD).
October 04, 2021
Disability Insurer’s Denial Of Claim Was Reasonable, Federal Judge Determines

MIAMI — A Florida federal judge on Sept. 22 granted a disability insurer’s motion for summary judgment, finding that the insurer reasonably denied the insured’s anxiety and depression disability claim and that the insured failed to provide records from a treating psychologist or psychiatrist to make a showing of disability under the plan.
September 27, 2021
Termination Of LTD Benefits Reasonable Based On Self-Reported Symptom Provision

BOSTON — A disability insurer’s termination of long-term disability (LTD) benefits based on the plan’s self-reported symptom limitation provision was not arbitrary and capricious, the First Circuit U.S. Court of Appeals said Sept. 22, noting that it also was reasonable for the insurer to require the claimant to provide objective evidence of her functional limitations.
September 21, 2021
Judge Grants Insurer’s Motion To Exclude In Row Over Policy Application Questions

FORT MYERS, Fla. — An expert retained by a doctor arguing that his insurer erroneously rescinded his disability policy cannot testify, a Florida federal judge ruled Sept. 17, agreeing with the insurer that his testimony constitutes improper legal conclusions.
September 16, 2021
Disability Claimant Alleges Benefits Wrongfully Terminated By Insurer, Reinsurer

CAMDEN, N.J. — A disability insurer and reinsurer wrongfully terminated a claimant’s long-term disability (LTD) benefits after determining that the claimant was capable of returning to work in his own occupation, a claimant alleges in a Sept. 8 complaint filed in New Jersey federal court.
September 09, 2021
Disability Claimant Alleges He Was Denied Full, Fair Review Of STD Claim

MEMPHIS, Tenn. — A disability claimant alleges in a Sept. 7 complaint that he was denied a full and fair review of his short-term disability benefits claim under Employee Retirement Income Security Act because the claims administrator refused to provide him with additional time to file an appeal despite the U.S. Department of Labor’s emergency regulation, issued in response to the COVID-19 pandemic, which extended the amount of time to appeal an adverse benefits decision.
September 09, 2021
Federal Judge Partially Grants Judgment In Favor Of Disability Claimant

SAN JOSE, Calif. — A California federal judge on Sept. 7 partially granted a disability claimant’s motion for judgment on the administrative record after determining that the claimant proved by a preponderance of the evidence that she was disabled for a period of time from performing the duties of her own occupation.
September 08, 2021
Denial Of Disability Benefits Was Not Arbitrary, Capricious, Panel Says In Affirming

CINCINNATI — A disability plan’s denial of disability benefits was not arbitrary and capricious because the plan’s denial was reasonable based on the available medical evidence, the Sixth Circuit U.S. Court of Appeals said Sept. 3 in affirming a district court’s ruling in favor of the plan.
September 07, 2021
District Court Properly Applied Arbitrary, Capricious Standard Of Review

NEW YORK — The Second Circuit U.S. Court of Appeals on Aug. 12 affirmed a district court’s ruling in favor of a disability insurer after determining that the lower court properly applied an arbitrary and capricious standard of review because California’s law banning the inclusion of discretionary authority provisions does not apply as the claimant is a resident of New York and not California.
September 02, 2021
Disability Insurer’s Termination Of Benefits Was Reasonable, Judge Says

UTICA, N.Y. — A disability insurer’s decision to terminate a claimant’s long-term disability benefits based on its finding that the claimant was capable of performing the duties of his own occupation was reasonable and supported by substantial evidence, a New York federal judge said Sept. 1 in entering judgment for the disability insurer.
September 02, 2021
Disability Claimant Is Not Entitled To Jury Trial, 10th Circuit Panel Says

DENVER — The 10th Circuit U.S. Court of Appeals on Sept. 1 affirmed a district court’s ruling in favor of a disability insurer and rejected the disability claimant’s argument that a jury trial on the insurer’s denial of benefits decision is warranted.
September 02, 2021
Disability Claimant Says Class Certification Appropriate In Subrogation Dispute

WILLIAMSPORT, Pa. — Class certification is appropriate in a disability benefits dispute over a disability insurer’s right to reimbursement following a claimant recovery of damages from a tortfeasor in an auto accident because the insurer engaged in a common course of conduct in seeking reimbursement from insureds, a disability claimant says in an Aug. 30 brief in support of her motion for class certification.
September 01, 2021
In Camera Inspection Of Administrative Record Is Necessary, Judge Says

SEATTLE — A Washington federal judge on Aug. 30 determined that it is necessary to conduct an in camera inspection of the administrative record in a disability benefits suit before ruling on the parties’ stipulated motion to seal the administrative record.
August 31, 2021
Disability Claimant Says Disability Insurers Breached Contracts, Acted In Bad Faith

SAN FRANCISCO — A disability claimant on Aug. 13 filed suit in California federal court against a group disability insurer and an individual disability income insurer, alleging that the insurers breached their contracts and acted in bad faith in terminating the claimant’s disability benefits.
August 27, 2021
Disability Claimant Is Entitled To Attorney Fees, Costs, Federal Judge Determines

ALBUQUERQUE, N.M. — A New Mexico federal judge on Aug. 25 granted a disability claimant’s motion for attorney fees after determining that the claimant achieved some success on the merits and awarded the claimant more than $47,000 in attorney fees and cost.