Mealey's Disability Insurance
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July 14, 2022
Termination Of Benefits Supported By Substantial Evidence, Judge Says
LEXINGTON, Ky. — A disability claimant failed to show that she is disabled from working in any occupation, a Kentucky federal judge said July 12 in determining that the medical evidence shows that the claimant is capable of performing some gainful activity.
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July 14, 2022
Termination Of LTD Benefits Based On Policy Limitation Supported By Medical Evidence
NEW ORLEANS — A disability insurer’s termination of long-term disability (LTD) benefits based on the policy’s 12-month limitation for neuromuscular disorders was not arbitrary and capricious because the claimant failed to show that he suffered from a disability that was not subject to the policy’s limitation, a Louisiana federal judge said July 11 in granting the insurer’s motion for judgment on the administrative record.
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July 14, 2022
Transfer Of Disability Suit From New York To Virginia Federal Court Is Appropriate
NEW YORK — A disability claimant’s suit must be transferred to Virginia federal court because the convenience of the parties and witnesses weigh in favor of transferring the suit, a New York federal magistrate judge said July 12 in granting the disability insurer’s motion to transfer venue.
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July 08, 2022
Disability Insurer Properly Rescinded Policy Based On Insured’s Misrepresentations
CENTRAL ISLIP, N.Y. — A New York federal magistrate judge on June 30 recommended granting summary judgment in favor of a disability insurer after determining that the insurer properly rescinded a disability policy based on fraudulent and material misrepresentations made by the insured regarding a preexisting neck condition and that the insurer did not act in bad faith in handling the insured’s claim.
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July 08, 2022
Judge Adopts Recommendation To Grant Judgment In Favor Of Disability Insurer
TAMPA, Fla. — A Florida federal judge on June 23 adopted a magistrate judge’s report and recommendation to grant summary judgment in favor of a disability insurer, agreeing with the magistrate judge that the insurer’s decision to deny a claim for long-term disability (LTD) benefits and to terminate a claim for short-term disability (STD) benefits was not arbitrary and capricious and was supported by the evidence in the administrative record.
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July 08, 2022
Evidence Supports Finding That Disability Claimant Not Disabled From Any Occupation
GREEN BAY, Wis. — A disability insurer did not act arbitrarily and capriciously in terminating a claimant’s long-term disability benefits based on its determination that the claimant was no longer disabled from performing the duties of any occupation because the insurer’s termination was rational and supported by the evidence, a Wisconsin federal judge said June 27 in denying the claimant’s motion for summary judgment.
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July 07, 2022
Disability Insurer Agrees To Pay Claimant Benefits For Post-COVID Syndrome
LOS ANGELES — A disability insurer agreed to pay long-term disability benefits to a claimant suffering from post-COVID syndrome, according to a June 24 notice of settlement filed by the parties in California federal court.
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July 07, 2022
Disability Claimant’s Suit Dismissed For Failure To Show STD Benefits Owed
LOUISVILLE, Ky. — A Kentucky federal judge on June 21 denied a disability claimant’s motion for leave to file an amended complaint and granted the defendants’ motion to dismiss after determining that the claimant failed to offer any additional facts in support of her contention that she is owed short-term disability benefits.
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July 07, 2022
Bad Faith Claims Are Not Preempted By ERISA In Disability Suit, Judge Says
SIOUX FALLS, S.D. — A disability claimant’s bad faith and breach of contract allegations can proceed because the claims are not preempted by the Employee Retirement Income Security Act, a South Dakota federal judge said June 30 after determining that the employee’s plan at issue is not governed by ERISA.
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July 07, 2022
Disability Insurer, Claimant Submit Proposed Judgment In Favor Of Claimant
LOS ANGELES — Following a California federal judge’s May 20 ruling that a disability claimant is entitled to the reinstatement of long-term disability (LTD) benefits because the evidence shows that claimant cannot perform the duties of any occupation, the parties on July 1 submitted a proposed judgment with the disability insurer agreeing to pay more than $22,000 in retroactive disability benefits and agreeing to reinstate the claimant’s LTD benefits.
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July 01, 2022
Disability Claimant Failed To File Suit Within 3 Years As Required By Policy
FORT LAUDERDALE, Fla. — An insured’s breach of contract and bad faith suit arising out of the denial of a disability income claim must be dismissed because the insured failed to file the suit within three years as required by the policy’s suit limitations provision, a Florida federal judge said June 29 in granting the insurer’s motion to dismiss.
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June 24, 2022
Disability Insurer Did Not Abuse Discretion In Denying Benefits, 2nd Circuit Affirms
NEW YORK — A disability insurer did not abuse its discretion in finding that a claimant was not physically disabled from performing the duties of any occupation because substantial medical evidence supports the insurer’s decision and the insurer was not obligated to defer to the opinions of the claimant’s treating physician regarding her ability to work, the Second Circuit U.S. Court of Appeals said June 21.
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June 21, 2022
Disability Claimant’s Benefits Were Properly Offset, 6th Circuit Panel Determines
CINCINNATI — A district court did not err in determining that a disability insurer was permitted to offset a claimant’s long-term disability (LTD) benefits by the amount of Social Security disability benefits received because the plan clearly allowed the benefits to be offset, the Sixth Circuit U.S. Court of Appeals said June 7.
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June 16, 2022
5th Circuit Says Pre-Existing Condition Exclusion Properly Applied To LTD Claim
NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on June 15 affirmed a district court’s ruling that a disability insurer properly denied a claim for long-term disability (LTD) benefits based on the plan’s pre-existing condition exclusion and found no support for the claimant’s argument that the insurer waived its right to assert the pre-existing condition exclusion.
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June 14, 2022
Magistrate Judge Says Additional Discovery Not Warranted In Disability Suit
NEW YORK — A disability claimant is not entitled to seek discovery beyond the administrative record because the claimant failed to provide any support for the allegation that the disability insurer operated under a financial conflict of interest that influenced the denial of her claim for long-term disability benefits, a New York federal magistrate judge said June 10.
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June 14, 2022
Disability Claimant Failed To Satisfy 90-Day Elimination Period, Panel Says
SEATTLE — A district court did not err in granting judgment in favor of a disability insurer because the claimant failed to meet his burden of proving that he satisfied the disability policy’s 90-day elimination period, the Ninth Circuit U.S. Court of Appeals said June 13.
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June 10, 2022
Disability Income Insurer Did Not Breach Contract In Paying Partial Benefits
DETROIT — A disability income insurer did not breach its contract in determining that a disability claimant was entitled to partial disability benefits rather than total disability benefits because the policy’s terms regarding partial disability and total disability are not ambiguous, a Michigan federal judge said June 8 in granting the insurer’s motion for summary judgment.
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June 10, 2022
STD Plan Is Not Subject To ERISA; Complaint Must Be Dismissed, Judge Says
PORTLAND, Ore. — An Oregon federal judge on June 2 adopted a magistrate judge’s May 4 findings and recommendation, agreeing with the magistrate judge that a disability claimant’s suit must be dismissed because the court lacks jurisdiction as the short-term disability (STD) plan at issue is not governed by the Employee Retirement Income Security Act.
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June 10, 2022
Medical Evidence Supports Finding That Claimant Is Disabled From Any Occupation
BURLINGTON, Vt. — A Vermont federal judge on June 8 entered judgment in favor of a disability claimant after determining that overwhelming medical evidence supports a finding that the claimant remained disabled under the disability policy’s any-occupation standard.
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June 09, 2022
District Court Erred In Dismissing Disability Claimant’s Suit, Panel Says
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 failed to issue a final decision on the claim within 45 days as required under ERISA, the Second Circuit U.S. Court of Appeals said June 7 in reversing the lower court’s ruling.
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June 08, 2022
Arbitrary, Capricious Standard Of Review Applies In Disability Suit, Judge Says
CHICAGO — A disability insurer was properly granted with the discretionary authority to make claims determinations, and the policy’s discretionary authority provision is not void under Illinois law because Florida law governs the disability policy, an Illinois federal judge said June 1, agreeing with the insurer that an arbitrary and capricious standard of review must be applied in the benefits denial suit.
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June 08, 2022
Suit Dismissed; Disability Claimant Failed To Exhaust All Administrative Remedies
NEW YORK — A disability claimant’s first amended complaint must be dismissed because the claimant failed to exhaust all administrative remedies before filing suit and failed to show that exhaustion of all administrative remedies would be futile, a New York federal judge said June 3 in granting a disability insurer’s motion to dismiss.
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June 07, 2022
Reduction Of LTD Benefits Was Not Unreasonable, 2nd Circuit Panel Says
NEW YORK — A disability insurer’s reduction of long-term disability benefits was not unreasonable because the plan at issue allowed for a reduction in benefits if a claimant returned to work with limitations, the Second Circuit U.S. Court of Appeal said June 6.
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June 03, 2022
Disability Claimant Not Capable Of Working In Any Occupation, Panel Says
ATLANTA — A disability insurer’s termination of long-term disability (LTD) benefits was not reasonable because the disability claimant was not cognitively capable of performing the duties of any occupation based on the claimant’s pain and the side effects of her pain medication, the 11th Circuit U.S. Court of Appeals said June 1 in reversing a district court’s judgment in favor of the insurer.
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June 03, 2022
Former NFL Player Is Entitled To Total, Permanent Disability Benefits, Judge Says
SAN FRANCISCO — A former National Football League player is entitled to total and permanent disability benefits under the NFL player retirement plan, a California federal magistrate judge said June 1 after determining that the medical evidence supports a finding that the former player is unable to perform the duties of any occupation.