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

Mealey's Disability Insurance

August 08, 2024
LTD Insurer’s Denial Of Benefits Was Not Abuse Of Discretion, Judge Says

PHILADELPHIA — A long-term disability (LTD) insurer did not abuse its discretion in denying a claim for LTD benefits because the claimant did not suffer any lost income based on the employer’s decision to continue paying the employee after he stopped working, a Pennsylvania federal judge said Aug. 7 in granting the insurer’s motion for summary judgment.
August 07, 2024
District Court Erred In Finding Disability Plan Abused Its Discretion, Panel Says

PHILADELPHIA — A district court erred in finding that a disability plan abused its discretion when it terminated a claimant’s long-term disability (LTD) benefits for failure to provide proof of a continued disability because the plan properly considered all of the medical evidence and properly interpreted the plan’s “own occupation” language, the Third Circuit U.S. Court of Appeals said Aug. 6 in vacating and remanding the district court’s opinion.
August 06, 2024
Disability Claimant Says Award Of Benefits, Not Remand, Is Appropriate Remedy

BALTIMORE — Reconsideration of a Maryland federal judge’s decision to remand a long-term disability (LTD) benefits claim is warranted because an award of benefits, rather than remand of the claim, is the appropriate form of relief, a disability claimant says in a reply brief in support of her motion for partial reconsideration of the judge’s ruling.
August 06, 2024
Former NFL Player’s Motion To Reinstate Appeal Over Disability Benefits Granted

ATLANTA — The 11th Circuit U.S. Court of Appeals on Aug. 5 granted a former National Football League player’s motion to reinstate his appeal in a dispute over additional disability benefits owed under the NFL’s disability plan.
August 06, 2024
Disability Insurer’s Denial Of LTD Claim Was Not De Novo Wrong, Judge Says

FORT MYERS, Fla. — A disability insurer’s denial of a long-term disability (LTD) claim was not de novo wrong because its decision is supported by the evidence in the administrative record and the claimant failed to provide any evidence to rebut the insurer’s basis for denial, a Florida federal judge said in granting the insurer’s motion for summary judgment.
August 06, 2024
Denial Of STD Claim Reasonable Based On Lack Of Evidence, Federal Judge Says

BIRMINGHAM, Ala. — The denial of a short-term disability (STD) benefits claim following a treating physician’s failure to respond to the STD claims administrator’s repeated requests regarding the claimant’s medical condition and the claimant’s ability to return to work was reasonable and not wrong, an Alabama federal judge said in granting the disability plan defendants’ motion for summary judgment and in denying the claimant’s motion for summary judgment.
August 05, 2024
Disability Claimant’s Suit Dismissed For Failure To Name Proper Defendant

SAN JUAN, Puerto Rico — A disability claimant’s suit against her former employer and disability plan administrator must be dismissed because the defendants are not the proper defendants as neither of the named defendants was responsible for making disability claims decisions under the short-term disability (STD) plan, a Puerto Rico federal judge said Aug. 2 in granting the defendants’ motion to dismiss.
August 02, 2024
STD, LTD Claims Remanded To Plan Administrator For Full, Fair Review

LOUISVILLE, Ky. — The denial of claims for short-term disability (STD) and long-term disability (LTD) benefits was arbitrary and capricious because the denials were not the result of a deliberate and principled reasoning process, a Kentucky federal judge said in remanding the claims to the plan administrator for a full and fair review.
August 01, 2024
District Court Properly Found Disability Claimant Is Totally Disabled, 8th Circuit Says

ST. LOUIS — A district court did not err in granting judgment in favor of a disability claimant because the claimant met her burden of showing that she is disabled from performing the duties of any occupation, the Eighth Circuit U.S. Court of Appeals said in affirming the lower court’s ruling.
July 29, 2024
Bad Faith Claim Against Disability Insurer Cannot Proceed, Judge Says

FORT SMITH, Ark. — A bad faith claim alleged against a disability insurer cannot proceed because the disability claimant fails to allege sufficient facts in support of the claim and the complaint alleges only that a disagreement exists over the insurer’s denial of his long-term disability (LTD) claim, an Arkansas federal judge said.
July 29, 2024
Disability Claimant’s Suit Fails; Policy Rider Clearly Stated Terms, Judge Says

LOS ANGELES — A California federal judge granted a disability insurer’s motion for summary judgment and dismissed a breach of contract and bad faith suit filed against a disability income insurer after determining that the insurer’s termination of cost-of-living benefits was proper pursuant to the terms of the policy rider and its termination provision.
July 29, 2024
Ex-NFL Player Seeks High Court Review, Says Wrong Standard Of Review Applied

WASHINGTON, D.C. — A former National Football League player filed a petition for writ of certiorari in the U.S. Supreme Court, contending that the high court should review the Fifth Circuit U.S. Court of Appeals’ ruling that he failed to prove that he is entitled to additional disability benefits under the NFL’s benefits plan because a de novo standard of review should have been applied based on the plan’s procedural violations.
July 29, 2024
NFL Disability Plan Says Former Player’s Appeal Should Not Be Reinstated

ATLANTA — The 11th Circuit U.S. Court of Appeals should summarily deny a former National Football League player’s motion to reinstate his appeal in a dispute over additional disability benefits owed under the NFL’s disability plan because the motion is untimely and because the former player failed to show any good cause to excuse the untimeliness of the appeal, the NFL plan maintains in response to the former player’s motion.
July 26, 2024
Parties Stipulate To Dismissal Of Long COVID Disability Benefits Suit After Settlement

MIAMI — Following a second order issued by a Florida federal judge, the parties in a long-term disability (LTD) benefits suit stemming from a claimant’s diagnosis with long COVID filed a joint stipulation of dismissal on July 25 after settling the LTD claim.
July 24, 2024
Disability Insurer Permitted To File Entire Administrative Record Under Seal

CINCINNATI — A disability insurer is permitted to file the entire administrative record in a disability benefits suit under seal because redaction of the sensitive and confidential information from the record would be time consuming and burdensome and filing the administrative record under seal would ensure that the claimant’s personal and confidential information remains protected, an Ohio federal judge said in granting the parties’ joint motion to file the administrative record under seal.
July 23, 2024
Disability Claimant Deprived Of Full, Fair Review, Florida Federal Judge Says

MIAMI — A Florida federal judge on July 22 remanded a long-term disability (LTD) claim to the plan administrator after determining that the claimant was deprived of a full and fair review because the disability insurer issued a decision on appeal without affording the claimant the opportunity to respond to two reports upon which it relied when terminating the claimant’s benefits.
July 17, 2024
California Judge Dismisses LTD Plan From Suit, Leaving Insurer As Sole Defendant

OAKLAND, Calif. — A California federal judge dismissed a long-term disability (LTD) plan from a disability claimant’s suit, leaving the disability insurer as the sole defendant after the parties jointly agreed to dismiss the plan as a defendant.
July 17, 2024
Panel Affirms Ruling In Favor Of Disability Claimant, Says Denial Was De Novo Wrong

ATLANTA — A disability insurer’s denial of a medical doctor’s long-term disability (LTD) benefits claim was de novo wrong because the insurer construed the policy language referring to compensation from a medical partnership without considering the context of the policy language as a whole, the 11th Circuit U.S. Court of Appeals said in affirming a district court’s summary judgment ruling entered in favor of a disability claimant.
July 08, 2024
LTD Claim Remanded To Allow Claimant To Respond To Independent Peer Reviews

MINNEAPOLIS — A Minnesota federal judge remanded a long-term disability (LTD) claim to allow a disability claimant to respond to independent peer reviews conducted by the disability insurer and to submit additional evidence in response to the peer reviews.
July 05, 2024
Pro Se Litigant’s Disability Suit Was Properly Dismissed, 6th Circuit Affirms

CINCINNATI — The Sixth Circuit U.S. Court of Appeals on July 3 affirmed a district court’s dismissal of a pro se disability claimant’s suit after determining that the claimant was afforded the opportunity to allege claims under the Employee Retirement Income Security Act but failed to do so in accordance with the district court’s directives.
July 05, 2024
Failure To Consider Cognitive Issues Was Abuse Of Discretion, Federal Judge Says

BALTIMORE — A Maryland federal judge determined that a disability insurer abused its discretion in terminating a disability claimant’s long-term disability (LTD) benefits because the insurer failed to consider how the claimant’s cognitive issues affect her ability to work in her regular occupation.
July 03, 2024
Termination Of LTD Benefits Not Arbitrary, Capricious, Ohio Federal Judge Says

COLUMBUS, Ohio — A disability insurer’s termination of long-term disability (LTD) benefits after paying benefits for 19 years was not arbitrary and capricious because substantial evidence supports the finding that the claimant was no longer disabled from performing the duties of any occupation and the claimant failed to identify any evidence showing that the termination was arbitrary and capricious, an Ohio federal judge said in granting the disability insurer’s motion for judgment on the administrative record.
July 03, 2024
After Evidence Of Insurability Probes, DOL Reports Settlements With Life Insurers

WASHINGTON, D.C. — Saying in a news release that “[i]nvestigations into other life insurance companies’ practices surrounding evidence of insurability [EOI] are ongoing,” the U.S. Department of Labor (DOL) announced two settlements in which its investigations were resolved by life insurers’ agreements to follow certain procedures.
June 25, 2024
Termination Of LTD Benefits Supported By Evidence In Administrative Record

BOSTON — A disability insurer’s termination of a claimant’s long-term disability (LTD) benefits was not arbitrary and capricious, a Massachusetts federal judge concluded June 24 after determining that the evidence in the administrative record clearly supports the insurer’s finding that the claimant was no longer disabled from performing the duties of any occupation.
June 21, 2024
Claimant Failed To Meet Burden Of Showing He Is Disabled From Own Occupation

CONCORD, N.H. — A disability claimant is not entitled to long-term disability (LTD) benefits because he failed to meet his burden of proving by a preponderance of the evidence that he is disabled as a result of narcolepsy from performing the duties of his own occupation, a New Hampshire federal judge said in denying the claimant’s motion for judgment on the administrative record and in granting the disability insurer’s motion for judgment on the administrative record.