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

Mealey's Disability Insurance

August 10, 2023
Disability Plan’s Termination Of Benefits Was Arbitrary, Capricious, Claimant Says

PORTLAND, Ore. — A disability plan’s termination of long-term disability (LTD) benefits was arbitrary and capricious because the plan’s termination was not based on substantial evidence showing that the claimant was no longer disabled from performing the duties of his own occupation as a software development engineer, the claimant says in a complaint filed in Oregon federal court.
August 10, 2023
LTD Benefits Owed Under Disability Plan, Claimant Says In Complaint

BOSTON — A disability insurer wrongfully terminated a claim for long-term disability (LTD) benefits because the claimant remains disabled from performing the duties of any occupation as required by the disability plan, the claimant contends in a complaint filed in Massachusetts federal court.
August 09, 2023
Disability Claimant Permitted To File Appeal In Forma Pauperis, Circuit Judge Says

CINCINNATI — A Sixth Circuit U.S. Court of Appeals judge granted a disability claimant’s motion to proceed in forma pauperis on appeal because it does not appear that the claimant’s appeal of a district court’s ruling in favor of a disability pension plan on the issue of the claimant’s disability onset date is frivolous.
August 09, 2023
Termination Of LTD Benefits Not Arbitrary, Capricious, 6th Circuit Panel Says

CINCINNATI — A third-party disability claims administrator’s termination of long-term disability (LTD) benefits was not arbitrary and capricious because the administrator engaged in a reasoned and principled process before terminating the benefits, the Sixth Circuit U.S. Court of Appeals said in affirming a district court’s decision.
August 09, 2023
Disability Claimant’s Suit Against Employer Is Barred By Doctrine Of Res Judicata

WASHINGTON, D.C. — The District of Columbia Circuit U.S. Court of Appeals affirmed a district court’s ruling that a disability claimant’s suit is barred by the doctrine of res judicata because the claimant’s suit is based on the same facts that were at issue in a previously dismissed lawsuit filed by the claimant.
July 24, 2023
Termination Of Disability Benefits Supported, Panel Majority Says In Reversing

ST. LOUIS — The majority of the Eighth Circuit U.S. Court of Appeals reversed a district court’s summary judgment ruling in favor of a disability claimant after determining that substantial evidence supports the disability insurer’s termination of benefits and that the disability insurer’s delay in deciding the claimant’s appeal was not an abuse of discretion.
July 20, 2023
Union Member Failed To Show Disability Was Caused By On-The-Job Injury, Panel Says

CHICAGO — A district court properly entered judgment in favor of a pension trust fund because the union member failed to offer evidence showing that his disability was caused by an injury sustained while working as required to qualify for disability benefits under the trust fund, the Seventh Circuit U.S. Court of Appeals said.
July 07, 2023
Breach Of Contract, Fraud Claims Preempted By ERISA, Federal Magistrate Judge Says

WEST PALM BEACH, Fla. — A Florida federal magistrate judge recommended dismissing a disability claimant’s breach of contract and fraud suit filed against three attorneys of her employer’s disability insurer after determining that the state law claims of breach of contract and fraud are preempted by the Employee Retirement Income Security Act because they relate to the denial of a short-term disability (STD) claim under a disability plan governed by ERISA.
July 07, 2023
Denial Of Benefits Was Arbitrary, Capricious, Judge Says In Remanding Claim

CAMDEN, N.J. — A disability insurer’s denial of benefits was arbitrary and capricious because it failed to conduct a substantive review of the claim for benefits, a New Jersey federal judge said in remanding the claim for further consideration.
July 07, 2023
Denial Of LTD Claim ‘Supported By Substantial Evidence,’ Panel Says

DENVER — A disability insurer’s denial of a long-term disability (LTD) benefits claim was not arbitrary and capricious because the insurer’s decision that the claimant was not disabled from performing the duties of her own occupation was “reasonable and supported by substantial evidence,” the 10th Circuit U.S. Court of Appeals said in affirming a district court’s ruling.
July 07, 2023
Bad Faith Claim In Disability Suit Proceeds; Emotional Distress Claim Dismissed

CAMDEN, N.J. — A New Jersey federal judge on July 6 determined that a disability claimant’s bad faith claim can proceed because the claimant sufficiently stated facts in support of the claim but a claim for intentional and negligent infliction of emotional distress cannot proceed because the claimant failed to show that the disability insurer’s conduct caused her to suffer emotional distress.
July 06, 2023
Termination Of LTD Benefits Was Result Of Deliberate Reasoning Process

CINCINNATI — The termination of a claimant’s long-term disability (LTD) benefits claim was not arbitrary and capricious under New York law because the record supported the denial of benefits and the third-party claims administrator’s decision was the result of a deliberate and principled reasoning process, the Sixth Circuit U.S. Court of Appeals said in affirming a district court’s judgment.
July 06, 2023
Evidence Supports Finding That Claimant Not Disabled From Working In Own Occupation

CHICAGO — A disability insurer’s denial of a long-term disability (LTD) benefits claim was not arbitrary and capricious because the evidence in the administrative record supports the insurer’s conclusion that the claimant was not disabled from performing the duties of her own occupation, an Illinois federal judge said in granted the insurer’s motion for summary judgment.
July 06, 2023
Question Of Fact Exists As To Whether Payments Were Disability Or Workers’ Comp

WASHINGTON, D.C. — A district court erred in granting summary judgment in favor of an employer in a dispute over whether an injured employee’s wages were properly reported as disability payments, which are taxable income, on W-2s filed with the Internal Revenue Service as opposed to workers’ compensation payments, which are nontaxable income, because a question of fact exists regarding what type of payments the employee received, the District of Columbia Circuit U.S. Court of Appeals said in reversing and remanding.
July 06, 2023
Panel Remands Disability Claimant’s Suit On Issue Of Bonus Calculation

SEATTLE — The Ninth Circuit U.S. Court of Appeals remanded a disability claimant’s suit to a district court to allow the court to determine if the claimant’s trimester bonuses should have been pro-rated over the applicable months as part of her benefits calculation.
July 06, 2023
Disability Insurer Did Not Abuse Discretion In Terminating LTD Benefits

RICHMOND, Va. — A disability insurer did not abuse its discretion in terminating a claimant’s long-term disability (LTD) benefits because the insurer’s decision to terminate the benefits was reasonable and based on substantial evidence, the Fourth Circuit U.S. Court of Appeals said in affirming a district court’s decision.
June 23, 2023
Disability Income Insurer Did Not Breach Contract, Act In Bad Faith, Judge Says

TRENTON, N.J. — A disability income insurer did not breach its contract or act in bad faith in denying an insured ophthalmologist’s claim for total disability benefits because the insured’s inability to perform surgery does not render him totally disabled in his occupation as he is still able to see patients, a New Jersey federal judge said in granting the insurer’s motion for summary judgment and denying the insured’s motion for summary judgment.
June 21, 2023
Disability Benefits Suit Transferred To Connecticut Federal Court

SAN FRANCISCO — A disability benefits suit filed by the trustee of the plan participant’s estate must be transferred to Connecticut federal court because Connecticut has a greater interest in the dispute as the plan participant received his medical treatment and plan benefits in Connecticut for 27 years, a California federal judge said in granting the disability plan defendants’ motion to transfer venue.
June 09, 2023
9th Circuit Partly Reverses Dismissal Of Disability Claims Against Insurers

SAN FRANCISCO — A Ninth Circuit U.S. Court of Appeals panel reversed in part and affirmed in part a California federal judge’s grant of summary judgment against an insured who accused two insurers of breach of contract and violation of California’s unfair competition law (UCL) for refusing to find her totally disabled since 1989 when she developed carpal tunnel syndrome and left her primary career, based on a claim she filed in 2020 after leaving a secondary job due to COVID-19-related health concerns.
June 09, 2023
Termination Of LTD Benefits Supported By Medical Evidence, Judge Says

BIRMINGHAM, Ala. — A disability insurer’s termination of benefits was not de novo wrong because the medical evidence supports the insurer’s finding that the claimant is capable of working in a sedentary occupation, an Alabama federal judge said in granting the insurer’s motion for judgment on the administrative record.
June 09, 2023
Denial Of LTD Claim Was Not Arbitrary, Capricious, Wisconsin Federal Judge Says

MILWAUKEE — A disability claimant failed to show that a disability insurer’s denial of a claim for long-term disability (LTD) benefits was not arbitrary and capricious because the record supports a finding that the claimant could perform the duties of his occupation in the national economy even if he was unable to perform the duties of that occupation with his current employer, a Wisconsin federal judge said in granting the disability insurer’s motion for summary judgment.
June 09, 2023
Disability Claimant’s Interpretation Of Plan Requirement Is More Reasonable

NEW YORK — A New York federal judge determined that a disability claimant’s interpretation of a plan’s monthly income loss requirement is more reasonable than the disability insurer’s interpretation and must be applied to calculate the claimant’s long-term disability (LTD) benefits.
June 06, 2023
Claimant Failed To Show She Was Continuously Disabled During Elimination Period

CINCINNATI — A district court did not err in finding that a disability claimant is not entitled to long-term disability (LTD) benefits because the claimant failed to prove that she was continuously disabled throughout the plan’s six-month elimination period, the Sixth Circuit U.S. Court of Appeal said in affirming the lower court’s ruling.
June 06, 2023
Breach Of Fiduciary Duty Claim Against Disability Insurer Not Foreclosed

PASADENA, Calif. — A district court erred in entering judgment in favor of a disability insurer on a breach of fiduciary duty claim because the insurer was acting in a fiduciary function when it miscalculated the claimant’s long-term disability benefits, resulting in a more than $56,000 overpayment to the claimant, the Ninth Circuit U.S. Court of Appeals said in reversing the district court’s judgment.
June 06, 2023
Former NFL Player Alleges NFL Disability Plan Breached Fiduciary Duty

WEST PALM BEACH, Fla. — A former National Football League player alleges in a complaint filed in Florida federal court that the NFL’s disability plan breached its fiduciary duty by failing to consider the former player’s claim for total and permanent disability benefits and by concealing that the player was eligible for the benefits when he submitted an application for disability benefits in 2006.