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

Mealey's Disability Insurance

September 28, 2022
Bifurcation Of Claims Not Warranted In Disability Suit, Ohio Federal Judge Says

COLUMBUS, Ohio — An Ohio federal judge denied a disability insurer’s motion to bifurcate breach of contract and bad faith claims in a disability benefits dispute, rejecting the insurer’s argument that it will be prejudiced if the claims proceed together.
September 23, 2022
District Court Erred In Denying Disability Claimant’s Motion To Supplement Record

PASADENA, Calif. — A district court erred in refusing to allow a disability claimant to supplement the administrative record with additional evidence to counter a disability insurer’s new rationale for terminating the claimant’s long-term disability benefits because the evidence used by the insurer to support its termination was not made available to the claimant before the denial of her administrative appeal, a panel of the Ninth Circuit U.S. Court of Appeals said in reversing and remanding the district court’s ruling.
September 23, 2022
Denial Of LTD Benefits Was Not Abuse Of Discretion, S.C. Federal Judge Finds

SPARTANBURG, S.C. — A disability insurer did not abuse its discretion in denying a claim for long-term disability (LTD) benefits because the claimant did not meet the conditions precedent for coverage under the plan and the disability insurer’s denial was reasonable, a South Carolina federal judge said in granting the insurer’s motion for judgment on the administrative record.
September 22, 2022
Judge Reverses Course, Says Disability Plan Not Governed By ERISA

TUCSON, Ariz. — In light of a recent Ninth Circuit U.S. Court of Appeals ruling, an Arizona federal judge reversed course and determined that a long-term disability (LTD) plan is not governed by the Employee Retirement Income Security Act because the single act of an employer purchasing insurance for an employee does not equate to the establishment of an ERISA plan.
September 19, 2022
7th Circuit Panel Says Disability Insurer, Not Employer, Handled Claims

CHICAGO — The Seventh Circuit U.S. Court of Appeals on Sept. 16 affirmed a district court’s finding that a disability claimant’s former employer did not handle discretionary decisions related to claims for disability benefits and warned the disability claimant, who filed two prior appeals in related lawsuits, that any further frivolous appeals may be subject to monetary sanctions.
September 14, 2022
Termination Of LTD Benefits Not Abuse Of Discretion, Texas Federal Judge Says

HOUSTON — A disability insurer’s termination of benefits was not an abuse of discretion because the insurer’s decision that the claimant was not disabled from performing sedentary work was supported by substantial evidence and was not arbitrary and capricious, a Texas federal judge said Sept. 12.
September 13, 2022
Claimant Met Burden Of Showing He Is Disabled From Working As Attorney

CINCINNATI — A disability claimant met his burden of proving by a preponderance of the evidence that he is unable to work as a personal injury attorney, the Sixth Circuit U.S. Court of Appeals said Sept. 9 in reversing a district court’s finding that the disability insurer’s termination of long-term disability benefits was supported by the medical evidence.
September 07, 2022
Disability Claimant Failed To Show Inability To Perform Duties Of Any Occupation

GRAND RAPIDS, Mich. — A Michigan federal judge on Sept. 6 denied a disability claimant’s motion to reconsider the remand of the claimant’s long-term disability (LTD) claim after determining that the claimant failed to show that he is unable to perform the duties of any gainful occupation.
September 02, 2022
Suit Seeking LTD Benefits Barred By Doctrine Of Res Judicata, Judge Says

SANTA ANA, Calif. — A disability claimant’s suit seeking long-term disability (LTD) benefits is barred by the doctrine of res judicata because the same parties and the same claims are at issue in the claimant’s instant suit as were at issue in the claimant’s prior suit, a California federal judge said Aug. 1 in granting the disability insurer’s motion to dismiss.
August 29, 2022
District Court Properly Found No Disability Benefits Owed, Disability Insurer Says

CHICAGO — A district court correctly found that a disability claimant was not entitled to long-term disability (LTD) benefits because the evidence supports a finding that the claimant did not show by a preponderance that he was unable to perform the duties of his own occupation, a disability insurer contends in its Aug. 24 appellee brief filed in the Seventh Circuit U.S. Court of Appeals.
August 29, 2022
Disability Claimant Failed To File Suit Within 3 Years As Required By Policy

ATLANTA — A district court properly dismissed a disability claimant’s suit alleging that her long-term disability benefits were wrongfully terminated because the claimant failed to file her suit within three years as required by the policy’s three-year suit limitations provision and failed to show that she did not have actual notice of the limitations provision, the 11th Circuit U.S. Court of Appeals said Aug. 25.
August 26, 2022
Texas Judge Approves NFL Plan’s Posting Of $3.3M Bond In Disability Suit

DALLAS — A Texas federal judge on Aug. 23 approved the posting of a $3.3 million appeal bond and stayed the execution of judgment in a former National Football League (NFL) player’s suit for disability benefits while the NFL retirement plan appeals the judgment entered in the player’s favor.
August 24, 2022
Administrative Record To Be Sealed In California Disability Benefits Suit

SAN FRANCISCO — A California federal magistrate judge on Aug. 22 granted a disability claimant’s motion to seal the administrative record pertaining to a disability benefits claim after determining that the claimant met the standard of providing compelling reasons to seal the record.
August 23, 2022
Disability Plan’s Termination Of Benefits Was Not Abuse Of Discretion, Judge Says

ALEXANDRIA, Va. — The termination of a claimant’s long-term disability (LTD) benefits based on a finding that the claimant was not disabled from performing the duties of any occupation was not an abuse of discretion because the decision was supported by adequate evidence and the claimant was afforded a full and fair review, a Virginia federal judge said Aug. 18 in granting the plan’s motion for summary judgment on the administrative record.
August 23, 2022
Disability Plan Did Not Abuse Discretion In Calculating Claimant’s LTD Benefits

EUGENE, Ore. — A disability plan’s refusal to pay a claimant 66.6% of his salary in long-term disability (LTD) benefits was not an abuse of discretion because the plan reasonably determined that the claimant’s disability onset date occurred before the effective date of the claimant’s “buy up” election to receive 66.6%, rather than 50%, of his salary in LTD benefits, an Oregon federal judge said Aug. 19 in granting the plan’s motion for summary judgment.
August 22, 2022
Mental Health Diagnoses Do Not Prevent Claimant From Working In Own Occupation

MINNEAPOLIS — A Minnesota federal judge on Aug. 19 granted a disability insurer’s motion for summary judgment and denied a disability claimant’s motion for summary judgment after determining that the insurer’s denial of long-term disability (LTD) benefits was not arbitrary and capricious because a reasonable person could have concluded that the claimant’s mental health diagnoses do not prevent the claimant from performing the duties of her own occupation.
August 22, 2022
Breach Of Contract Claim Can Proceed, Bad Faith Claim Fails In Disability Suit

SAN FRANCISCO — A disability claimant’s breach of contract claim can proceed because a question of fact exists as to whether the claimant can perform the material duties of a general and pediatric anesthesiologist; however, the claimant’s bad faith claim cannot proceed because the claimant failed to show that the disability insurer’s investigation was unreasonable, a California federal judge said Aug. 19.
August 22, 2022
Discovery Permitted In Denial Of Disability Benefits Suit, Magistrate Judge Says

ST. LOUIS — A disability claimant is entitled to conduct limited discovery on claims of breach of fiduciary duty and wrongful denial of disability benefits because the claimant has shown that good cause exists to determine whether the disability insurer operated under a conflict of interest and committed procedural irregularities in the handling of the claim, a Missouri federal magistrate judge said Aug. 15.
August 17, 2022
Panel: Denial Of LTD Benefits For Failure To Provide Medical Records Was Reasonable

RICHMOND, Va. — A disability insurer’s denial of long-term disability (LTD) benefits based on a claimant’s failure to provide requested medical documentation in support of his disability was reasonable because the policy at issue specifically states that failure to provide any requested materials could result in the denial of a claim, the Fourth Circuit U.S. Court of Appeals said Aug. 16 in affirming a district court’s opinion.
August 16, 2022
Disability Claimant’s Suit Dismissed Without Prejudice; No Support For Agent Theory

SAN FRANCISCO — A California federal judge on Aug. 12 granted a disability insurer’s motion to dismiss a breach of contract and bad faith lawsuit after determining that the claimant, who sought disability benefits under a policy issued to a bone marrow donor program, failed to show that that the program was acting as an agent for the disability insurer when his claim for benefits was denied.
August 15, 2022
Prior Plan Exclusion Applies; No LTD Benefits Owed, 11th Circuit Panel Affirms

BIRMINGHAM, Ala. — The 11th Circuit U.S. Court of Appeals on Aug. 10 affirmed a district court’s finding that a disability insurer’s decision to deny a long-term disability (LTD) benefits claim based on the plan’s prior plan exclusion was not wrong because the insurer’s interpretation of the exclusion as a bar to coverage was reasonable.
August 11, 2022
Parties File Stipulation Of Dismissal In Long COVID, Disability Benefits Suit

SAN FRANCISCO — A disability insurer and a disability claimant suffering from symptoms of long COVID following a battle with COVID-19 have settled the claimant’s suit seeking a reinstatement of short-term disability (STD) benefits and a finding that she is entitled to long-term disability (LTD) benefits, according to an Aug. 8 stipulation of dismissal filed by the parties in California federal court.
August 04, 2022
Disability Claimant Achieved Some Success On Merits; Attorney Fee Award Warranted

CONCORD, N.H. — Because a disability claimant achieved some success on the merits when a disability insurer agreed to remand a long-term disability (LTD) benefits claim for reconsideration after the claimant filed suit, the claimant is entitled to attorney fees of $17,312, a New Hampshire federal judge said July 28.
August 04, 2022
LTD Claim Remanded To Plan Administrator For Full, Fair Review

GREEN BAY, Wis. — A Wisconsin federal judge on July 29 remanded a long-term disability (LTD) benefits claim to a plan administrator after determining that the denial of the claim was arbitrary and capricious based on the claims administrator’s finding that the medical evidence did not support the claimant’s disability.
August 04, 2022
Termination Of Benefits Was Not Arbitrary, Capricious, Federal Judge Determines

NEWARK, N.J. — A disability insurer’s decision to terminate a claimant’s long-term disability benefits was not arbitrary and capricious because the claimant was paid the maximum amount of benefits for a mental illness under the plan and failed to show that she was physically disabled from performing the duties of her own occupation, a New Jersey federal judge said July 29 in granting the disability insurer’s motion for summary judgment and in denying the claimant’s motion for summary judgment.