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

Mealey's Disability Insurance

August 02, 2022
Judge Allows Disability Insurer To Stay A Portion Of Judgment Reinstating Benefits

SEATTLE — A Washington federal judge on July 25 granted a disability insurer’s motion to stay a portion of a judgment reinstating a claimant’s past long-term disability (LTD) benefits upon the posting of a bond while the insurer’s appeals the judgment but denied the insurer’s motion to stay the portion of the judgment ordering the insurer to pay ongoing LTD benefits because the portion of the judgment related to the ongoing benefits qualifies as injunctive relief that is not subject to an automatic stay.
August 01, 2022
Court Erred In Not Allowing Disability Claimant To Present Additional Evidence

ATLANTA — The 11th Circuit U.S. Court of Appeals on July 29 reversed and remanded a district court’s ruling that a disability claimant was not permitted to submit additional evidence in support of his claim that a disability insurer wrongfully terminated his claim because 11th Circuit precedent allows evidence outside of the administrative record to be presented when a de novo standard of review applies.
July 29, 2022
No Ambiguity Exists In Disability Policy, 5th Circuit Panel Says In Affirming

NEW ORLEANS — A district court did not err in finding that a disability insurer properly terminated a claimant’s benefits after five years because the policy phrase “any gainful occupation” is not ambiguous, the Fifth Circuit U.S. Court of Appeal said July 27.
July 27, 2022
Disability Insurer Properly Rescinded Policy, Federal Judge Says In Adopting Report

CENTRAL ISLIP, N.Y. — In a July 22 docket order, a New York federal judge adopted a magistrate judge’s recommendation to grant a disability insurer’s motion for summary judgment, agreeing with the magistrate judge’s conclusion that the insurer properly rescinded the disability policy based on fraudulent and material misrepresentations made by the insured regarding a preexisting neck condition and that the insurer did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.
July 21, 2022
Amount In Controversy Not Met In Disability, Bad Faith Suit, Magistrate Judge Says

AUGUSTA, Ga. — A disability claimant’s breach of contract and bad faith suit should be remanded to Georgia state court because the disability insurer failed to prove by a preponderance of the evidence that the amount in controversy exceeds the federal jurisdictional minimum of $75,000, a Georgia federal magistrate judge recommended June 27.
July 21, 2022
Disability Insurer Did Not Abuse Its Discretion In Terminating LTD Benefits

HOUSTON — A disability insurer did not abuse its discretion in determining that a disability claimant was not disabled from performing the duties of any gainful occupation because the record shows that the insurer conducted multiple peer-to-peer reviews with the claimant’s treating physicians and that the claimant did not suffer from functional limitations as a result of her physical and mental health ailments, a Texas federal judge said July 18.
July 20, 2022
Judge Awards Enhanced Lodestar, Conditional Attorney Fees In NFL Disability Row

DALLAS — Saying “David took on Goliath and prevailed,” a Texas federal judge on July 18 awarded enhanced attorney fees of $1,232,058.75 and conditional appellate attorney fees of $600,000 in a former National Football League player’s suit for disability benefits under the Employee Retirement Income Security Act.
July 19, 2022
Denial Of Benefits Was Not Arbitrary, Capricious, Federal Judge Says

LOUISVILLE, Ky. — A disability insurer’s denial of a long-term disability benefits claim was not arbitrary and capricious because the insurer thoroughly considered the claimant’s restrictions before concluding that the claimant was not disabled from performing the duties of her own occupation, a Kentucky federal judge said July 18.
July 19, 2022
4th Circuit Affirms Finding That Claimant Did Not Suffer From Physical Disability

RICHMOND, Va. — A disability insurer did not abuse its discretion in terminating a claimant’s long-term disability benefits based on its finding that the claimant did not suffer from a physical disability that precluded him from performing the duties of any occupation, the Fourth Circuit U.S. Court of Appeals said July 18 in affirming a district court’s ruling.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.