Mealey's Disability Insurance
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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.
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May 27, 2022
Disability Insurer Not Permitted To Expand Administrative Record
CENTRAL ISLIP, N.Y. — A New York federal magistrate judge on May 13 granted a disability claimant’s motion to preclude a disability insurer from expanding the administrative record because the insurer failed to establish any good cause that would justify the expansion of the administrative record beyond the date on which the claimant’s second appeal was deemed denied.
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May 26, 2022
Judgment Properly Granted In Favor Of Disability Insurer, Panel Affirms
ATLANTA — A district court properly granted judgment in favor of a disability insurer because the disability claimant failed to prove that he was continuously disabled throughout the plan’s elimination period, a necessary requirement to qualify for long-term disability (LTD) benefits, the 11th Circuit U.S. Court of Appeals said May 24.
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May 25, 2022
Insurer Breached Contract In Denying Surgeon’s Total Disability Benefits Claim
CHICAGO — A disability insurer breached its contract in denying a claim for total disability benefits because the claimant was unable to perform the duties of his primary occupation as a liver transplant surgeon; however, the insurer did not unreasonably deny coverage, an Illinois federal judge said May 20.
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May 24, 2022
9th Circuit Reverses, Remands Denial Of Attorney Fees In Disability Suit
PASADENA, Calif. — The Ninth Circuit U.S. Court of Appeals on May 20 reversed a district court’s denial of a disability claimant’s motion for attorney fees after determining that the district court failed to properly view the remand of a long-term disability benefits claim as constituting some success on the merits.
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May 17, 2022
Insurer Wrongfully Denied LTD Benefits For COVID Long-Haul Symptoms, Claimant Says
SEATTLE — A disability insurer wrongfully denied long-term disability benefits to an employee suffering from COVID-19 long-haul symptoms because the employee is unable to perform the duties of her own occupation as a result of her symptoms, the employee claims in a May 13 complaint filed in Washington federal court.
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May 13, 2022
Plan’s Decision To Terminate Disability Benefits Was Reasonable, Panel Says
CHICAGO — A panel of the Seventh Circuit U.S. Court of Appeals on May 11 affirmed a district court’s ruling in favor of a disability plan after determining that the decision to terminate a claimant’s short-term disability benefits was not arbitrary and capricious; however, the panel reversed the lower court’s award in favor of the plan for pro hac vice admission fees after determining that those fees are not taxable costs.
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May 05, 2022
Termination Of Disability Benefits Was Reasonable, Federal Judge Determines
TAMPA, Fla. — A disability insurer did not act arbitrarily and capriciously in terminating a disability claimant’s benefits because the insurer reasonably concluded that the claimant was capable of working in a sedentary occupation and not disabled from performing the duties of any occupation, a Florida federal judge said March 31.
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May 05, 2022
Intentional Infliction Of Emotional Distress Claim To Proceed In Disability Suit
SAN DIEGO — A California federal judge on April 20 determined that a claim for intentional infliction of emotional distress alleged by a disability claimant can proceed because the claimant raised questions of fact regarding the outrageousness of the conduct of a third-party administrator’s agent and the severity of the emotional distress experienced by the claimant who became homeless following the denial of her claim for disability benefits.
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May 05, 2022
Disability Claimant Is Entitled To LTD Benefits Under Plan’s Own-Occupation Standard
RENO, Nev. — A disability claimant is entitled to the reinstatement of long-term disability (LTD) benefits under his health care plan’s own-occupation standard because the disability insurer abused its discretion in determining that the claimant failed to provide medical evidence in support of his disability, a Nevada federal judge said March 24 in granting the claimant’s motion for summary judgment.
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May 04, 2022
Administrative Record In Disability Suit Permitted To Be Filed Under Seal
OXFORD, Miss. — A Mississippi federal magistrate judge on May 3 granted a disability insurer’s unopposed motion to file an administrative record under seal because the more than 1,700-page record contains personal and confidential information protected from disclosure by state and federal law.
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May 03, 2022
Claimant Remained Disabled And Was Unable To Perform Duties Of Any Occupation
SEATTLE — A disability insurer’s termination of long-term disability benefits is not supported by the medical evidence in the administrative record, a Washington federal judge said May 2 after determining that the disability claimant met his burden of proving by a preponderance of the evidence that he remained physically disabled and unable to perform the duties of any occupation.
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May 03, 2022
Ohio Federal Judge Grants Disability Plan’s Motion For Stay Of Execution
CINCINNATI — An Ohio federal judge on April 26 granted a disability plan’s motion to stay the execution of a judgment entered against it until the plan’s appeal is resolved by the Sixth Circuit U.S. Court of Appeals because the plan posted a bond that covers the judgment entered against it in addition to up to 12 months of additional long-term disability (LTD) benefits and post-judgment interest.
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May 03, 2022
Magistrate: Disability Claimant Failed To State Claim For Relief Under ERISA
PORTLAND, Maine — A federal magistrate judge in Maine on April 12 recommended dismissing a disability claimant’s complaint after determining that the claimant failed to state a plausible claim for relief under the Employee Retirement Income Security Act.
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May 03, 2022
Claim For LTD Benefits Is Moot Based On Reinstatement Of Benefits Without Offset
AUSTIN, Texas — A Texas federal magistrate judge on April 13 determined that a disability plan participant’s claim for long-term disability (LTD) benefits is moot based on a disability insurer’s reinstatement of benefits without an offset but said that the disability claimant should be entitled to collect prejudgment interest on the amount of benefits to which the offset was applied.
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April 29, 2022
Disability Claimant Alleges Insurer Breached Contract In Terminating Benefits
WEST PALM BEACH, Fla. — A disability claimant alleges in an April 12 complaint filed in Florida federal court that a disability insurer breached its contract in terminating payments for long-term disability (LTD) income benefits and in terminating a waiver of premiums owed for the disability and life insurance policies issued to the claimant.
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April 29, 2022
Disability Insurer Failed To Provide Full, Fair Review, Claimant Says In Complaint
TAMPA, Fla. — A disability insurer wrongfully denied a claim for long-term disability (LTD) benefits in violation of the Employee Retirement Income Security Act and failed to provide a full and fair review of the claim as required by ERISA, a disability claimant alleges in an April 20 complaint filed in Florida federal court.