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

Mealey's Disability Insurance

March 18, 2024
5th Circuit Majority Denies Ex-NFL Player’s Petition For Rehearing En Banc

NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals denied a former National Football League (NFL) player’s petition for panel rehearing and the majority of the court denied rehearing en banc, voting 11-5 against rehearing en banc, and issued a substituted opinion on March 15, reiterating that a district court’s ruling in favor of the former player must be reversed because the former player failed to show that he had any changed circumstances that would entitle him to additional disability benefits under the plan.
March 15, 2024
Termination Of LTD Benefits Was Result Of Deliberate Reasoning Process, Panel Says

CINCINNATI — A disability insurer’s termination of a claimant’s long-term disability (LTD) benefits was not arbitrary and capricious because the insurer’s decision was the result of a deliberate and principled reasoning process and was supported by substantial medical evidence, the Sixth Circuit U.S. Court of Appeals said in affirming a district court’s opinion.
March 13, 2024
Oral Surgeon’s Breach Of Contract, Bad Faith Claims Against Disability Insurer Fail

FRESNO, Calif. — An insured’s breach of contract and bad faith claims against a disability insurer cannot proceed because there is no evidence that any doctor advised the insured to stop working as an oral surgeon to reduce the risk of contracting COVID-19 and suffering complications from the virus based on his comorbid conditions of asthma and hypertension.
March 08, 2024
Claimant Says Additional LTD Benefits Are Owed Under Disability Plan

PORTLAND, Maine — In a March 7 complaint filed in Maine federal court, a disability claimant maintains that she is entitled to unpaid long-term disability (LTD) benefits under a disability plan because she remains disabled under the terms of the plan.
March 08, 2024
District Court’s Decision Should Be Affirmed, Disability Claimant Maintains

PHILADELPHIA — A district court’s judgment in favor of a disability claimant should be affirmed because the court properly found that the plan’s termination of the claimant’s long-term disability (LTD) benefits was arbitrary and capricious and that the decision was inadequate for a number of reasons, the claimant says in an appellee brief filed in the Third Circuit U.S. Court of Appeals.
March 08, 2024
Disability Insurer’s Interpretation Of Plan Terms Was Incorrect, Judge Says

KANSAS CITY, Kan. — A Kansas federal judge granted a disability claimant’s motion for summary judgment after determining that the claimant is owed disability benefits under his employer’s disability plan because the disability insurer’s interpretation of the plan terms regarding eligibility of coverage was incorrect.
March 08, 2024
Disability Claimant Failed To Meet Burden Of Proving Disability, Judge Says

LAS VEGAS — A disability claimant failed to meet his burden of proving that he was disabled from performing the duties of his regular occupation as an attorney, a Nevada federal judge held after determining that the long-term disability (LTD) insurer engaged in meaningful dialogue with the claimant and did not abuse its discretion in denying the claim for LTD benefits.
March 08, 2024
Parties Settle Long-Haul COVID Disability Dispute; Dismissal Order Entered

BOSTON — A Massachusetts federal judge entered an order of dismissal after the parties in a dispute over the availability of long-term disability (LTD) benefits for long-haul COVID symptoms notified the court that they reached a settlement.
March 07, 2024
Exhaustion Of Remedies Under LTD Plan Not Required Prior To Filing Suit

TACOMA, Wash. — A disability insurer’s motion for judgment on the pleadings must be denied because the long-term disability (LTD) plan at issue did not require the disability claimant to exhaust all administrative remedies prior to filing suit, a Washington federal judge concluded in denying the insurer’s motion.
March 07, 2024
Judge Refuses To Compel Disability Claimant To Exhaust Administrative Remedies

PORTLAND, Ore. — An Oregon federal judge denied a disability plan’s motion to compel a disability claimant to exhaust all administrative remedies because the disability plan failed to adhere to the 45-day deadline for deciding a claimant’s appeal of a long-term disability (LTD) benefits claim and failed to show that a special circumstance existed that warranted an extension to the 45-day deadline.
March 06, 2024
Disability Insurer Abused Its Discretion In Denying LTD Benefits, Judge Determines

ALEXANDRIA, Va. — A disability insurer abused its discretion in denying a claim for long-term disability (LTD) benefits because the insurer failed to consider the opinions of the claimant’s treating physicians and failed to consider whether the claimant’s heart condition and health would deteriorate if he was forced to work in a high-stress job, a Virginia federal judge said in granting the claimant’s motion for summary judgment and denying the insurer’s motion for summary judgment.
March 06, 2024
Award Of Attorney Fees, Costs Not Warranted Based On Remand Of Claim, Judge Says

TULSA, Okla. — A disability claimant is not entitled to an award of attorney fees or costs based on the remand of the claimant’s short-term disability (STD) claim to the plan administrator because the remand order was a procedural ruling and does not constitute a success on the merits of the claim, an Oklahoma federal judge said in denying the claimant’s motion for an award of attorney fees and costs.
March 06, 2024
LTD Benefits Must Be Reinstated, Kentucky Federal Judge Says

OWENSBORO, Ky. — A disability claimant’s long-term disability (LTD) benefits must be reinstated because the disability insurer’s termination of benefits is not supported by the medical evidence, a Kentucky federal judge said in granting the disability claimant’s motion for judgment.
March 06, 2024
Disability Claimant Awarded Costs As The Prevailing Party In Benefits Dispute

HUNTSVILLE, Ala. — An Alabama federal judge awarded a disability claimant more than $11,000 in costs after determining that the claimant is entitled to recover the costs because she is the prevailing party on a breach of contract claim asserted against her disability insurer.
March 06, 2024
Disability Claimant Not Provided Full, Fair Review, Texas Federal Judge Says

DALLAS — A Texas federal judge remanded a claim for long-term disability (LTD) benefits to the plan administrator after determining that the claimant was deprived of a full and fair review based on the disability insurer’s failure to consult with a different physician regarding the claimant’s appeal following the termination of her claim.
February 20, 2024
High Court Denies Review Of Petition On ERISA Claims Procedure Regulations

WASHINGTON, D.C. — The U.S. Supreme Court on Feb. 20 denied a disability claimant’s petition for writ of certiorari seeking review of whether the Sixth Circuit U.S. Court of Appeals properly determined whether violations of claims procedure regulations under the Employee Retirement Income Security Act can be excused if the disability plan claims administrator substantially complied with the regulations.
February 09, 2024
LTD Benefits Owed For Post-COVID-19 Syndrome, Claimant Says In Complaint

NEW YORK — A former regional sales manager filed suit in New York federal court, seeking a ruling that he is entitled to long-term disability (LTD) benefits for post-COVID-19 syndrome under a disability plan sponsored by his employer because the plan administrator’s denial of benefits was contrary to the weight of the medical and vocational evidence.
February 08, 2024
Disability Plan Says Lower Court Erred In Entering Judgment For Claimant

PHILADELPHIA — A district court’s judgment in favor of a disability claimant should be reversed because substantial evidence shows that the claimant did not meet her burden of proving that she was disabled from performing the duties of her own occupation following three ankle surgeries, the disability plan says in its appellant brief filed in the Third Circuit U.S. Court of Appeals.
February 08, 2024
Limited Benefit Provision Properly Applied But Remand On Portion Of Claim Warranted

ALEXANDRIA, Va. — A disability insurer reasonably applied a limited benefit provision in finding that a claimant’s migraine headaches entitled her to only 24 months of benefits; however, the insurer’s explanation for its denial of benefits for the claimant’s cervical radiculopathy was not consistent, a Virginia federal judge said in determining that remand of claimant’s cervical radiculopathy claim is warranted.
February 07, 2024
Disability Claimant’s Breach Of Fiduciary Duty Claims To Proceed, Judge Says

BALTIMORE — A Maryland federal judge on Feb. 6 denied a plan administrator’s motion to dismiss claims for breach of fiduciary duty after determining that a disability claimant sufficiently alleged facts in support of the claims pertaining to the long-term disability (LTD) and life insurance plans at issue.
February 07, 2024
Disability Benefits Suit Settled; Parties File Stipulation Of Dismissal

DALLAS — Following a Texas federal judge’s ruling that a disability claimant’s long-term disability (LTD) benefits must be reinstated, the parties reached a settlement of the LTD benefits dispute and filed a joint stipulation of dismissal with prejudice.
February 07, 2024
Disability Claimant Says Insurer Fails To Show Policy Rider Is Clear, Unambiguous

SAN FRANCISCO — A disability insurer fails to show that a rider included in its disability income policy is not ambiguous and should be enforced, a disability claimant says, maintaining in his appellant reply brief filed in the Ninth Circuit U.S. Court of Appeals that a district court incorrectly interpreted the policy’s monthly benefit rider.
February 06, 2024
Disability Insurer Breached Fiduciary Duty In Terminating Benefits, Claimant Says

DENVER — A disability insurer breached its fiduciary duty in terminating a claim for long-term disability (LTD) benefits because the insurer mischaracterized the claimant’s medical condition and failed to follow the plan’s guidelines and procedures in handling the claim, a disability claimant alleges in a complaint filed Feb. 5 in Colorado federal court.
February 06, 2024
Disability Insurer Improperly Terminated Benefits, Claimant Alleges In Complaint

DENVER — A disability claimant alleges in a Feb. 5 complaint filed in Colorado federal court that a disability insurer acted improperly, arbitrarily and capriciously in terminating her long-term disability (LTD) benefits based on a finding that she was not disabled from performing the duties of any occupation.
February 01, 2024
LTD Claim Remanded To Plan Administrator To Complete Full, Fair Review

CEDAR RAPIDS, Iowa — An Iowa federal judge remanded a disability claimant’s long-term disability (LTD) claim to the disability plan administrator after determining that the claimant was deprived of a full and fair review because the claimant was not afforded the opportunity to respond to new information used by the disability insurer in denying the claimant’s appeal.