- Volume 18, Issue #12
- Issues Of Fact Exist As To Whether Disability Insurer Properly Denied Claim
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on May 31 reversed a district court's ruling in favor of a disability insurer after determining that genuine issues of fact exists regarding whether the insurer improperly denied the claim before the amount of time to submit additional materials had expired (Narciso Cuaresma Jr. v. Farmers Group Disability Income Plan, et al., No. 16-16946, 9th Cir., 2018 U.S. App. LEXIS 14368).
- Disability Insurer's Denial Of Claims Was Reasonable, Federal Judge Determines
CHICAGO - A disability insurer's denial of short-term disability (STD) and long-term disability (LTD) benefits was reasonable as the insurer undertook a thorough review of the claims for benefits, an Illinois federal judge said May 15 in granting the insurer's motion for summary judgment (Shirley Lacko v. United of Omaha Life Insurance Co., No. 17-2100, N.D. Ill., 2018 U.S. Dist. LEXIS 81117).
- Woman Asks 4th Circuit To Reverse Disability Insurance Benefit Ruling
RICHMOND, Va. - A North Carolina woman is asking the Fourth Circuit U.S. Court of Appeals to reverse a lower court's ruling regarding her disability insurance coverage claim because benefit increases that she purchased on her policy were wrongly retracted when the insurer initially denied her claim and then later elected to pay benefits to a retroactive date (Jessica Slice-Sadler v. Principal Life Insurance Company, No. 17-2249, 4th Cir.).
- Disability Claimant Alleges Denials Were Based On Profit-Making Motive
CHATTANOOGA, Tenn. - A disability insurer breached its contract and acted in bad faith when it terminated a claimant's short-term disability (STD) benefits and denied a claim for long-term disability (LTD) benefits because the decisions were based on a profit-making motive rather than the evidence of the claimant's disability, the claimant alleges in a May 14 complaint filed in Tennessee federal court (Janet Mitchell v. Unum Life Insurance Company of America, et al., No. 18-94, E.D. Tenn.).
- Former Newspaper Reporter Entitled To Retroactive Disability Benefits, Judge Says
NEWARK, N.J. - A New Jersey federal judge on May 31 determined that a former newspaper reporter is entitled to short-term disability and long-term disability benefits under a disability plan issued by his employer because the wealth of medical evidence supports a finding that the claimant is disabled as a result of chronic fatigue syndrome under the terms of the plan and unable to perform the duties of his own occupation (Brian Vastag v. Prudential Insurance Company of America, No. 15-6197, D. N.J., 2018 U.S. Dist. LEXIS 91458).
- Disability Claimant Capable Of Performing Sedentary Work, Judge Determines
OAKLAND, Calif. - A California federal judge on May 11 determined that a disability insurer properly denied a claimant long-term disability benefits under a plan's any-occupation standard because the evidence supports the insurer's finding that the claimant was capable of performing sedentary work (Dave Nagy v. Hartford Life and Accident Insurance Co., et al., No. 16-5309, N.D. Calif., 2018 U.S. Dist. LEXIS 80278).
- Cause Of Disability Incorrectly Classified As Sickness Rather Than Injury
PHOENIX - An Arizona federal judge on May 29 granted an insured's motion for summary judgment after determining that a disability insurer incorrectly classified the insured's disability as resulting from a sickness rather than from an accidental injury because the insured was not totally disabled by a pre-existing degenerative disc disease until after the accidental injury occurred (Thomas Scott Wood v. Provident Life and Accident Insurance Co., No. 17-2330, D. Ariz., 2018 U.S. Dist. LEXIS 89056).
- Termination Of LTD Benefits Based On Policy Limitation Was Reasonable
ALEXANDRIA, Va. - A Virginia federal judge on May 29 granted a disability insurer's motion for summary judgment after determining that the insurer's termination of benefits based on the policy's mental and nervous disorder limitation was reasonable and not an abuse of discretion (Roger D. Shepard v. Liberty Life Assurance Company of Boston, No. 17-1055, E.D. Va., 2018 U.S. Dist. LEXIS 89241).
- Former NFL Player Files Class Action, Alleges Plan Breached Fiduciary Duties
NEW YORK - A former National Football League player on May 22 filed suit in New York federal court, alleging that the NFL's retirement plan and its fiduciaries duty violated the Employee Retirement Income Security Act by refusing to reclassify players' disability benefits as football degenerative (FD) benefits despite evidence showing that the disabilities suffered by players were caused by numerous hits to the head and concussions sustained while playing in the NFL (Christopher Hudson, et al., v. National Football League Management Council, et al., No. 18-4483, S.D. N.Y.).
- Breach Of Fiduciary Claim Dismissed; Recovery Of Benefits Is Adequate Remedy
BIRMINGHAM, Ala. - An Alabama federal judge on May 30 granted a disability insurer's motion to dismiss a claimant's breach of fiduciary duty claim after determining that the claim seeking recovery of benefits under the Employee Retirement Income Security Act provides an adequate remedy to the claimant (Carol H. Stewart v. Hartford Life & Accident Insurance Co., No. 17-1423, N.D. Ala., 2018 U.S. Dist. LEXIS 89508).
- High Court's Review Of 9th Circuit's Offset Ruling Not Warranted, Plan Says
WASHINGTON, D.C. - The U.S. Supreme Court should deny a disability claimant's petition for writ of certiorari in a dispute over the offsetting of a claimant's long-term disability (LTD) benefits to account for Social Security disability income (SSDI) benefits received on behalf of the claimant's dependents because the plan administrators applied the language of the LTD plan as written, the defendants maintain in a May 25 response brief (Susan Rene Jones v. Merck Sharpe & Dohme Corp., et al., No. 17-1478, U.S. Sup.).
- District Court Correctly Dismissed Disability Claimant's Suit, Panel Says
SAN FRANCISCO - A district court did not abuse its discretion in dismissing a disability claimant's amended complaint because the prelitigation costs and attorney fees sought by the claimant are not available as equitable relief under the Employee Retirement Income Security Act, the Ninth Circuit U.S. Court of Appeals said May 31 (Larry A. Benson v. Life Insurance Company of North America, No. 17-55253, 9th Cir., 2018 U.S. App. LEXIS 14367).
- ERISA Prohibited Transaction Claims Alleged Against Disability Insurer Dismissed
WASHINGTON, D.C. - A District of Columbia federal judge on June 6 dismissed claims alleging that a short-term disability (STD) insurance provider violated the Employee Retirement Income Security Act by engaging in prohibited transactions after determining that the plan's trustees failed to prove that the insurer engaged in any transactions that are prohibited under ERISA (Joseph Sellers Jr., et al., v. Anthem Life Insurance Co., No. 16-2428, D. D.C., 2018 U.S. Dist. LEXIS 95278).
- Magistrate Judge Recommends Dismissing State Law Claims, Says They Are Preempted
SACRAMENTO, Calif. - A California federal judge on June 4 recommended dismissing a disability claimant's state law claims because the state law claims are preempted under the Employee Retirement Income Security Act (Jerome Clay v. AT&T Umbrella Benefit Plan No. 3, No. 17-749, E.D. Calif., 2018 U.S. Dist. LEXIS 93784).
- Disability Claimants Seek High Court's Review Of Service-Of-Suit Ruling
WASHINGTON, D.C. - The U.S. Supreme Court should grant a petition for writ of certiorari because the Colorado Supreme Court's dismissal of two long-term disability insurance lawsuits based on the failure to serve the proper parties has widened an existing conflict between federal courts of appeal regarding whether a benefit plan governed by the Employee Retirement Income Security Act is a proper defendant, the petitioners argue in their May 11 brief filed in the high court (Brenda Olivar v. Public Service Employee Credit Union Long Term Disability Plan, and Caroline Burton, et al. v. Colorado Access, et al., No. 17-1543, U.S. Sup., 2018 U.S. S. Ct. Briefs LEXIS 1932).
- Disability Claimant Permitted To Conduct Limited Discovery, Federal Judge Says
DETROIT - A Michigan federal judge on June 1 upheld a magistrate judge's order permitting a disability claimant to conduct limited discovery on the number of times a disability insurer employed a specific doctor to complete medical reviews of long-term disability claims because the claimant made "a sufficient predicate showing" to warrant the limited discovery (Precious Robert Johnson v. Harleysville Life Insurance Co., No. 17-10321, E.D. Mich., 2018 U.S. Dist. LEXIS 92833).