http://www.lexisnexis.com/mealeys/news.aspx Headline Disability Insurance Legal News from LexisNexis® en-us http://www.lexisnexis.com/mealeys/images/lexismealeyslogo.gif 130 29 http://www.lexisnexis.com/mealeys/news.aspx Copyright 2013 http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NASHVILLE, Tenn. - An ERISA-governed disability insurer that terminated benefits to a claimant with arthritis acted reasonably, a Tennessee federal judge ruled May 6 (Arlene Cook v. The Hartford, et al., No. 3-12-0749, M.D. Tenn.; 2013 U.S. Dist. LEXIS 64125). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SALT LAKE CITY - An ERISA-governed disability insurer that denied benefits to a claimant with chronic obstructive pulmonary disease, back pain and arthritis abused its discretion, a Utah federal judge ruled April 24 (Cheryl E. Krum v. Hartford Life and Accident Insurance Co., No. 2:11-932, D. Utah; 2013 U.S. Dist. LEXIS 58909). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CINCINNATI - An Ohio federal judge on April 16 reversed a grant of summary judgment to an insurer on its decision to deny long-term disability benefits to a claimant who underwent brain surgery. The judge ordered the claim remanded for a full and fair review of whether she is capable of performing the duties of her occupation (Karen Connors v. Life Insurance Company of North America, No. 2:12-cv-073, S.D. Ohio; 2013 U.S. Dist. LEXIS 54032). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DENVER - An ERISA-governed disability insurer's denial of long-term disability benefits to a claimant with anxiety disorder and depression was reasonable, a Colorado federal judge ruled April 24 (Ted Rall v. Aetna Life Insurance Co., No. 12-cv-00184, D. Colo.; 2013 U.S. Dist. LEXIS 58617). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' HARRISON, Ark. - An ERISA-governed disability plan administrator that terminated benefits to a claimant during a plan's any-occupation coverage period acted reasonably, an Arkansas federal judge ruled April 19 (Keith R. Crosby v. Eaton Corp., No. 3:11-CV-03084, W.D. Ark.; 2013 U.S. Dist. LEXIS 56406). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' ATLANTA - A disability plan insurer did not violate the Employee Retirement Income Security Act by terminating long-term disability benefits because the insurer reasonably relied on the opinions of an independent medical examiner and a vocational rehabilitation consultant, the 11th Circuit U.S. Court of Appeals affirmed April 29 in an unpublished opinion (Patricia Herring v. Aetna Life Insurance Company, No. 12-15864, 11th Cir.; 2013 U.S. App. LEXIS 8667). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CINCINNATI - An insurer did not act arbitrarily or capriciously in denying a claim for total and permanent disability benefits, even though it recited an incorrect definition of disability in its initial denial letter, because it applied the correct definition during the administrative process, the Sixth Circuit U.S. Court of Appeals ruled 2-1 on March 25 (Thomas Judge v. Metropolitan Life Insurance Company, No. 12-1092, 6th Cir.; 2013 U.S. App. LEXIS 6710). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' KNOXVILLE, Tenn. - Although a Tennessee federal judge on April 11 found that a policyholder's breach of contract claim survived his insurer's dismissal motion, the judge disposed of an accompanying bad faith claim, finding "legitimate grounds" for the insurer's denial of benefits under a total disability policy (Stephen Bowery v. Berkshire Life Insurance Company of America, No. 3:11-cv-00003, E.D. Tenn.; 2013 U.S. Dist. LEXIS 52234). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BROOKLYN, N.Y. - A claimant's action against his individual disability insurer seeking benefits for separate claims of disability for mental illness is not barred by equitable estoppel or fraud, a New York federal judge ruled April 19 (Rao Suryadevara v. Unum Group, No. 12-CIV-3651, E.D. N.Y.; 2013 U.S. Dist. LEXIS 56641). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CINCINNATI - The Sixth Circuit U.S. Court of Appeals on April 26 upheld a lower court's order of sanctions against a disability claimant's counsel who started opening statements by accusing the insurer of committing "corporate greed" (James Sabatine v. Paul Revere Life Insurance Co., No. 12-3719, 6th Cir.; 2013 U.S. App. LEXIS 8579). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2011%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - The U.S. Supreme Court on April 15 agreed to review a Second Circuit U.S. Court of Appeals unpublished order upholding dismissal of a wrongful denial of disability benefits action under the Employee Retirement Income Security Act (Julie Heimeshoff v. Hartford Life & Accident Insurance Co., et al., No. 12-729, U.S. Sup.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2012%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CHICAGO - An Illinois federal judge on April 25 ruled that the proper standard of review is de novo in an ERISA-governed insurer's benefit termination decision (Lilian Borich v. Life Insurance Company of North America, et al., No. 12-C-734, N.D. Ill.; 2013 U.S. Dist. LEXIS 59674). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2013%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' LOUISVILLE, Ky. - A deemed denial after an insurer's failure to issue a timely decision as required under ERISA is not a default for a change of the standard of review, a Kentucky federal judge ruled May 8 (Boyd Van Winkle Jr. v. Life Insurance Company of North America, et al., No. 12-253, E.D. Ky.; 2013 U.S. Dist. LEXIS 65539). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-11%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2014%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CHICAGO - An Illinois statute prohibiting discretionary clauses in insurance policies applies to a disability policy governed by the Employee Retirement Income Security Act, where the policy was renewed and the insurer terminated the participant's disability benefits after the statute was adopted, a federal judge in Illinois ruled May 1 (Zaccone v. Standard Life Insurance Company, No. 10 CV 00033, N.D. Ill.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CINCINNATI - The Sixth Circuit U.S. Court of Appeals on March 21 reversed a grant of summary judgment to a group disability insurer, finding that the insurer's reliance on a record review and a review by a vocational expert was arbitrary (James Neaton v. Hartford Life and Accident Insurance Co., No. 11-6061, 6th Cir.; 2013 U.S. App. LEXIS 5814). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on April 2 upheld a grant of summary judgment to an ERISA-governed disability insurer that denied benefits to a claimant with back, neck and leg pain (Alan McFadden v. Prudential Insurance Company of America, et al., No. 12-60569, 5th Cir.; 2013 U.S. App. LEXIS 6571). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WILMINGTON, Del. - An ERISA-governed insurer that relied on medical record reviews in its decision to deny benefits to a claimant with ankle and leg pain acted reasonably, a New York federal judge ruled March 21 (Lynne M Smith v. Automatic Data Processing Inc., et al., No. 1:11-cv-00243, D. Del.; 2013 U.S. Dist. LEXIS 38962). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW YORK - A New York federal judge on March 19 ruled that an ERISA-governed disability insurer's denial of benefits to a claimant with back and joint pain was reasonable (Sarah E. Schrom v. Guardian Life Insurance Company of America, No. 11-1680, S.D. N.Y.; 2013 U.S. Dist. LEXIS 38039). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DETROIT - A Michigan federal judge on March 20 dismissed a fraud claim against two disability insurers, finding that the claim is not "separate and distinct" from the contract (Louis Leonor v. Provident Life and Accident Co., et al., No. 12-15343, E.D. Mich.; 2013 U.S. Dist. LEXIS 38423). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SAN FRANCISCO - A California federal judge on March 15 ruled that the abuse of discretion standard of review is proper, finding that an ERISA-governed disability plan properly conferred discretion to the administrator (William Goodes, et al. v. Pacific Gas & Electric Co., No. C-12-1667, N.D. Calif.; 2013 U.S. Dist. LEXIS 37478). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SYRACUSE, N.Y. - A New York federal judge on March 20 dismissed claims against a group disability plan and other parties involved in the administration of a disability claim for failure to provide forms related to filing a claim, holding that the parties could not be held liable under ERISA because they were not the plan administrator (Christina Delprado v. Sedgwick Claims Management Services Inc., et al., No. 1:12-CV-0673, N.D. N.Y.; 2013 U.S. Dist. LEXIS 38159). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' MILWAUKEE - Claims questioning the method of claim investigation and the ultimate denial of disability benefits against a group disability insurer are properly governed by the Employee Retirement Income Security Act, a Wisconsin federal judge ruled March 19, dismissing a claimant's state law claims (Eileen M. Dreczka, et al. v. Hartford Life and Accident Insurance Co., No. 10-C-0002, E.D. Wisc.; 2013 U.S. Dist. LEXIS 37774). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW YORK - A disability insurer's counterclaim seeking return of overpaid benefits is an action for "appropriate equitable relief" properly brought under Employee Retirement Income Security Act Section 502(a)(3), the Second Circuit U.S. Court of Appeals ruled March 13 (Sharon Thurber v. Aetna Life Insurance Company, Nos. 12-370-cv, 12-521-cv, 2nd Cir.; 2013 U.S. App. LEXIS 5022). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW ORLEANS - A disability insurer did not abuse its discretion under the Employee Retirement Income Security Act by determining that a traveling nurse's per diem allowance for meals and housing constituted a "fringe benefit" and, therefore, was excluded from her rate of pay when calculating her benefits due, the Fifth Circuit U.S. Court of Appeals affirmed March 11 in an unpublished opinion (Kathleen M. O'Brien v. Hartford Life & Accident Insurance Company, No. 12030641, 5th Cir.; 2013 U.S. App. LEXIS 4827). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2011%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' WASHINGTON, D.C. - The U.S. Supreme Court on April 1 denied review of a First Circuit U.S. Court of Appeals ruling that the limitations period for filing a legal claim provided in a disability plan bars a participant's claim for reinstatement of benefits under the Employee Retirement Income Security Act (Luis Arturo Santaliz-Rios v. Metropolitan Life Insurance Co., No. 12-923, U.S. Sup.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-10%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2012%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BOSTON - A disability insurer violated the Employee Retirement Income Security Act by offsetting a participant's payments under the plan by service-connected disability compensation under the Veterans' Benefits Act, the First Circuit U.S. Court of Appeals affirmed March 29, concluding that disability benefits under the Veterans' Benefits Act are significantly different from benefits under the Social Security Act (SSA) and the Railroad Retirement Act (RRA) (David Hannington v. Sun Life and Health Insurance Company, No. 12-1085, 1st Cir.; 2013 U.S. App. LEXIS 6515). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%201%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' PHILADELPHIA - A disability insurer that terminated benefits to its policyholder when he turned 65 acted reasonably, the Third Circuit U.S. Court of Appeals ruled Feb. 15 (Barry Sunshine v. Reassure America Life Insurance Co., et al., No. 12-1796, 3rd Cir.; 2013 U.S. App. LEXIS 3250). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%202%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DENVER - An ERISA-governed disability insurer that based its benefit calculation on the insured's "actual earnings" acted reasonably, the 10th Circuit U.S. Court of Appeals ruled Feb. 27 (Jose Cardoza v. United of Omaha Life Insurance Co., No. 12-2033, 10th Cir.; 2013 U.S. App. LEXIS 4060). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%203%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' HOUSTON - An ERISA-governed disability insurer's occupational review did not support its decision to terminate benefits to a claimant with neck and head tremors, a Texas federal judge ruled Feb. 28 (Jeffrey Mattson v. Aetna Life Insurance Co., No. H-11-3742, S.D. Texas; 2013 U.S. Dist. LEXIS 27387). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%204%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' SAN FRANCISCO - An ERISA-governed disability insurer that terminated benefits to a claimant with chronic neck, back and leg pain acted reasonably, a California federal judge ruled March 1 (Tami Hegger v. Unum Life Insurance Company of America, et al., No. C-11-04229, N.D. Calif.; 2013 U.S. Dist. LEXIS 28587). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%205%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' NEW ORLEANS - The U.S. Supreme Court on Feb. 19 denied review of a Fifth Circuit U.S. Court of Appeals ruling that a plan administrator that refused to classify a disability as "football degenerative" to allow for an award of higher benefits did not abuse its discretion under the Employee Retirement Income Security Act (Gene Atkins v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 12-718, U.S. Sup.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%206%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' CHICAGO - De novo is the proper standard of review in a wrongful denial of disability benefits case against an ERISA-governed insurer that was not conferred discretionary authority, an Illinois federal judge ruled Feb. 25 (Lawrence Gavin v. Life Insurance Company of North America, et al., No. 12-C-6178, N.D. Ill.; 2013 U.S. Dist. LEXIS 28038). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%207%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DETROIT - A three-year contractual limitations period in a short-term disability (STD) and a long-term disability (LTD) plan bars a claimant's action filed beyond that period, a Michigan federal judge ruled Feb. 27 (Richard Twort v. Cigna Group Insurance Co., et al., No. 12-12569, E.D. Mich.; 2013 U.S. Dist. LEXIS 26646). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%208%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DETROIT - A claimant's ERISA wrongful denial of benefits action that was filed after the expiration of the plan's three-year contractual limitations period is barred, a Michigan federal judge ruled Feb. 28 (Joseph Moyer v. Metropolitan Life Insurance Co., No. 12-cv-10766, E.D. Mich.; 2013 U.S. Dist. 27770). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%209%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BOSTON - The First Circuit U.S. Court of Appeals on Feb. 8 denied a disability plan's petition seeking panel rehearing and rehearing en banc of the court's ruling that the plan abused its discretion under the Employee Retirement Income Security Act by terminating benefits to a claimant who risked relapse of her opioid addition (Julie Colby v. Union Security Insurance Company & Management Company for Merrimack Anesthesia Associates Long Term Disability Plan, No. 11-2270, 1st Cir.). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2010%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' BOSTON - A claimant cannot seek statutory penalties against an insurer that was not the administrator of a group disability plan, a Massachusetts federal judge ruled March 5 (Michele C. Tetreault v. Reliance Standard Life Insurance Co., et al., No. 10-11420, D. Mass.; 2013 U.S. Dist. LEXIS 29213). http://www.lexis.com/research/xlink?canceldest=form&keyenum=25271&keytnum=0&searchtype=get&search=13-9%20Mealey%27s%20Litig.%20Rep.%20Disab.%20Ins.%2011%20(2013)&view=full&ORIGINATION_CODE=00144 target='_blank' DETROIT - A Michigan county's disability plan established for county employees is not subject to the Employee Retirement Income Security Act, a Michigan federal judge ruled Feb. 26 (Marilyn Wells v. Aetna Life Insurance Co., No. 12-CV-10985, E.D. Mich.; 2013 U.S. Dist. LEXIS 25839).