Subscribe: LexisNexis® Mealey's™ Disability Insurance Legal News
http://feeds.feedburner.com/DisabilityInsuranceLegalNews
Added By: Feedage Forager Feedage Grade B rated
Language: English
Tags:
benefits  claimant  disability insurer  disability  dist lexis  federal judge  federal  insurance  insurer  judge  lexis  plan 
Rate this Feed
Rate this feedRate this feedRate this feedRate this feedRate this feed
Rate this feed 1 starRate this feed 2 starRate this feed 3 starRate this feed 4 starRate this feed 5 star

Comments (0)

Feed Details and Statistics Feed Statistics
Preview: LexisNexis® Mealey's™ Disability Insurance Legal News

LexisNexis® Mealey's™ Disability Insurance Legal News



Headline Disability Insurance Legal News from LexisNexis®



 



Evidence Shows Claimant Not Able To Work In Sedentary Position, Panel Says
SAN FRANCISCO - A district court erred in determining that a disability claimant was capable of working in a sedentary position because the evidence shows that the claimant was able to sit for only four hours in an eight-hour workday, the Ninth Circuit U.S. Court of Appeals said Nov. 4 (Avery Armani v. Northwestern Mutual Life Insurance Co., No. 14-56866, 9th Cir.; 2016 U.S. App. LEXIS 19925).



Claimant Capable Of Working In Sedentary Position, Panel Affirms
ATLANTA - A district court did not err in granting summary judgment in favor of an employer and a disability insurer because the evidence supported the disability insurer's conclusion that the disability claimant was capable of working in a sedentary position, the 11th Circuit U.S. Court of Appeals said Oct. 21 (Andrew Ramdeen v. Prudential Insurance Company of America, et al., No. 16-11179, 11th Cir.; 2016 U.S. App. LEXIS 18962).



Evidence Supports Finding That Claimant Could Perform Duties Of Usual Occupation
SAN FRANCISCO - A district court did not err in concluding that a disability claimant was not totally disabled by fibromyalgia because the evidence supports the insurer's determination that the claimant could perform the material and substantial duties of her usual occupation, the Ninth Circuit U.S. Court of Appeals said Oct. 26 (Cheryl Leslie v. United of Omaha Life Insurance Co., No. 14-56775, 9th Cir.; 2016 U.S. App. LEXIS 19348).



Termination Of Benefits Was Reasonable, Majority Of 9th Circuit Panel Determines
SAN FRANCISCO - The majority of a Ninth Circuit U.S. Court of Appeals panel on Oct. 28 denied a disability claimant's motion for rehearing and reiterated that the termination of the claimant's benefits was reasonable because the claimant did not undergo an independent medical exam as requested by the insurer and as required under the plan (Curtis F. Lee v. ING Groep, N.V., et al., No. 14-15848, 9th Cir.; 2016 U.S. App. LEXIS 19513).



Denial Of Benefits Was Reasonable Based On Evidence, 6th Circuit Panel Says
CINCINNATI - A disability insurer's denial of long-term disability benefits was reasonable based on the substantial amount of evidence showing that the claimant was not disabled until after he was no longer covered under the disability plan at issue, the Sixth Circuit U.S. Court of Appeals said Oct. 4 (James J. Connelly v. Standard Insurance Co., No. 16-3036, 6th Cir.; 2016 U.S. App. LEXIS 18214).



Insurer's Termination Of Benefits Supported By Evidence, Federal Judge Says
HARRISBURG, Pa. - A disability insurer's termination of a claimant's benefits was not unreasonable because the evidence supports the insurer's conclusion that the claimant was not disabled after her discharge from an inpatient program at a mental health facility, a Pennsylvania federal judge said Oct. 17 (Cheryl Gailey v. Life Insurance Company of North America, No. 15-564, M.D. Pa.; 2016 U.S. Dist. LEXIS 143110).



Termination Of Benefits Supported By Medical Evidence, Federal Judge Says
LITTLE ROCK, Ark. - The termination of a claimant's long-term disability (LTD) benefits was reasonable based on the evidence considered by the disability plan prior to terminating benefits, an Arkansas federal judge said Oct. 7 (Evelyn Thompson v. ConAgra Foods Inc., et al., No. 14-41, E.D. Ark.; 2016 U.S. Dist. LEXIS 140149).



Mississippi Federal Judge: Request To Reopen Disability Benefits Suit Is Premature
OXFORD, Miss. - A Mississippi federal judge on Oct. 26 denied a former National Football League (NFL) player's request to reopen his disability benefits case on the basis that the request is premature because the plan administrator has yet to render a final decision on his claim (Christopher Hudson v. Retirement Board, as the administrator of the Bert Bell/Pete Rozelle NFL Player Retirement Plan, No. 15-128, N.D. Miss.; 2016 U.S. Dist. LEXIS 151115).



Monthly Benefits Payable Based On Most Current Benefit Increase, Federal Judge Says
WINSTON-SALEM, N.C. - A North Carolina federal judge on Oct. 6 rejected a disability insurer's argument that a monthly disability benefit should be based on the last benefit increase accepted by the insured before the disability claim and said the claimant is entitled to the current monthly benefit payable under the policy (Jessica Slice-Sadler v. Principal Life Insurance Co., No. 15-216, M.D. N.C.; 2016 U.S. Dist. LEXIS 138990).



Insurer's Termination Of Long-Term Care Benefits Was Correct, Federal Judge Says
TAMPA, Fla. - A disability insurer correctly determined that a claimant was no longer eligible for long-term care disability benefits because it is clear from the evidence that the claimant no longer qualified for benefits under the policy's cognitive-impairment or functional-disability provisions, a Florida federal judge said Oct. 17 (David Carr v. John Hancock Life Insurance Co. [USA], No. 14-2867, M.D. Fla.; 2016 U.S. Dist. LEXIS 143050).



Plan Defendants Argue Plan Is Not Bound By SSA's Disability Onset Date
RICHMOND, Va. - A district court misinterpreted a disability plan's provisions when it determined that the plan and its administrator are bound by the disability onset date determined by the Social Security Administration (SSA), the plan defendants argue in a Nov. 2 brief filed in the Fourth Circuit U.S. Court of Appeals (Jesse Solomon v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 16-1730, 4th Cir.).



Complaint Seeks Finding That Insurer Wrongfully Offset Veterans' Benefits
BOSTON - A U.S. Army veteran filed a class action suit on Oct. 25 in Massachusetts federal court against a disability insurer, alleging that the insurer wrongfully offset disability benefits payable under the insurer's policy by disability benefits received from the U.S. Department of Veterans Affairs because the policy does not list veterans disability benefits as income eligible for an offset under the policy (Marco Martinez v. Sun Life Assurance Company of Canada, No. 16-12154, D. Mass.).



Insurer Is Not Entitled To Collect Attorney Fees, Florida Federal Judge Says
TAMPA, Fla. - A disability insurer is not entitled to collect more than $48,000 in attorney fees against a claimant because the claimant's suit was not frivolous and the claimant was partially successful in his bid to recover disability benefits, a Florida federal judge said Oct. 20 (Kristian Horneland v. United of Omaha Life Insurance Co., No. 15-1703, M.D. Fla.; 2016 U.S. Dist. LEXIS 145405).



Information About Medical Reviewers Is Relevant, Kentucky Federal Judge Says
OWENSBORO, Ky. - A Kentucky federal judge on Oct. 21 rejected a disability insurer's objections to a magistrate judge's discovery order and the insurer's motion for a protective order regarding information about the medical reviewers used by the insurer in evaluating a disability claim because the information sought by the claimant is relevant and not unduly burdensome (Paulette Owens v. Liberty Life Assurance Company of Boston, No. 15-71, W.D. Ky.; 2016 U.S. Dist. LEXIS 145941).



Claimant Should Not Be Permitted To Conduct Discovery, Plan Argues
INDIANAPOLIS - A disability claimant should not be permitted to conduct discovery to determine if a plan operated under a conflict of interest because the claimant failed to prove that the discovery sought is necessary, the plan argues in a Nov. 3 response brief filed in Indiana federal court (Donald Fessenden v. Reliance Standard Life Insurance Co., et al., No. 15-370, N.D. Ind.).



Montana Federal Judge Denies Motion To Remand, Says Removal Was Proper
MISSOULA, Mont. - A Montana federal judge on Oct. 11 denied a disability claimant's motion to remand a suit to Montana state court on the basis that jurisdiction in federal court is proper and none of the relevant factors weighs in favor of remanding the suit (Philip Cardan v. New York Life Insurance Co., No. 16-102, D. Mont.; 2016 U.S. Dist. LEXIS 140731).



Diversity Of Citizenship Does Not Exist; Suit Must Be Remanded, Federal Judge Says
LOS ANGELES - Because it is possible for a disability claimant to amend a complaint to plead claims with more particularity against a California doctor who conducted an independent medical exam for the disability insurer and the hospital who employed the doctor, a California federal judge on Oct. 11 said the suit must be remanded to state court as complete diversity of citizenship does not exist (Mayna Chau-Barlow v. Provident Life and Accident Insurance Co. et al., No. 16-1694, C.D. Calif.; 2016 U.S. Dist. LEXIS 140833).



Federal Magistrate Judge Denies Motion To Order IME For Failure To Serve Motion
TAMPA, Fla. - Because a disability plan administrator was not served with a claimant's motion seeking an order requiring the plan administrator to reschedule and videotape an independent medical exam (IME), a Florida federal magistrate judge on Oct. 21 denied the claimant's motion without prejudice and allowed the claimant to refile and serve the motion on the plan administrator (Alexander Stratigos v. Prudential Insurance Company of America, No. 16-2780, M.D. Fla.; 2016 U.S. Dist. LEXIS 146094).



Claimant Failed To Prove That He Suffered From Bipolar Disorder, Panel Says
SAN FRANCISCO - A district court did not err in determining that a disability insurer's termination of a claimant's benefits was reasonable based on the plan's mental illness limitation because the claimant failed to carry his burden of proving that he suffered from bipolar disorder, the Ninth Circuit U.S. Court of Appeals affirmed Sept. 26 (David Hoffmann v. Life Insurance Company of North America, et al., No. 15-55093, 9th Cir.; 2016 U.S. App. LEXIS 17491).



Claimant Failed To Show She Was Incapable Of Performing Duties Of Own Occupation
PHILADELPHIA - A Pennsylvania federal judge on Sept. 30 granted a disability insurer's motion for summary judgment and denied a claimant's motion for summary judgment after finding that the insurer's denial of claims for short-term and long-term disability benefits based on its determination that she was capable of performing the duties of her own occupation was reasonable and supported by substantial evidence (Anna Ackaway v. Aetna Life Insurance Co., No. 14-1300, E.D. Pa.; 2016 U.S. Dist. LEXIS 135368).



Kentucky Federal Judge: Evidence Shows Claimant Could Perform Other Occupations
OWENSBORO, Ky. - A disability insurer did not act arbitrarily and capriciously in terminating a claimant's long-term disability (LTD) benefits because the evidence shows that the claimant was not totally disabled and was able to perform other occupations, a Kentucky federal judge said Sept. 26 (Sabrina Austin-Conrad v. Reliance Standard Life Insurance Co., No. 14-127, W.D. Ky.; 2016 U.S. Dist. LEXIS 131047).



Termination Under Plan's Any-Occupation Standard Is Supported, Federal Judge Says
ALLENTOWN, Pa. - A disability insurer's termination of a claimant's benefits under the plan's any-occupation standard was not arbitrary and capricious because the evidence clearly supports the insurer's decision, a Pennsylvania federal judge said Sept. 26 (Calvin Shatto v. Liberty Life Assurance Company of Boston, No. 14-5653, E.D. Pa.; 2016 U.S. Dist. LEXIS 131097).



Claimant's Evidence Supports Inability To Work, Michigan Federal Judge Determines
DETROIT - A Michigan federal judge on Sept. 30 reinstated a disability claimant's long-term disability (LTD) benefits after determining that the claimant submitted sufficient medical evidence supporting his inability to work (Mohamed Ahmed Mokbel-Aljahmi v. United of Omaha Life Insurance Co., No. 15-12537, E.D. Mich.; 2016 U.S. Dist. LEXIS 135100).



Claim Denial Supported By Available Medical Evidence, Michigan Federal Judge Says
DETROIT - A federal magistrate judge did not err in recommending that a defendant's motion for summary judgment be granted because the available medical evidence supports the denial of a disability claimant's long-term disability claim, a Michigan federal judge said Sept. 13 in adopting the magistrate judge's report and overruling the claimant's objections to the report (Scott M. Bennetts v. AT&T Umbrella Plan No. 1, No. 15-10087, E.D. Mich.; 2016 U.S. Dist. LEXIS 123583).



Denial Of Benefits Was Reasonable Based On Plan Provisions, Federal Judge Says
MIAMI - A disability insurer did not act arbitrarily and capriciously in denying long-term disability (LTD) benefits to a claimant because the insurer's denial was reasonable based on the plan's provisions, a Florida federal judge said Sept. 30 (Myles German v. Metropolitan Life Insurance Co., No. 15-60392, S.D. Fla.; 2016 U.S. Dist. LEXIS 135845).



Washington Federal Judge: Additional Briefing Needed On Discretionary Clause
SEATTLE - A Washington federal judge on Sept. 19 ordered parties involved in a disability benefits dispute to submit additional briefing on whether a discretionary clause, included in a disability plan that was issued in the State of Texas, is valid in the State of Washington where the claimant resides (Anthony Flaaen v. McLane Co. Inc., et al., No. 15-5899, W.D. Wash.; 2016 U.S. Dist. LEXIS 127448).



Plan Administrator Not Granted Discretionary Authority, Federal Judge Says
SAN FRANCISCO - A de novo standard of review should be applied in a disability benefits suit because the plan at issue did not confer discretionary authority to the disability plan administrator, a California federal judge said Oct. 3 (Cathleen Murphy v. California Physicians Service, et al., No. 14-2581, N.D. Calif.; 2016 U.S. Dist. LEXIS 137159).



Denial Of Claims Was Not An Abuse Of Discretion, 9th Circuit Panel Says
PHOENIX - The denial of two short-term disability claims was not an abuse of discretion because the medical evidence did not support a finding that the claimant was disabled from performing the duties of her job, the Ninth Circuit U.S. Court of Appeals said Sept. 19 (Carol Molanick v. United Services Automobile Association, No. 14-16404, 9th Cir.; 2016 U.S. App. LEXIS 17087).



Michigan Federal Judge Says Prejudgment Interest Owed For Wrongful Benefits Denial
DETROIT - On remand from the Sixth Circuit U.S. Court of Appeals, a Michigan federal judge on Sept. 29 ordered a disability insurer to calculate the amount of prejudgment interest it owes to the estate of a disability claimant for the time period of July 2002 through September 2016 after determining that prejudgment interest is warranted based on the insurer's wrongful denial of benefits (Todd R. Rochow, et al. v. Life Insurance Company of North America, No. 04-73628, E.D. Mich.; 2016 U.S. Dist. LEXIS 134229).



Award Of Attorney Fees Denied; Claimant's Arguments Were Reasonable, Judge Says
CHICAGO - A disability insurer is not entitled to recoup $40,000 in attorney fees because the disability claimant's arguments were reasonable and not so lacking in merit as to justify an award of attorney fees, an Illinois federal judge said Sept. 27 (Donna Geiger v. Aetna Life Insurance Co., No. 15-3791, N.D. Ill.; 2016 U.S. Dist. LEXIS 131807).



Claimant Is Permitted To Pursue Discovery Outside Of Administrative Record
LOUISVILLE, Ky. - A Kentucky federal judge on Sept. 29 determined that a disability claimant is entitled to pursue discovery outside of the administrative record on her claim alleging that the disability plan administrator operated under a conflict of interest because the discovery is permitted under the Employee Retirement Income Security Act (Suzette Scott-Warren v. Liberty Life Assurance Company of Boston, No. 14-738, W.D. Ky.; 2016 U.S. Dist. LEXIS 136513).



8th Circuit Denies Petitioner Who Opposed Disability Plan's Forum-Selection Clause
ST. LOUIS - An Eighth Circuit U.S. Court of Appeals panel on Sept. 27 denied a disability plan participant's petition for writ of mandamus directing a Missouri federal judge to disregard the plan's forum-selection clause and transfer her case to Arizona, where she has lived and worked for more than a decade (In re Lorna Clause, No. 16-2607, 8th Cir.).



Claimant Failed To Prove She Is Totally Disabled, 6th Circuit Panel Says
CINCINNATI - A district court did not err in finding that a disability claimant's long-term benefits were properly terminated because the claimant failed to show by a preponderance of the evidence that she is totally disabled as defined by the plan, the Sixth Circuit U.S. Court of Appeals said Aug. 23 (Christina Saunders v. Procter & Gamble Health & Long-Term Disability Benefit Plan, No. 16-3043, 6th Cir.; 2016 U.S. App. LEXIS 15743).



Denial Of Benefits Was Not Arbitrary And Capricious, Ohio Federal Judge Says
CINCINNATI - A disability insurer's termination of a long-term disability (LTD) claim was not arbitrary and capricious because the insurer's decision was well reasoned and supported by substantial medical evidence, an Ohio federal judge said Aug. 26 (Kevin E. Demeritt v. Liberty Life Assurance Company of Boston, No. 15-146, S.D. Ohio; 2016 U.S. Dist. LEXIS 114760).



Panel Majority Says District Court Failed To Consider Effect Of Medications
SAN FRANCISCO - A district court erred in entering judgment in favor of a disability plan and a disability insurer because it failed to consider how medications taken by the disability claimant would affect his ability to function in a workplace under the "any occupation" test, the majority of a Ninth Circuit U.S. Court of Appeals panel said Aug. 26 (Daniel G. Demer v. IBM Corporation LTD Plan, et al., No. 13-17196, 9th Cir.; 2016 U.S. App. LEXIS 15788).



Pennsylvania Federal Judge: Termination Of Benefits Was Not Unreasonable
PITTSBURGH - The termination of a disability claimant's long-term disability (LTD) benefits was not arbitrary and capricious because the medical evidence supports the plan's determination that the claimant could perform the duties of her own occupation, a Pennsylvania federal judge said Aug. 26 (Antoinette F. Swanberg v. The PNC Financial Services Group Inc. and Affiliates Long Term Disability Plan, No. 15-544, W.D. Pa.; 2016 U.S. Dist. LEXIS 114551).



Denial Of Benefits Was Not Rational, 6th Circuit Appeals Panel Says In Reversing
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Sept. 7 reversed and remanded a district court's ruling that a disability claimant is not entitled to long-term disability benefits beyond the plan's one-year limitation for mental disorders because the plan administrator's decision was arbitrary and capricious (Patti Okuno v. Reliance Standard Life Insurance Co., No. 15-4043, 6th Cir.; 2016 U.S. App. LEXIS 16423).



Plan's Pre-Existing Condition Exclusion Bars Claim For Benefits, Federal Judge Says
TAMPA, Fla. - A disability plan's pre-existing condition exclusion bars a claim for long-term disability benefits because the claimant was treated for the same back pain for which he sought disability benefits during the plan's look-back period, a Florida federal judge said Aug. 23 in denying the claimant's motion for summary judgment (Kristian Horneland v. United of Omaha Life Insurance Co., No. 15-1703, M.D. Fla.; 2016 U.S. Dist. LEXIS 111902).



Denial Of Claim Was Proper; Lawsuit Was Untimely Filed, 8th Circuit Panel Determines
ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on Aug. 22 affirmed a disability insurer's denial of a long-term disability (LTD) claim on the basis that the claimant's lawsuit was not filed within the plan's contractual limitations period (Jeff Schmitz v. Sun Life Assurance Company of Canada, No. 14-3701, 8th Cir.; 2016 U.S. App. LEXIS 15319).



Judge Awards Insurer More Than $53,000 In Long-Term Disability Payments
WORCESTER, Mass. - Although a federal judge in Massachusetts expressed concerns with how an estimate of overpayment of long-term disability payments was reached and how "narrow a view" an instruction on remand was regarding allocation of permanent scarring benefits in a related personal injury settlement, the judge on Aug. 25 ruled that an insurer was entitled to recovery of $53,292.80 in benefit overpayment from its insured in an insurance breach of contract and bad faith lawsuit (Rachel C. Sugalski v. The Paul Revere Life Insurance Co., No. 14-40015, D. Mass.; 2016 U.S. Dist. LEXIS 113016).



Kentucky Federal Judge Dismisses Insurer's Unjust Enrichment Counterclaim
LOUISVILLE, Ky. - A Kentucky federal judge on Aug. 19 granted a disability claimant's motion for partial judgment on an insurer's unjust enrichment counterclaim after determining that the disability plan governs only whether the insurer can recover alleged overpayments and not whether the claimant should repay any overpayments (Linda Graves v. Standard Insurance Co., No. 14-558, W.D. Ky.; 2016 U.S. Dist. LEXIS 111035).



Alabama Federal Magistrate Recommends Dismissal Of Breach Of Fiduciary Duty Claims
MONTGOMERY, Ala. - An Alabama federal magistrate judge on Aug. 25 recommended that breach of fiduciary claims alleged against an employee welfare plan and a disability insurer be dismissed because the plaintiff is provided with an adequate remedy under Section 502(a)(1)(B) of the Employee Retirement Income Security Act (Richard P. Shultz v. Aetna Life Insurance Co. et al., No. 16-94, M.D. Ala.; 2016 U.S. Dist. LEXIS 114889).



6th Circuit Majority Says Remand To Plan Administrator Was Not Violation Of Mandate
CINCINNATI - The majority of a Sixth Circuit U.S. Court of Appeals panel on Aug. 19 determined that remanding a disability retirement claim to the plan administrator was not an abuse of discretion because the remand remained within the purview of an earlier mandate issued by the Sixth Circuit (Kyle D. Kennard v. Means Industries Inc., No. 15-1872, 6th Cir.; 2016 U.S. App. LEXIS 15308).



Statute Voiding Discretionary Clauses Does Not Apply To Health Plan, Judge Says
SAN FRANCISCO - A California statute voiding discretionary clauses in disability and life insurance policies does not apply to a claim for medical expenses under a health insurance policy because New York law applies to the dispute and because health insurance is not a form of disability insurance, a California federal judge said Aug. 30 (David Bain et al., v. United Healthcare Inc., No. 15-3305, N.D. Calif.; 2016 U.S. Dist. LEXIS 116805).



Pennsylvania Federal Judge Says Motor Vehicle Statute Saves Claim From Preemption
SCRANTON, Pa. - A Pennsylvania federal judge on Aug. 2 partially denied a life insurance company's motion to dismiss a putative class action for benefits under an Employee Retirement Income Security Act plan, finding that a section of a state motor vehicle statute "regulates insurance" and is therefore saved from ERISA preemption (Eric Yost, et al. v. Anthem Life Insurance Co., No. 3:16-cv-00079, M.D. Pa.; 2016 U.S. Dist. LEXIS 101202).



Authority For LTD Plan Eligibility Determinations Debated In 1st Circuit
BOSTON - The First Circuit U.S. Court of Appeals has been asked to decide whether a federal court erred in determining that an insurer in Puerto Rico was delegated with discretionary authority to make eligibility determinations for long-term disability benefits and whether the trial court used the correct standard of review in granting the insurer summary judgment on a woman's claims that her benefits were halted improperly (Nilda Rodriguez-Lopez v. Triple-S Vida, Inc., No. 15-2413, 1st Cir.).



Federal Magistrate Judge: Insurer Must Produce Files On Medical Claims Reviewers
OWENSBORO, Ky. - A disability insurer must produce information related to its disability medical claims reviewers, a Kentucky federal magistrate judge said Aug. 26, rejecting the insurer's argument in its motion for reconsideration that producing the information would create an undue burden on the insurer (Paulette Owens v. Liberty Life Assurance Company of Boston, No. 15-71, W.D. Ky.; 2016 U.S. Dist. LEXIS 114470