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Preview: LexisNexis® Mealey's™ Disability Insurance Legal News

LexisNexis® Mealey's™ Disability Insurance Legal News



Headline Disability Insurance Legal News from LexisNexis®



 



Panel Remands Disability Claim After Finding Questions Of Fact Exist Regarding Denial
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on Jan. 24 determined that a district court properly applied an abuse-of-discretion standard of review in a disability benefits dispute but remanded the suit after determining that questions of facts exist regarding the disability insurer's decision not to conduct an independent medical evaluation and disregard of the claimant's fatigue and pain complaints (Renee Killebrew v. The Prudential Insurance Company of America, No. 17-2137, 3rd Cir., 2018 U.S. App. LEXIS 1672).



Denial Of Disability Benefits Was Not Arbitrary, Capricious, Federal Judge Says
LEXINGTON, Ky. - A Kentucky federal judge on Feb. 5 affirmed a disability plan's denial of long-term disability benefits after determining that the evidence supports the denial of benefits for the claimant's injury and that the plan provided a reasoned explanation for its denial of benefits (Tracy Kellar v. Aetna Life Insurance Co., et al., No. 17-81, E.D. Ky., 2018 U.S. Dist. LEXIS 18065).



Indiana Federal Judge Says Plan's Denial Of Disability Benefits Must Be Affirmed
SOUTH BEND, Ind. - Noting that an arbitrary and capricious standard of review applies in a disability benefits dispute based on a district court's prior decision, an Indiana federal judge on Jan. 17 affirmed the disability insurer's denial of benefits on the basis that there is rational support for the insurer's denial of benefits (Donald Fessenden v. Reliance Standard Life Insurance Co., et al., No. 15-370, N.D. Ind., 2018 U.S. Dist. LEXIS 7754).



Disability Benefits Claim Was Properly Denied, California Federal Judge Determines
SAN FRANCISCO - A claim for pension disability benefits was properly denied because the disability claimant failed to submit medical records detailing his disability as requested on multiple occasions by the plan at issue, a California federal judge said Feb. 6 (Vanmark Strickland v. AT&T Pension Benefit Plan, No. 17-01393, N.D. Calif., 2018 U.S. Dist. LEXIS 19566).



Disability Claimant Is Owed Benefits Under Any-Occupation Standard, Federal Judge Says
TUCSON, Ariz. - An Arizona federal judge on Jan. 19 determined that a disability claimant is entitled to current and retroactive long-term disability (LTD) benefits because the evidence supports a finding that the claimant is clearly disabled from performing the duties of any occupation (Rebecca Brown v. Life Insurance Company of North America, et al., No. 16-162, D. Ariz., 2018 U.S. Dist. LEXIS 9759).



Disability Insurer Must Reimburse Claimant For Amount Of Offset Benefits
MISSOULA, Mont. - A Montana federal judge on Jan. 30 reinstated a disability claimant's long-term disability benefits and ordered the disability insurer to reimburse the claimant for the amount offset by the insurer after determining that a settlement received by the claimant was not subject to offset because the settlement was not for the same disability for which the claimant was receiving disability benefits (Dawn Rustad-Link v. Providence Health and Services, et al., No. 16-136, D. Mont., 2018 U.S. Dist. LEXIS 14928).



9th Circuit Panel Denies Petition For Rehearing In Disability Offset Suit
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Jan. 9 refused to reconsider its ruling that a disability plan administrator did not abuse its discretion in offsetting a claimant's long-term disability (LTD) benefits to account for Social Security disability income (SSDI) benefits that she receives for her dependents (Susan Rene Jones v. Life Insurance Company of North America, et al., No. 16-16172, 9th Cir., 2018 U.S. App. LEXIS 565).



Disability Insurer's Denial Of Claim Warranted Based On Pre-Existing Condition
JACKSON, Miss. - A disability claimant is not entitled to long-term disability (LTD) benefits because the plan's pre-existing condition limitation bars benefits because the claimant was treated for back pain within the plan's look-back period, a Mississippi federal judge said Jan. 24 (Gary Bales v. Hartford Life & Accident Insurance Co., No. 15-790, S.D. Miss., 2018 U.S. Dist. LEXIS 11180).



Texas Federal Judge Dismisses Remaining Bias Claim In Gender Dysphoria Suit
DALLAS - A Texas federal judge on Jan. 26 dismissed the remaining discrimination claim in a disability claimant's suit seeking benefits under a short-term disability (STD) plan for breast augmentation surgery to treat the illness of gender dysphoria after determining that the claimant failed to prove that the employer discriminated against her under Title VII of the Civil Rights Act (Charlize Marie Baker v. Aetna Life Insurance Co., et al., No. 15-3679, N.D. Texas; 2018 U.S. Dist. LEXIS 12854).



Disability Claimant Failed To Exhaust Administrative Remedies, 6th Circuit Says
CINCINNATI - A claim alleging that a disability insurer violated the Employee Retirement Income Security Act when it offset a plan participant's disability benefits was properly dismissed because the claim arose under the disability plan and the claimant was required to administratively exhaust the plan's remedies or plead futility, neither of which the claimant did, the Sixth Circuit U.S. Court of Appeals said Jan. 23 (Oliver H. Barber III, et al. v. Lincoln National Life Insurance Co., No. 17-5588, 6th Cir., 2018 U.S. App. LEXIS 1560).



Statute Of Limitations Bars Disability Claimant's Suit, Maryland Federal Judge Says
BALTIMORE - A Maryland federal judge on Feb. 1 determined that a disability claimant's breach of contract suit is barred by the applicable statute of limitations because the statute of limitations began to run when the insurer issued its denial letter and not when the insurer denied the claimant's appeal (Nancy F. George v. Massachusetts Mutual Life Insurance Co., No. 17-1073, D. Md., 2018 U.S. Dist. LEXIS 16528).



District Court Erred By Reducing Attorney Fees, 1st Circuit Panel Determines
BOSTON - The First Circuit U.S. Court of Appeals on Jan. 18 affirmed a district court's ruling that a disability claimant is entitled to disability benefits but vacated the lower court's calculation of attorney fees and prejudgment interest awarded to the claimant after determining that the court's downward adjustment in the attorney fee award was not appropriate (Diahann L. Gross v. Sun Life Assurance Company of Canada, Nos. 16-2002, 16-1958, 1st Cir., 2018 U.S. App. LEXIS 1190).



Magistrate Judge Says Discovery Not Warranted In Disability Dispute
INDIANAPOLIS - An Indiana federal magistrate judge on Feb. 2 denied a disability claimant's motion to compel discovery on the basis that the claimant failed to meet her burden of proving that the plan operated under a conflict of interest that would entitle her to conduct discovery (Angel Allen v. The Lilly Extended Disability Plan, et al., No. 16-2224, S.D. Ind., 2018 U.S. Dist. LEXIS 17290).



Disability Claimant's Suit Dismissed; Nevada Not Proper Venue, Federal Judge Says
LAS VEGAS - A Nevada federal judge on Jan. 24 dismissed a disability claimant's suit against a disability insurer after determining that the claimant failed to prove that Nevada is the proper jurisdiction for the suit (Edgar Ortiz v. Reliance Standard Life Insurance Co., No. 17-580, D. Nev., 2018 U.S. Dist. LEXIS 11374).



Motion To Transfer Disability Suit Denied; Suit Remains In California
LOS ANGELES - A California federal judge on Feb. 6 denied a motion to transfer a disability claimant's suit to Pennsylvania federal court because the defendants failed to prove that transferring the suit would serve the convenience of the parties and would promote the interests of justice (Stephanie Stefan v. Life Insurance Company of North America, et al., No. 17-6165, C.D. Calif., 2018 U.S. Dist. LEXIS 20356).



Termination Of Disability Benefits Was Arbitrary, Capricious, Panel Says
DENVER - A district court did not err in reversing a disability insurer's termination of a claimant's long-term disability (LTD) benefits because the insurer failed to address whether the claimant was capable of working on a full-time basis, the 10th Circuit U.S. Court of Appeals said Jan. 2 (Carl Van Steen v. Life Insurance Company of North America, Nos. 16-1405, 16-1421, 10th Cir., 2018 U.S. App. LEXIS 17).



Disability Insurer Erred In Finding Claimant Could Work In Own Occupation, Judge Says
LOS ANGELES - A California federal judge on Dec. 21 determined that a disability insurer erred in denying a claim for long-term disability benefits under the plan's own-occupation standard because the description of the claimant's position as an assistant news editor in the Department of Labor's Dictionary of Occupational Titles is outdated and does not accurately describe the duties of the claimant's position (Kenneth Popovich v. Metropolitan Life Insurance Co., et al., No. 15-9791, C.D. Calif., 2017 U.S. Dist. LEXIS 210427).



Termination Of Disability Benefits Was Reasonable Under Any-Occupation Standard
CINCINNATI - A disability insurer's termination of long-term disability (LTD) benefits was not arbitrary and capricious because the insurer's decision to terminate benefits under the plan's any-occupation standard is supported by substantial medical evidence and was based on a deliberate reasoning process, the Sixth Circuit U.S. Court of Appeals said Jan. 2 (Bari Kemper v. Life Insurance Company of North America, et al., No. 16-6507, 6th Cir., 2018 U.S. App. LEXIS 55).



4th Circuit Affirms Disability Insurer Did Not Abuse Its Discretion
RICHMOND, Va. - The Fourth Circuit U.S. Court of Appeals on Dec. 19 affirmed a district court's ruling that a disability insurer did not abuse its discretion in terminating a claimant's long-term disability (LTD) benefits (Kimberly H. Stoddard v. First Unum Life Insurance Co., No. 16-2065, 4th Cir., 2017 U.S. App. LEXIS 25581).



Disability Plan Administrator Did Not Err In Terminating Claimant's Benefits
BIRMINGHAM, Ala. - A disability plan administrator did not act arbitrarily and capriciously in terminating a claimant's short-term disability (STD) benefits because the medical evidence supports the plan administrator's decision, an Alabama federal magistrate judge said Jan. 9, noting that the claimant's benefits were extended for an additional seven months after the claimant's second appeal (D'Anza Johnson v. AT&T Umbrella Benefit Plan No. 3, No. 15-1074, N.D. Ala., 2018 U.S. Dist. LEXIS 3379).



U.S. Supreme Court Refuses To Review 2nd Circuit's Offset Ruling
WASHINGTON, D.C. - The U.S. Supreme Court on Dec. 11 refused to review the Second Circuit U.S. Court of Appeals' ruling that a New York law barring the offset of a claimant's disability benefits with the proceeds of the claimant's settlement of a personal injury suit is not preempted by the Employee Retirement Income Security Act (Aetna Life Insurance Co. v. Salvatore Arnone, No. 17-416, U.S. Sup.).



Insurer Entitled To Offset LTD Benefits Based On Social Security Awards
NEW ORLEANS - A disability insurer was entitled to offset a claimant's long-term disability (LTD) benefits based on his Social Security disability award and a separate award to his son for family Social Security disability benefits, a Louisiana federal judge said Dec. 19 in granting the insurer's motion for summary judgment (John Jackson v. Aetna Life Insurance Co., No. 16-15837, E.D. La., 2017 U.S. Dist. LEXIS 208188).



Federal Judge Denies Disability Claimant's Motion For Contempt
BILLINGS, Mont. - A Montana federal judge on Dec. 19 denied a disability claimant's motion for contempt after determining that the insurer reasonably believed that it was entitled to a stay of a judgment in the disability claimant's favor while it pursued an appeal (Theresa Sand-Smith v. Liberty Life Assurance Company of Boston, No. 17-0004, D. Mont., 2017 U.S. Dist. LEXIS 208486).



5th Circuit Says Genuine Dispute Exists As To Cause Of Disability
NEW ORLEANS - After finding that a disability claimant raised a genuine dispute of material fact as to the cause of his disability, the Fifth Circuit U.S. Court of Appeals on Dec. 29 reversed a district court's ruling against the claimant on a breach of contract claim (David M. Cox v. Provident Life and Accident Insurance Company, No. 16-60831, 5th Cir., 2017 U.S. App. LEXIS 27036).



Federal Judge Dismisses Breach Of Fiduciary Claim In Disability Benefits Suit
RICHMOND, Va. - A Virginia federal judge on Dec. 22 dismissed a breach of fiduciary duty claim against a long-term disability plan and its plan administrator after determining that the breach of fiduciary claim is a reformulation of the claimant's wrongful denial of benefits claim (Faye F. Archer v. SunTrust Bank, et al., No. 17-616, E.D. Va., 2017 U.S. Dist. LEXIS 211290).



5th Circuit Says 1-Year Statute Of Limitations Bars Disability Claimant's Suit
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on Dec. 14 affirmed a district court's ruling that a disability claimant's suit is barred under Louisiana's applicable one-year statute of limitations because the suit was not filed within a year after the claimant requested plan documents from the plan administrator (Todd M. Babin v. Quality Energy Services Inc., No. 17-30059, 5th Cir., 2017 U.S. App. LEXIS 25275).



Disability Claimant Not Entitled To Jury Trial; Demand For Jury Dismissed
MEMPHIS, Tenn. - A Tennessee federal judge on Dec. 20 granted a disability insurer's motion to dismiss as it pertained to a claimant's demand for a jury trial because the claimant is not entitled to a jury trial under the Employee Retirement Income Security Act (Patricia Bradshaw v. Principal Financial Group, et al., No. 17-2174, W.D. Tenn., 2017 U.S. Dist. LEXIS 209572).



Washington Federal Judge Grants Disability Claimant's Motion For Attorney Fees
TACOMA, Wash. - A Washington federal judge on Dec. 21 granted a disability claimant's motion for attorney fees after determining that the claimant was successful on the merits of his claim (Anthony Flaaen v. Principal Life Insurance Co. Inc., No. 15-5899, W.D. Wash., 2017 U.S. Dist. LEXIS 210284).



Additional Discovery Not Needed In Disability Suit, Maryland Federal Judge Says
BALTIMORE - A Maryland federal judge on Dec. 13 denied a disability claimant's motion to compel the production of documents related to the doctors who reviewed the claimant's case after determining that the administrative record is sufficient to determine whether the insurer operated under a conflict of interest (Karin Reidy v. The Unum Life Insurance Company of America et al., No. 16-2926, D. Md., 2017 U.S. Dist. LEXIS 204705).



Motion To Remand Denied; Disability Insurer Met Burden Of Proving Fraudulent Joinder
BIRMINGHAM, Ala. - An Alabama federal judge on Dec. 21 denied a disability claimant's motion to remand a suit seeking long-term disability benefits after determining that the disability insurer met its burden of proving that its insurance agents were fraudulently joined to defeat federal diversity jurisdiction (Glen L. Brawley, DMD v. Northwestern Mutual Life Insurance Co. et al., No. 17-1513, N.D. Ala., 2017 U.S. Dist. LEXIS 210031).



Change For Disability Plans' Claims Procedures To Be Effective April 1
WASHINGTON, D.C. - The U.S. Department of Labor (DOL) on Jan. 5 announced that a final rule amending the claims procedure requirements for employee disability benefit plans governed by the Employee Retirement Income Security Act will go into effect on April 1.



Fact Issues Exist On Cause Of Claimant's Disability, 11th Circuit Panel Says
ATLANTA - The 11th Circuit U.S. Court of Appeals on Nov. 17 remanded a disability claimant's suit after determining that a district court erred in granting summary judgment in favor of the insurer because genuine issues of material fact exist regarding the cause of the claimant's disability and whether the plan's pre-existing conditions exclusion applies (Kristian Horneland v. United of Omaha Insurance Co., No. 16-16935, 11th Cir., 2017 U.S. App. LEXIS 23129).



Termination Of LTD Benefits Supported By Medical Evidence, Appeals Panel Says
PHILADELPHIA - A district court did not err in finding that a disability insurer's termination of long-term disability benefits under the plan's any-occupation standard was not arbitrary and capricious because the termination is supported by substantial evidence, the Third Circuit U.S. Court of Appeals held Nov. 13 (Kristen Ann Davies v. First Reliance Standard Life Insurance Co., No. 17-1782, 3rd Cir., 2017 U.S. App. LEXIS 22656).



Federal Judge Says Claimant Cannot Perform Material Duties Of Any Occupation
SEATTLE - A plaintiff who is receiving long-term disability (LTD) benefits is entitled to waiver of premium (WOP) benefits under a life insurance policy because the plaintiff cannot perform the material duties of any occupation as she is unable to perform the material duties of any occupation on a full-time basis, a Washington federal judge said Dec. 4 in vacating the insurer's denial of WOP benefits (Adasha Turner v. Life Insurance Company of North America, No. 17-1, W.D. Wash., 2017 U.S. Dist. LEXIS 199004).



Denial Of LTD Claim Supported By Evidence, Pennsylvania Federal Judge Says
PHILADELPHIA - A Pennsylvania federal judge on Nov. 13 denied a disability claimant's motion for summary judgment and granted a disability plan's motion for summary judgment after determining that the plan's denial of the claim for long-term disability benefits was not arbitrary and capricious because the denial is supported by the evidence (Karen O'Conner v. The PNC Financial Services Group Inc. et al., No. 15-5051, E.D. Pa., 2017 U.S. Dist. LEXIS 186692).



Federal Judge Dismisses Disability Benefits Suit After Parties Reach Settlement
LOS ANGELES - A California federal judge on Nov. 29 dismissed a disability claimant's suit after the parties reached a settlement following remand of the suit from the Ninth Circuit U.S. Court of Appeals (Sonia Cruz-Baca v. Edison International Long Term Disability Plan, No. 14-7887, C.D. Calif., 2017 U.S. Dist. LEXIS 197347).



Offset Was Not Abuse Of Discretion, 9th Circuit Panel Says In Affirming
SAN FRANCISCO - A disability plan administrator did not abuse its discretion in offsetting a claimant's long-term disability (LTD) benefits to account for Social Security disability income (SSDI) benefits that she receives for her dependents, the Ninth Circuit U.S. Court of Appeals said Nov. 17 in affirming a district court's ruling for the plan (Susan Rene Jones v. Life Insurance Company of North America, et al., No. 16-16172, 9th Cir., 2017 U.S. App. LEXIS 23244).



Disability Insurer Says 2nd Circuit Incorrectly Found Offset Is Barred
WASHINGTON, D.C. - Review of the Second Circuit U.S. Court of Appeals' ruling that New York law bars the offset of a claimant's disability benefits with the proceeds of the claimant's settlement of a personal injury suit is warranted because the Employee Retirement Income Security Act preempts the New York law at issue, a disability insurer argues in a Nov. 17 reply brief filed in the U.S. Supreme Court (Aetna Life Insurance Co. v. Salvatore Arnone, No. 17-416, U.S. Sup., 2017 U.S. S. Ct. Briefs LEXIS 4511).



Rhode Island Federal Judge Determines That De Novo Standard Of Review Applies
PROVIDENCE, R.I. - A Rhode Island federal judge on Dec. 1 determined that de novo standard of review must be applied in a dispute alleging wrongful termination of disability benefits because the plan in effect when the benefits claim was filed did not grant discretionary authority to the plan insurer (Nancy A. Tullie v. The Prudential Life Insurance Company of America, No. 16-662, D. R.I., 2017 U.S. Dist. LEXIS 198365).



Pennsylvania Federal Judge Says ERISA Applies To Subrogation Dispute
SCRANTON, Pa. - A Pennsylvania federal judge on Dec. 1 denied a plaintiff's motion to remand a suit seeking a declaration that a recovery service company hired by a disability insurer is not entitled to collect reimbursement for paid disability benefits because the Employee Retirement Income Security Act applies to the dispute and, therefore, federal subject matter jurisdiction exists (Denise Wingo v. Trover Solutions Inc., No. 17-846, M.D. Pa., 2017 U.S. Dist. LEXIS 197751).



Federal Magistrate Judge Says ERISA Preempts Intentional Inducement Claim
PITTSBURGH - A Pennsylvania federal magistrate judge on Nov. 28 recommended the dismissal a claim alleging intentional inducement to breach a contract of confidentiality against a disability plan administrator and one of its case managers after determining that the claim is preempted by the Employee Retirement Income Security Act because the claim relates to the claimant's denial of benefits under an ERISA plan (Gregory Addington v. Senior Vice President - Human Resources, Consol Energy Inc., No. 17-444, W.D. Pa., 2017 U.S. Dist. LEXIS 196020).



Negligence Claim For Practice Of Medicine Without License Is Preempted By ERISA, Judge Says
LEXINGTON, Ky. - A Kentucky federal judge on Nov. 28 determined that a plaintiff's claim for negligence per se for the practice of medicine without a license based on a defendant's certification of information about the plaintiff's disability without approval from the plaintiff's doctor is preempted by the Employee Retirement Income Security Act and must be dismissed (Mark Morcus v. Medi-Copy Services Inc., et al., No. 17-229, E.D. Ky., 2017 U.S. Dist. LEXIS 195485).



California Federal Judge Transfers Disability Suit To New Jersey Federal Court
SAN FRANCISCO - A California federal judge on Nov. 16 granted a disability insurer's motion to transfer a disability claimant's suit to New Jersey federal court after determining that New Jersey is the more convenient forum for the parties and for the witnesses (Ernest Tarasovsky v. The Guardian Life Insurance Company of America, No. 17-03464, N.D. Calif., 2017 U.S. Dist. LEXIS 189926).



Disability Income Insurer Must Produce Documents Pertaining To Claims Decision
COLUMBUS, Ohio - Following an in camera review, an Ohio federal magistrate judge on Nov. 27 granted an insured's motion to compel the production of seven documents after determining that the documents will help to determine whether the insurer acted in bad faith in its handling of the insured's disability income claim (Mukesh R. Shah, M.D. v. Metropolitan Life Insurance Co., et al., No. 16-1124, S.D. Ohio, 2017 U.S. Dist. LEXIS 194347).



Discovery Outside Of Administrative Record Is Not Warranted, Judge Says
BALTIMORE - A disability claimant is not permitted to conduct discovery outside of the administrative record because the claimant failed to identify any specific need for extra-record discovery, a Maryland federal judge said Nov. 16 (Amy Silverstone v. Reliance Standard Life Insurance Co., No. 17-0111, D. Md., 2017 U.S. Dist. LEXIS 189528).



Department Of Labor Delays Change For Disability Plan Claims Procedures
WASHINGTON, D.C. - The U.S. Department of Labor's Employee Benefits Security Administration on Nov. 29 published a notification in the Federal Register of a 90-day delay in the applicability of a final rule amending the claims procedure requirements that are applicable to employee disability benefit plans governed by the Employee Retirement Income Security Act.