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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®



 



Disability Claimant Failed To Provide Objective Medical Evidence To Support Claim
CINCINNATI - A disability plan administrator did not act arbitrarily or capriciously in denying a plan participant's claims for short-term disability benefits because the participant failed to provide objective medical evidence supporting the disability, the Sixth Circuit U.S. Court of Appeals said Oct. 10 (Rebecca Filthaut v. AT&T Midwest Disability Benefit Plan et al., No. 16-2707, 6th Cir., 2017 U.S. App. LEXIS 19882).



Termination Of Disability Benefits Was Arbitrary And Capricious, Federal Judge Says
NEWARK, N.J. - A disability insurer's termination of long-term disability benefits after approving the claimant's benefits for seven years was arbitrary and capricious because the insurer failed to properly define the material duties of the claimant's occupation and because the evidence does not support the insurer's termination, a New Jersey federal judge said Oct. 23 (Christopher Patterson v. Aetna Life Insurance Co., No. 15-8156, D. N.J., 2017 U.S. Dist. LEXIS 175543).



Disability Insurer Did Not Act In Bad Faith In Failing To Pay Disability Claim
MOBILE, Ala. - A disability insurer did not act in bad faith in investigating and in failing to pay a disability claim because the insurer conducted an extensive investigation into the claim and had an arguable and debatable reason for denying the claim, an Alabama federal judge said Oct. 24 in granting the insurer's motion for summary judgment (Scott R. Weisberg, M.D., v. Guardian Life Insurance Company of America et al., No. 16-568, N.D. Ala., 2017 U.S. Dist. LEXIS 176021).



California Federal Judge Allows Disability Claimant's Amended Complaint On ERISA Claim
SAN FRANCISCO - A disability claimant is permitted to amend a complaint against a disability plan but only as it pertains a wrongful denial of benefits claim alleged under the Employee Retirement Income Security Act, a California federal judge said Oct. 19 (Vanmark Strickland v. AT&T West Disability Benefits Program, No. 17-1393, N.D. Calif., 2017 U.S. Dist. LEXIS 174357).



Disability Claimant's Suit Dismissed After Failure To File Amended Complaint
PHILADELPHIA - A Pennsylvania federal judge on Oct. 31 dismissed a disability claimant's suit because the claimant failed to file an amended complaint pursuant to the court's prior order and because the claimant has not communicated with the court in nine months (Albert Yerke v. Aetna, No. 16-06512, E.D. Pa., 2017 U.S. Dist. LEXIS 179958).



Disability Claimant Must File Proposed Amendment, Tennessee Federal Judge Says
MEMPHIS, Tenn. - A disability claimant alleging that her long-term benefits were wrongfully terminated must provide the details of a proposed amendment to a complaint before a ruling can be made on whether the claimant is entitled to file an amended complaint, a Tennessee federal judge said Oct. 18 in reserving a ruling on the motion (Patricia Bradshaw v. Principal Financial Group, et al., No. 17-2174, W.D. Tenn., 2017 U.S. Dist. LEXIS 172072).



Disability Insurer Erred In Applying Pre-Existing Condition Exclusion
FLINT, Mich. - A Michigan federal judge on Nov. 2 granted judgment in favor of a disability claimant after rejecting the disability insurer's argument that the plan's pre-existing condition exclusion barred coverage for the claimant's disability (Cheryl L. Wallace v. Beaumont Healthcare Employee Welfare Benefit Plan, et al., No. 16-10625, E.D. Mich., 2017 U.S. Dist. LEXIS 182028).



Disability Insurer Erred In Determining Claimant's Date Of Disability, Panel Says
ATLANTA - A disability insurer acted arbitrarily and capriciously in determining the date of a claimant's disability, the 10th Circuit U.S. Court of Appeals said Oct. 17 in reversing a district court's judgment in favor of the insurer (Greggory B. Owings v. United Of Omaha Life Insurance Co., No. 16-3128, 10th Cir., 2017 U.S. App. LEXIS 20228).



Disability Claimant Properly Exhausted Administrative Remedies, Federal Judge Says
PEORIA, Ill. - An Illinois federal judge on Oct. 10 denied a motion to dismiss a complaint alleging wrongful denial of disability benefits after determining that the claimant exhausted her administrative remedies by submitting additional medical evidence in response to the disability insurer's denial of her claim (Sherry Meyer v. Group Long Term Disability Plan for Employees of Edward D. Jones & Co. L.P., et al., No. 16-1282, C.D. Ill., 2017 U.S. Dist. LEXIS 166947).



Federal Judge Dismisses Breach Of Fiduciary Claim Based On Misrepresentation
SCRANTON, Pa. - A Pennsylvania federal judge on Oct. 27 reiterated that a section of Pennsylvania's motor vehicle statute "regulates insurance" and is therefore saved from preemption under the Employee Retirement Income Security Act but said that the plaintiffs' claim for breach of fiduciary duty based on a disability insurer's misrepresentations must be dismissed because it is not clear that the insurer misrepresented the terms of the plan at issue (Eric Yost, et al. v. Anthem Life Insurance Co., No. 3:16-cv-00079, M.D. Pa.; 2017 U.S. Dist. LEXIS 178883).



Ohio Federal Judge Dismisses Breach Of Fiduciary Duty Claim In Disability Benefits Suit
COLUMBUS, Ohio - An Ohio federal judge on Oct. 10 dismissed a claim for breach of fiduciary duty alleged against a disability insurer because the same equitable relief sought by the disability claimant can be obtained if the claimant prevails on his claim seeking recovery of disability benefits (Edward Osborn Sr. v. Principal Life Insurance Co., No. 17-329, S.D. Ohio, 2017 U.S. Dist. LEXIS 166877).



Missouri Federal Judge Dismisses Disability Suit On Preemption Basis
CAPE GIRARDEAU, Mo. - A Missouri federal judge on Nov. 3 granted a disability insurer's motion to dismiss a claimant's suit alleging that the insurer acted in bad faith in denying a claim for disability benefits because the claimant's state law claims are preempted by the Employee Retirement Income Security Act and the claimant alleged no ERISA claims that can withstand dismissal (Patricia Carmack v. Liberty Life Assurance Company of Boston, No. 17-121, E.D. Mo., 2017 U.S. Dist. LEXIS 182319).



Disability Claimant's Amended Complaint Dismissed; Claims Not Timely, Judge Says
MIAMI - A Florida federal judge on Oct. 30 dismissed a disability claimant's amended complaint after determining that the claims alleged against the disability insurer are barred by Florida's applicable statutes of limitations (Victor Gonzalez-Guzman v. Metropolitan Life Insurance Co., No. 17-20107, S.D. Fla., 2017 U.S. Dist. LEXIS 179259).



Disability Claimant Permitted To Conduct Discovery Outside Of Administrative Record
WICHITA, Kan. - A disability claimant is permitted to conduct limited discovery outside of the administrative record, a Kansas federal magistrate judge said Oct. 10 after determining that the claimant met her burden of showing that "some limited extra-record discovery" is relevant and appropriate as it applies to the defendant's dual role of plan insurer and plan administrator (Karen A. Baty v. Metropolitan Life Insurance Co., 17-1200, D. Kan., 2017 U.S. Dist. LEXIS 171014).



Washington Federal Judge Denies Disability Claimant's Motion To Supplement Record
SEATTLE - A Washington federal judge on Nov. 8 denied a disability claimant's motion to supplement the administrative record with a disability benefits decision made by the Social Security Administration because the claimant failed to establish the existence of any exceptional circumstances to warrant supplementing the record (Kristen Reetz v. Hartford Life and Accident Insurance Co., No. 17-84, W.D. Wash., 2017 U.S. Dist. LEXIS 185362).



N.Y. Federal Judge Says Disability Claimant's Request Was Properly Denied
NEW YORK - A New York federal judge on Oct. 12 overruled a disability claimant's objections to a magistrate judge's order denying the claimant's request for statistical information on claim acceptance rates by a disability insurer after determining that the requested statistics do not directly relate to the disability claim at issue (Cherylle McFarlane v. First Unum Life Insurance Co., No. 16-7806, S.D. N.Y., 2017 U.S. Dist. LEXIS 169052).



Denial Of Appellate Attorney Fees In Disability Dispute Was An Abuse Of Discretion
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Oct. 31 reversed a district court's denial of attorney fees to a disability plan acting on behalf the plan participant after determining that the plan is entitled to collect the attorney fees it incurred as result of the disability insurer's appeal and that the district court's denial of attorney fees was an abuse of discretion (John Paul Micha M.D., v. Sun Life Assurance Of Canada, Inc., No. 16-55053, 9th Cir., 2017 U.S. App. LEXIS 21800).



Montana Federal Judge Awards Disability Claimant Attorney Fees
BILLINGS, Mont. - A Montana federal judge on Oct. 23 granted a disability claimant's motion for more than $28,000 in attorney fees because the claimant prevailed on her claim for disability benefits and the disability insurer failed to file a response to the claimant's motion (Theresa Sand-Smith v. Liberty Life Assurance Company of Boston, No. 17-0004, D. Mont., 2017 U.S. Dist. LEXIS 175177).



Vocational Assessment Was Flawed, Disability Claimant Is Owed Benefits, Judge Says
TACOMA, Wash. - A Washington federal judge on Sept. 27 granted judgment in favor of a disability claimant after determining that the insurer's vocational assessment was flawed because the assessment relied on unsupported information taken from the claimant's social media profiles to conclude that the claimant had enough experience to secure a job in the media industry (Anthony Flaaen v. Principal Life Insurance Co. Inc., No. 15-5899, W.D. Wash., 2017 U.S. Dist. LEXIS 159142).



9th Circuit Panel Says Denial Of Disability Benefits Was Reasonable Decision
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Sept. 18 affirmed a district court's finding that a disability insurer's denial of benefits was reasonable, noting that the medical evidence supports the insurer's determination (Nannette Fawn Anderson v. Life Insurance Company of North America, No. 16-15522, 9th Cir., 2017 U.S. App. LEXIS 18055).



Disability Insurer Considered All Medical Records Before Denying LTD Claims
SAN JOSE, Calif. - A California federal judge on Sept. 7 granted a disability insurer's motion for summary judgment after determining that the insurer thoroughly considered all of the medical records before finding that the claimant was not entitled to long-term disability benefits (Robert Gordon v. Metropolitan Insurance Co., No. 10-5399, N.D. Calif., 2017 U.S. Dist. LEXIS 145200).



Illinois Federal Judge Says Disability Insurer Reasonably Terminated Benefits
CHICAGO - A disability insurer did not breach its contract or act unreasonably by terminating a claimant's total disability benefits because the evidence shows that the claimant was able to undertake a number of mentally and physically demanding activities, an Illinois federal judge said Sept. 14 (Henry G. Fiorentini v. Paul Revere Life Insurance Co., No. 15-3292, N.D. Ill., 2017 U.S. Dist. LEXIS 149392).



Appellate Panel Refuses To Rehear Plan's Arguments In Disability Benefits Suit
WASHINGTON, D.C. - A District of Columbia Circuit U.S. Court of Appeals panel on Sept. 11 refused to reconsider its finding that a woman was totally disabled under the terms of her Employee Retirement Income Security Act-governed long-term disability plan and that the plan administrator did not satisfactorily supported its conclusion that she was ever capable of full-time work after November 2007 (Jill Marcin v. Reliance Standard Life Insurance Co., et al., No. 16-7125, D.C. Cir., 2017 U.S. App. LEXIS 17551).



Disability Insurer's Benefits Denial Was Not Arbitrary, Capricious, Federal Judge Says
YOUNGSTOWN, Ohio - An Ohio federal judge on Sept. 25 determined that a disability insurer's denial of long-term disability (LTD) benefits based on the plan's any-occupation standard was not arbitrary and capricious and found merit in the insurer's argument that the claimant's history of drug abuse would preclude him from benefits under the plan's two-year limitation provision for drug and alcohol abuse (Robert M. Hoperich v. Aetna Life Insurance Co., No. 16-2590, N.D. Ohio, 2017 U.S. Dist. LEXIS 156490).



Colorado Federal Judge Affirms Denial Of LTD Claim Based On Pre-Existing Limitation
DENVER - A Colorado federal judge on Sept. 29 determined that a plan administrator's denial of long-term disability (LTD) benefits based on the plan's pre-existing condition limitation was not arbitrary and capricious because substantial evidence supports the plan administrator's finding that the disability for which the claimant sought benefits was likely caused by a pre-existing condition (Michael Green v. Life Insurance Company of North America, No. 16-2366, D. Colo., 2017 U.S. Dist. LEXIS 160900).



Claimant Failed To Prove Her Disability Had A Physical Component, 9th Circuit Holds
SAN FRANCISCO - A district court correctly concluded that a disability claimant is not entitled to long-term disability benefits because the claimant failed to prove that her disability had a physical component that would not be excluded under the plan's mental-health limitation, the Ninth Circuit U.S. Court of Appeals ruled Sept. 11 (Leah A. Bilyeu v. Morgan Stanley Long Term Disability Plan, et al., No. 16-15254 No. 16-15314, 9th Cir., 2017 U.S. App. LEXIS 17510).



Mental Illness Limitation Is Not Valid Under Montana's Mental Health Parity Law
BILLINGS, Mont. - A Montana federal judge on Sept. 20 granted a disability claimant's motion for summary judgment after determining that Montana's mental health parity law requires the plan to provide the claimant with the same benefits for her mental illness as it would if her disability were physical (Theresa Sand-Smith v. Liberty Life Assurance Company of Boston, No. 17-0004, D. Mont., 2017 U.S. Dist. LEXIS 153217).



Termination Of Disability Benefits Based On Plan's Limitation Was Reasonable
SAN FRANCISCO - A disability insurer's termination of benefits based on the plan's self-reported symptoms limitation was reasonable because the claimant did not provide any additional evidence supporting her disability, the Ninth Circuit U.S. Court of Appeals said Sept. 22 (Robin Curran v. United of Omaha Life Insurance Co., and United of Omaha Life Insurance Co. v. Robin Curran, Nos. 15-56599, 15-56668, 9th Cir., 2017 U.S. App. LEXIS 18443).



Arbitrary And Capricious Standard Of Review Applies In Disability Benefits Dispute
NEW YORK - An arbitrary and capricious standard of review will be applied in a disability benefits dispute because the plan at issue clearly granted discretionary authority to the insurer and the claimant failed to carry the burden of proving that a de novo standard of review should be applied, a New York federal judge said Sept. 26 (Laurie Tietjen v. Unum Life Insurance Company of America, No. 16-7021, S.D. N.Y., 2017 U.S. Dist. LEXIS 157721).



Disability Insurer Seeks High Court's Review Of 2nd Circuit's Offset Ruling
WASHINGTON, D.C. - The Second Circuit U.S. Court of Appeals erred in finding that New York law bars the offset of disability benefits when a claim for personal injuries is settled because the decision conflicts with rulings in other circuits and because the New York law is preempted by the Employee Retirement Income Security Act, a disability insurer argues in a Sept. 19 petition for writ of certiorari 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 3637).



U.S. Supreme Court Won't Consider Whether Negligence Claim Is Preempted By ERISA
WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 2 denied a disability claimant's petition for writ of certiorari of the Sixth Circuit U.S. Court of Appeals' decision that a negligence claim is completely preempted by the Employee Retirement Income Security Act (Samantha Milby v. MCMC LLC, No. 16-1409, U.S. Sup.).



High Court Refuses To Consider Preemption Ruling In Disability Suit
WASHINGTON, D.C. - The U.S. Supreme Court on Oct. 2 refused to review the Sixth Circuit U.S. Court of Appeals' decision that a former marketing director's claims for disability insurance coverage against a medical review company are completely preempted by the Employee Retirement Income Security Act (James Hackney v. Allmed Healthcare Management Inc., No. 17-102, U.S. Sup.).



Award Of Attorney Fees Warranted As Disability Claimant Achieved Some Success
SAN FRANCISCO - A California federal judge on Sept. 14 awarded a disability claimant more than $100,000 in attorney fees after determining that the award was warranted because the claimant achieved "some degree" of success on the merits (Robert Bosley v. Metropolitan Life Insurance Co., No. 16-00139, N.D. Calif., 2017 U.S. Dist. LEXIS 149453).



California Federal Judge Allows Disability Claimant To Remain Anonymous
SACRAMENTO, Calif. - A California federal judge on Sept. 12 granted a disability claimant's motion for leave to proceed anonymously after determining that the private facts at issue and the absence of a compelling interest in exposing the claimant's identity warrant anonymity (Jane Doe v. Hartford Fire Insurance Company Employee Income Protection Plan, No. 17-1714, E.D. Calif., 2017 U.S. Dist. LEXIS 147786).



Woman Should Not Be Released Pending Appeal Of Fraud Conviction, Judge Says
SACRAMENTO, Calif. - A woman who was convicted on one count of making false statements to a grand jury as part of its investigation of a scheme involving fraudulent employment insurance benefits and disability claims should not be released on bail pending her appeal, a federal judge in California ruled Aug. 23, finding that the appeal does not raise substantial questions (United States of America v. Harjit Kaur Johal, No. 14-cr-00169-GEB, E.D. Calif., 2017 U.S. Dist. LEXIS 135345).



Disability Plan Failed To Consider Reliable Evidence, 9th Circuit Panel Says
SAN FRANCISCO - A district court erred in finding that a disability plan administrator did not abuse its discretion in terminating a claimant's benefits because the plan failed to consider reliable evidence in support of the plan participant's claim, the Ninth Circuit U.S. Court of Appeals said Sept. 6 in reversing and remanding the lower court's ruling in favor of the plan (Sonia Cruz-Baca v. Edison International Long Term Disability Plan, No. 15-56921, 9th Cir., 2017 U.S. App. LEXIS 17214).



District Court Correctly Found Disability Claimant Is Owed Benefits, Panel Says
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Aug. 28 affirmed a district court's reinstatement of a disability claimant's long-term disability (LTD) benefits after determining that the lower court did not err in finding that the claimant submitted sufficient medical evidence supporting his inability to work (Mohamed Ahmed Mokbel-Aljahmi v. United Omaha Life Insurance Co., No. 16-2616, 6th Cir., 2017 U.S. App. LEXIS 16587).



Federal Judge Remands LTD Claim To Plan Administrator For Full, Fair Review
PHOENIX - A disability insurer abused its discretion by failing to consider all of the available evidence and by failing to engage in a meaningful dialogue with the claimant during the handling of the benefits claim, an Arizona federal judge said Sept. 1 in remanding the claim to the plan administrator (Wendy S. Vaughan v. Reliance Standard Life Insurance Co., No. 16-341, D. Ariz., 2017 U.S. Dist. LEXIS 143169).



Claimant Failed To Prove She Is Disabled Under Terms Of Plan, Federal Judge Says
KALAMAZOO, Mich. - A Michigan federal judge on Aug. 22 denied a disability claimant's motion for summary judgment after determining that the claimant failed to prove by a preponderance of the evidence that she was disabled under the plan at issue (Andrea Irwin v. Mutual of Omaha Insurance Co., No. 16-982, W.D. Mich., 2017 U.S. Dist. LEXIS 133606).



Disability Claimant Failed To Prove Reconsideration Is Warranted, Federal Judge Says
ATLANTA - A Georgia federal judge on Aug. 28 denied a disability claimant's motion to reconsider because the claimant failed to prove that there were any manifest errors of fact warranting reconsideration of the court's finding that the claimant is not entitled to benefits under a policy's lifetime sickness rider (William F. Nefsky v. Unum Life Insurance Company of America, No. 15-2119, N.D. Ga., 2017 U.S. Dist. LEXIS 137596).



11th Circuit Says Disability Plan's Pre-Existing Condition Provision Does Not Apply
ATLANTA - The 11th Circuit U.S. Court of Appeals on Aug. 31 reversed and remanded a district's court ruling after determining that a disability insurer's denial of benefits based on the plan's pre-existing condition provision was not reasonable because there is no evidence that the claimant's healthy pregnancy caused or contributed to a stroke suffered by the claimant six months after her child was born (Julissa Bradshaw v. Reliance Standard Life Insurance Co., No. 16-11125, 11th Cir., 2017 U.S. App. LEXIS 16779).



Disability Claimant Not Disabled From Any Gainful Occupation, Federal Judge Says
DETROIT - A Michigan federal judge on Aug. 31 denied a disability claimant's motion for summary judgment and granted a disability plan's motion for summary judgment after determining that the evidence supports the plan's determination that the claimant was not disabled from performing the duties of any gainful occupation (Lisa Chester v. Mutual of Omaha Insurance Co., No. 16-11647, E.D. Mich., 2017 U.S. Dist. LEXIS 140569).



Disability Insurer Did Not Misclassify Claimant's Own Occupation, Federal Judge Says
KALAMAZOO, Mich. - A disability insurer did not act arbitrarily and capriciously when it classified a claimant's own occupation as sedentary because it relied on information from the claimant and the claimant's employer, a Michigan federal judge said Aug. 15 (Daniel Venier v. Liberty Life Assurance Company of Boston, No. 15-1016, W.D. Mich., 2017 U.S. Dist. LEXIS 129691).



Appeals Panel Says ERISA Preempts California Law Barring Discretionary Clauses
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Aug. 15 vacated and remanded a district court's ruling that a de novo standard of review rather than an abuse of discretion standard of review should be applied in a disability benefits dispute because the Employee Retirement Income Security Act preempts the application of California's insurance law, which prohibits the use of discretionary clauses (Yvette Williby v. Aetna Life Insurance Co., No. 15-56394, 9th Cir., 2017 U.S. App. LEXIS 15213).



County Plan Is Preempted Under ERISA Governmental Plan Exemption, Judge Says
SAN JOSE, Calif. - A California federal judge on Aug. 9 determined that the governmental plan exemption to the Employee Retirement Income Security Act applies to preempt a county disability plan from ERISA because the county "maintained" the long-term disability plan (Roxy Hariri v. Reliance Standard Life Insurance Co., No. 15-3054, N.D. Calif., 2017 U.S. Dist. LEXIS 126491).



6th Circuit Correctly Found Disability Claims Preempted By ERISA, Respondent Says
WASHINGTON, D.C. - The U.S. Supreme Court should deny a petition for writ of certiorari because the Sixth Circuit U.S. Court of Appeals correctly determined that a former marketing director's claims for coverage against a medical review company are completely preempted by the Employee Retirement Income Security Act and because there is no split in authority regarding whether medical licensing claims are completely preempted by ERISA (James Hackney v. Allmed Healthcare Management Inc., No. 17-102, U.S. Sup., 2017 U.S. S. Ct. Briefs LEXIS 3012).



Respondent Files Response, Argues Negligence Claim Is Preempted By ERISA
WASHINGTON, D.C. - The Sixth Circuit U.S. Court of Appeals correctly followed the U.S. Supreme Court's analysis for complete preemption when it determined that a negligence claim is completely preempted by the Employee Retirement Income Security Act, a disability claims reviewer argues in its Aug. 11 response to the disability claimant's petition for writ of certiorari filed in the high court (Samantha Milby v. MCMC LLC, No. 16-1409, U.S. Sup., 2017 U.S. S. Ct. Briefs LEXIS 2883).



Disability Claimant Awarded Attorney Fees After Reduction In Attorneys' Billable Hours
YOUNGSTOWN, Ohio - An Ohio federal judge on Aug. 23 awarded a disability claimant more than $21,000 in attorney fees after reducing the amount of hours billed by the claimant's attorneys for prelitigation fees and attorney-fee-related work as those hours cannot be recovered (Tina Myers v. Mutual of Omaha Life Insurance Co., No. 14-2421, N.D. Ohio, 2017 U.S. Dist. LEXIS 135079).



Disability Insurer Cannot Add Medical Records To Trial Exhibit, Federal Judge Says
PHOENIX - An Arizona federal judge on Aug. 29 denied a disability insurer's request to allow additional medical records to be added to a claims file for use as a trial exhibit after determining that the request is untimely and would be prejudicial to the disability claimant (Benjamin McClure v. Country Life Insurance Company, et al., No. 15-2597, D. Ariz., 2017 U.S. Dist. LEXIS 138530).