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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 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).



11th Circuit Affirms Finding That Insurer's Termination Of Benefits Was Reasonable
ATLANTA - The 11th Circuit U.S. Court of Appeals on July 12 affirmed a district court's ruling that a disability insurer's termination of long-term care disability benefits was reasonable based on the evidence properly considered by the insurer (David Carr v. John Hancock Life Insurance Company USA, No. 16-17134, 11th Cir., 2017 U.S. App. LEXIS 12404).



Insurer's Vocational Assessment Was Not Flawed, Mississippi Federal Judge Says
JACKSON, Miss. - A disability insurer's denial of long-term disability benefits was not an abuse of discretion, a Mississippi federal judge said July 11 after rejecting the claimant's argument that the insurer's assessment of her occupation was flawed (Theresa A. Taylor v. The Prudential Insurance Company of America, No. 12-702, S.D. Miss., 2017 U.S. Dist. LEXIS 106783).



Plan Must Consider How Carpal Tunnel Affects Ability To Perform Own Occupation
CHICAGO - An Illinois federal judge on July 31 vacated and remanded a disability plan's denial of a long-term disability benefits claim after determining that the plan failed to consider how the claimant's carpal tunnel syndrome would affect her ability to perform the duties of her own occupation (Jodi Suson v. The PNC Financial Services Group Inc. and Affiliates Long Term Disability Plan, et al., No. 15-10817, N.D. Ill., 2017 U.S. Dist. LEXIS 119473).



Disability Claimant Met Burden Of Proving She Was Disabled Under Plan
SAN FRANCISCO - A California federal judge on July 24 determined that a disability claimant is entitled to long-term disability benefits because the claimant met her burden of proving that she was disabled according to the terms of the plan at issue (Hadar Meiri v. Hartford Life and Accident Insurance Co., No. 16-103, N.D. Calif., 2017 U.S. Dist. LEXIS 115224).



Maryland Federal Judge: Denial Of Disability Benefits Was Arbitrary, Capricious
BALTIMORE - A Maryland federal judge on July 21 granted a disability claimant's motion for summary judgment after determining that a disability insurer's denial of benefits was arbitrary and capricious because substantial evidence does not support the denial (Wiley Joseph Smith v. The PNC Financial Services Group, et al., No. 15-2232, D. Md., 2017 U.S. Dist. LEXIS 113683).



Alabama Federal Magistrate Recommends Disability Claim Be Remanded For Review
DOTHAN, Ala. - An Alabama federal magistrate judge on July 13 recommended that a disability claimant's motion for summary judgment be granted and that the claim be remanded to the plan administrator for consideration because the termination of benefits was not reasonable based on the medical evidence (Richard O. Shultz v. Aetna Life Insurance Co., et. al., No. 16-94, M.D. Ala., 2017 U.S. Dist. LEXIS 109654).



Federal Judge Remands A Portion Of Claim For Disability Benefits
NEW YORK - A New York federal judge on July 24 adopted a federal magistrate's recommendation to remand a long-term disability claim as it pertained to the claimant's physical disability, but not the claimant's psychiatric disability, because the evidence may support a finding that the claimant is physically disabled according to the terms of the plan (Marie Richter v. Metropolitan Life Insurance Co., No. 15-8266, S.D. N.Y., 2017 U.S. Dist. LEXIS 115119).



Disability Plan's Discretionary Authority Provision Is Void Under California Law
SACRAMENTO, Calif. - A de novo standard of review must be applied in a denial of disability benefits suit because the disability plan's discretionary authority provision is not valid under California law, a California federal judge said July 12 in granting the disability claimant's motion for summary judgment (Renee Johnson Monroe v. Metropolitan Life Insurance Co., No. 15-2079, E.D. Calif., 2017 U.S. Dist. LEXIS 109012).



Interpretation Of Plan's Terms Was Reasonable Based On Extrinsic Evidence
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on July 28 affirmed a district court's ruling that a pension plan had the discretion to decide which level of disability retirement benefits should be paid to a plan participant and that the interpretation of the plan's terms by the plan's board of trustees was reasonable based on the extrinsic evidence (Harold Davis v. Pension Trust Fund for Operating Engineers, et al., No. 15-17212, 9th Cir., 2017 U.S. App. LEXIS 13727).



LTD Plan Is Ambiguous As To Whether Insurer's Offset Was Permitted, Panel Says
NEW ORLEANS - A district court did not err in finding that a disability insurer abused its discretion in offsetting a claimant's long-term disability benefits because the plan is ambiguous as to whether a direct rollover of pension funds to an individual retirement account entitles the insurer to offset the claimant's disability benefits, the Fifth Circuit U.S. Court of Appeals said July 18 (Joel Thomason v. Metropolitan Life Insurance Co., et al., No. 16- 10634, 5th Cir., 2017 U.S. App. LEXIS 12932).



Disability Insurer Did Not Breach Contract By Enforcing Offset Provision
PHOENIX - An Arizona federal judge on Aug. 7 denied a disability claimant's motion for partial summary judgment on the basis that the insurer did not breach its contract by enforcing the policy's offset provision when it reinstated the claimant's disability benefits (Benjamin McClure v. Country Life Insurance Company, et al., No. 15-2597, D. Ariz., 2017 U.S. Dist. LEXIS 123967).



Federal Judge Dismisses Disability-Related Coverage Claims As Time-Barred
SAN DIEGO - A California federal judge on Aug. 3 granted an insurer's motion to dismiss claims for breach of contract and fraud in relation to its denial of long-term disability (LTD) benefits for a university employee, finding that all of the employee's claims were untimely (Laurel Davis v. Liberty Life Assurance Company of Boston, No. 3:17-cv-00738, S.D. Calif., 2017 U.S. Dist. LEXIS 122776).



Plan Will Not Be Prejudiced If Disability Claimant Proceeds Under Pseudonym
OAKLAND, Calif. - A California federal judge on July 26 granted a disability claimant's motion to proceed under a pseudonym after determining that the need for anonymity outweighs prejudice to the defendant and the public's interest in knowing the claimant's identity (John Doe v. Lincoln National Life Insurance Co., No. 17-3963, N.D. Calif., 2017 U.S. Dist. LEXIS 117110).



Attorney Fees Awarded To Disability Claimant, But No Contingency Enhancement
DETROIT - A Michigan federal judge on Aug. 1 granted a disability claimant's motion for attorney fees because the claimant achieved a modest level of success on the merits, but the judge refused to apply a contingency enhancement, as requested by the claimant's attorney, after determining that a contingency enhancement is not appropriate when using the lodestar model to calculate the appropriate amount of attorney fees (Kyle D. Kennard v. Means Industries Inc., No. 11-15079, E.D. Mich., 2017 U.S. Dist. LEXIS 120457).



Disability Claimant Awarded Attorney Fees, Costs As The Prevailing Party
LOS ANGELES - A California federal judge on July 24 awarded a disability claimant more than $100,000 in attorney fees and costs because the claimant prevailed on his claim for disability benefits (Avery Armani v. Northwestern Mutual Life Insurance Co., et al., No. 13-7058, C.D. Calif., 2017 U.S. Dist. LEXIS 117203).



Missouri Federal Judge Grants Limited Discovery In Disability Benefits Suit
ST. LOUIS - A Missouri federal judge on July 11 partially granted a disability claimant's motion for additional discovery, but only as it pertained to a plan administrator's claims-handling guidelines, an administrative services agreement and a limited number of documents from a third-party vendor responsible for conducting independent medical reviews on behalf of the plan administrator (Teresa Heartsill v. Ascension Health Alliance et al., No. 17-155, E.D. Mo., 2017 U.S. Dist. LEXIS 106749).



Disability Insurer's Denial Of Benefits Supported By Medical Records, Panel Says
ST. LOUIS - A disability insurer did not abuse its discretion in denying a claim for disability benefits because the medical records and evidence support the insurer's denial, the Eighth Circuit U.S. Court of Appeals said July 5 (Michelle E. Cooper v. Metropolitan Life Insurance Company, No. 16-3429, 8th Cir., 2017 U.S. App. LEXIS 11933).



Denial Of Disability Claim Was Reasonable Based On Evidence, Federal Judge Says
DETROIT - A disability insurer did not act arbitrarily and capriciously in denying a claim for disability benefits because the medical evidence supports the denial of benefits and the claimant failed to provide any evidence to rebut the insurer's evidence, a Michigan federal judge said June 20 (Philip J. Holmes v. Aetna Life Insurance Co., et al., No. 16-11538, E.D. Mich., 2017 U.S. Dist. LEXIS 94258).



Disability Plan Did Not Abuse Its Discretion By Denying Benefits Claim, Judge Says
HOUSTON - A Texas federal judge on June 14 granted a disability plan's motion for judgment on the administrative record after determining that the plan did not abuse its discretion when it denied a former National Football League player's disability claim (Brian C. Jackson v. NFL Disability and Neurocognitive Benefit Plan, et al., No. 16-1278, S.D. Texas, 2017 U.S. Dist. LEXIS 91042).



Wisconsin Federal Judge Finds Termination Of Benefits Was Not Arbitrary
MADISON, Wis. - A Wisconsin federal judge on June 14 granted summary judgment in favor of a disability plan after determining that the plan's decision to terminate a claimant's benefits after learning that the claimant worked as a dog trainer was not arbitrary and capricious (Sarah B. Kalnajs v. The Lilly Extended Disability Plan, No. 16-62, W.D. Wis., 2017 U.S. Dist. LEXIS 91276).



Disability Claimant's Evidence Supports Finding That Benefits Are Owed
NEW YORK - A New York federal magistrate judge on June 13 recommended that a disability claimant's motion for summary judgment be granted because the medical opinions of the insurer's reviewing physicians are not consistent with the medical evidence presented by the claimant (Philip Hafford v. Aetna Life Insurance Co., No. 16-4425, S.D. N.Y., 2017 U.S. Dist. LEXIS 91763).



Evidence Supports Termination Of Disability Benefits Based On Substance Abuse Provision
CINCINNATI - A disability plan administrator did not act arbitrarily and capriciously when it terminated a claimant's benefits based on the plan's substance abuse provision because the evidence supports the administrator's finding that the claimant's disability was caused by the effects of opioid medications, the Sixth Circuit U.S. Court of Appeals said June 30 (Angela Blount v. United of Omaha Life Insurance Company, No. 16-6372, 6th Cir., 2017 U.S. App. LEXIS 11779).



Termination Of Disability Benefits Was Reasonable, 9th Circuit Panel Affirms
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on June 12 affirmed a district court's ruling that the termination of a disability claim was reasonable based on the plan's mental health coverage limitation and the medical evidence considered by the disability insurer (Kathee A. Colman v. American International Group Inc. Group Benefit Plan, et al., No. 15-15903, 9th Cir., 2017 U.S. App. LEXIS 10394).



New York Federal Judge: Bipolar Disorder Subject To Disability Plan's 24-Month Cap
BROOKLYN, N.Y. - A New York federal judge on June 14 said a disability insurer did not act arbitrarily and capriciously in relying on the American Psychiatric Association's definition of mental illness when determining that bipolar disorder is a mental illness and subject to the plan's 24-month cap on disability benefits for a mental illness (Marry Kim v. The Hartford Life Insurance Co., No. 15-2474, E.D. N.Y., 2017 U.S. Dist. LEXIS 91660).



Pre-Existing Condition Provision Barred Claim For Long-Term Disability Benefits
HARRISBURG, Pa. - A Pennsylvania federal judge on June 19 determined that a disability insurer's denial of long-term disability (LTD) benefits was not arbitrary and capricious because the policy included a pre-existing condition exclusion that clearly precluded coverage to the claimant (Yvonne Hilbert v. The Lincoln National Life Insurance Co., 15-471, M.D. Pa., 2017 U.S. Dist. LEXIS 93424).



Substantial Evidence Supports Termination Of Disability Benefits, Appeals Panel Says
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on June 14 affirmed a district court's ruling that a disability insurer did not abuse its discretion in terminating a claimant's long-term disability benefits because there is substantial evidence supporting the insurer's termination of benefits (Lashondra Davis v. Aetna Life Insurance Co., No. 16-10895, 5th Cir., 2017 U.S. App. LEXIS 10576).



Claimant Owed Disability Benefits Under Plan's 'Own Occupation' Provision
SAN FRANCISCO - Following a one-day bench trial, a California federal judge on June 13 determined that a disability claimant submitted sufficient evidence showing that he was disabled under a plan's "own occupation" provision but failed to prove that he was disabled under the plan's "any occupation" standard (Robert Bosley v. Metropolitan Life Insurance Co., No. 16-00139, N.D. Calif., 2017 U.S. Dist. LEXIS 90803).



D.C. Appellate Panel: ERISA Plan Administrator Wrongfully Denied Woman Benefits
WASHINGTON, D.C. - A District of Columbia appeals panel on June 30 said a federal judge correctly ruled 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 has 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. 16-78125, D.C. Cir., 2017 U.S. App. LEXIS 11670).



4th Circuit Panel Says Plan Defendants Are Required To Adopt SSA's Onset Date
RICHMOND, Va. - Because a plan administrator failed to follow a reasoned process in determining a disability claimant's onset date of disability, the plan must adopt the disability onset date determined by the Social Security Administration (SSA), the Fourth Circuit U.S. Court of Appeal said June 23 in affirming a district court's decision (Jesse Solomon v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 16-1730, 4th Cir., 2017 U.S. App. LEXIS 11197).



Disability Insurer's Offset Of Benefits Was Reasonable, 3rd Circuit Panel Determines
PHILADELPHIA - A disability insurer was entitled to offset a disability claimant's long-term disability benefits against income the claimant earned by working part time for her medical practice because the claimant still received the benefit of her earnings even though the earnings were applied against debt she owed her medical practice, the Third Circuit U.S. Court of Appeals said June 7 (Amy Patrick, M.D. v. Reliance Standard Life Insurance Co., No. 16-3980, 3rd Cir., 2017 U.S. App. LEXIS 10105).



New York Law Bars Offset For Personal Injury Settlement, Appeals Panel Concludes
NEW YORK - The Second Circuit U.S. Court of Appeals on June 22 reversed a district court's ruling that a disability insurer was entitled to offset a claimant's benefits based on the claimant's settlement of his personal injury claim after determining that New York law bars the disability insurer from offsetting benefits when a claim for personal injuries is settled (Salvatore Arnone v. Aetna Life Insurance Co., No. 15-2322, 2nd Cir., 2017 U.S. App. LEXIS 11055).



Florida Federal Magistrate Recommends Dismissal Of Claim For LTD Benefits
WEST PALM BEACH, Fla. - A Florida federal magistrate judge on June 19 recommended that a claim seeking a declaration that long-term disability (LTD) benefits are owed be dismissed because the disability claimant did not file a claim for LTD benefits and did not exhaust all her administrative remedies related to the claim for such benefits (Jamie R. Nagy v. The Prudential Insurance Company of America, No. 17-80198, S.D. Fla., 2017 U.S. Dist. LEXIS 94819).



Federal Judge Says Disability Claimant Is Entitled To Attorney Fees
NEW HAVEN, Conn. - A Connecticut federal judge on June 20 awarded a disability claimant more than $38,000 in attorney fees after finding that the claimant is entitled to attorney fees for achieving some success on the merits of his claim (Jeff Schuman v. Aetna Life Insurance Co., et al., No. 15-1006, D. Conn., 2017 U.S. Dist. LEXIS 94557).



Kentucky Federal Judge Denies Disability Claimant's Motion To Strike Declaration
LOUISVILLE, Ky. - A Kentucky federal judge on June 23 denied a disability claimant's motion to strike a corporate representative's declaration after determining that the declaration was properly submitted with the disability insurer's motion for summary judgment (William Kennedy v. Life Insurance Company of North America, No. 15-741, W.D. Ky., 2017 U.S. Dist. LEXIS 97341).