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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®



 



11th Circuit Affirms Insurer Did Not Abuse Its Discretion In Denying Benefits Claim
ATLANTA - A disability insurer did not abuse its discretion in denying a claim for long-term disability benefits because the claimant failed to prove that she was disabled under the plan and the insurer's denial was reasonable based on the available evidence, the 11th Circuit U.S. Court of Appeals said Jan. 30 (Susan Till v. Lincoln National Life Insurance Co. et al., No. 16-14799, 11th Cir., 2017 U.S. App. LEXIS 1589).



Insurer Failed To Consider Physician's Statement Of Functionality, Judge Says
KALAMAZOO, Mich. - A Michigan federal judge on Feb. 8 reversed a disability insurer's denial of benefits after determining that the insurer failed to provide any reasonable explanation for disregarding the only assessment, made by the claimant's treating physician, of the claimant's functionality (Mary Beth Tobin v. Hartford Life and Accident Insurance Co., No. 14-187, W.D. Mich., 2017 U.S. Dist. LEXIS 17455).



Michigan Federal Judge: Benefits Must Be Reinstated; Evidence Supports Disability
GRAND RAPIDS, Mich. - A Michigan federal judge on Jan. 25 determined that a claimant's long-term disability benefits must be reinstated because the claimant's medical records support the claim and surveillance video obtained by the insurer does not support the insurer's termination of benefits (Michelle R. Rouleau v. Liberty Life Assurance Company of Boston, No. 15-546, W.D. Mich.; 2017 U.S. Dist. LEXIS 9984).



Pennsylvania Federal Judge: Benefits Termination Was Not Arbitrary And Capricious
PHILADELPHIA - The decision to terminate a claimant's long-term disability (LTD) benefits was not arbitrary and capricious because the insurer's termination was reasonable based on all of the available evidence, a Pennsylvania federal judge said Jan. 31 in granting the insurer's motion for summary judgment (Donna J. Killian v. Hartford Life and Accident Insurance Co., No. 16-1377, E.D. Pa., 2017 U.S. Dist. LEXIS 12874).



Louisiana Federal Judge Says Claimant Failed To Provide Evidence To Support Claim
NEW ORLEANS - A Louisiana federal judge on Jan. 18 determined that summary judgment in favor of a disability plan administrator and the employer that sponsored the plan is appropriate because the claimant failed to submit any evidence in support of her claim for benefits (Deborah Davis v. Aetna Life Insurance Co., No. 16-4263, E.D. La.; 2017 U.S. Dist. LEXIS 6529).



Issue Of Fact Exists As To Whether Claimant Was Disabled, Federal Judge Says
SEATTLE - A Washington federal judge on Jan. 26 denied a disability insurer's motion for summary judgment after determining that an issue of fact exists as to whether the claimant was disabled pursuant to the policy's terms (Tracie D. Morgan v. Hartford Life and Accident Insurance Co., No. 16-5183, W.D. Wash.; 2017 U.S. Dist. LEXIS 11168).



Claimant Owed Back Benefits And Future Benefits, Federal Judge Says
PHOENIX - A disability insurer must pay back benefits to a disability claimant in addition to future benefits for as long as the claimant remains disabled because the insurer failed to prove that the claimant was not disabled prior to the claimant's termination from his place of employment, an Arizona federal judge said Jan. 17 (Eduardo L. Nieves v. Prudential Insurance Company of America, No. 16-768, D. Ariz., 2017 U.S. Dist. LEXIS 6187).



Texas Federal Judge Dismisses Gender Identity Discrimination Claims
DALLAS - A Texas federal judge on Jan. 13 dismissed claims alleging gender identity discrimination under Section 1557 of the Patient Protection and Affordable Care Act (ACA) against an insurer and an employer because the plaintiff failed to cite any controlling precedent that recognizes a cause of action under Section 1557 for gender identity discrimination (Charlize Marie Baker v. Aetna Life Insurance Co., et al., No. 15-3679, N.D. Texas; 2017 U.S. Dist. LEXIS 5665).



Arbitrary And Capricious Standard Of Review Applies In Disability Benefits Suit
PITTSBURGH - An arbitrary and capricious standard of review will be applied in a suit challenging the denial of a long-term disability benefits because the plan clearly granted the insurer the discretionary authority to determine a claimant's eligibility for benefits, a Pennsylvania federal judge said Jan. 23 (James Neal v. Life Insurance Company of North America, et al., No. 16-1146, W.D. Pa.; 2017 U.S. Dist. LEXIS 8498).



Claimant Failed To Meet Plan's Work Requirements, Federal Magistrate Says
NASHVILLE, Tenn. - A Tennessee federal magistrate judge on Jan. 30 recommended that a disability claimant's motion for judgment on the record be denied because the claimant did not work at least 120 hours during the year in which he claimed he became disabled or in the year prior to becoming disabled as required by the plan at issue (Jeffrey Brent Brooks v. Boilermakers-Blacksmith Union National Pension Trust, No. 15-1034, M.D. Tenn., 2017 U.S. Dist. LEXIS 13235).



Disability Insurer Waived Right To Assert Claimant Was Ineligible For Coverage
BIRMINGHAM, Ala. - An Alabama federal judge on Jan. 13 determined that by continuing to accept a disability claimant's premium payments, an insurer waived its right to assert that the claimant was ineligible for coverage under the policy (Arturo J. Otero v. Unum Life Insurance Company of America, No. 14-2253, N.D. Ala.; 2017 U.S. Dist. LEXIS 5119).



Louisiana Federal Judge Remands Claim To Plan Administrator For Reconsideration
NEW ORLEANS - A Louisiana federal judge on Jan. 17 remanded a claim for long-term disability benefits to the plan administrator for reconsideration after determining that the plan administrator did not substantially comply with procedural requirements when it denied the claimant's appeal (Tommy W. Senegal v. Reliance Standard Life Insurance Co., No. 16-1961, E.D. La., 2017 U.S. Dist. LEXIS 6044).



High Court Will Not Hear Issue Of Forum-Selection Clause In ERISA Disability Plan
WASHINGTON, D.C. - The U.S. Supreme Court on Jan. 17 denied review of a ruling by the Eighth Circuit U.S. Court of Appeals that enforced a forum-selection clause in a disability plan governed by the Employee Retirement Income Security Act (Lorna Clause v. U.S. District Court for the Eastern District of Missouri, et al., No. 16-641, U.S. Sup.).



Plaintiff's Claims Are Preempted By ERISA, Illinois Federal Judge Says
CHICAGO - An Illinois federal judge on Jan. 12 denied a plaintiff's motion to remand after determining that her state law claims arising out of the disclosure of medical records without consent are preempted by the Employment Retirement Income Security Act (Jane Doe v. Aetna Inc., et al., No. 16-8390, N.D. Ill.; 2017 U.S. Dist. LEXIS 4866).



New York Federal Judge Awards Disability Claimant Reduced Attorney Fees And Costs
NEW YORK - A New York federal judge on Feb. 3 awarded a disability claimant more than $233,000 in attorney fees and more than $5,000 in costs but only after determining that a reduction of the hours charged by the claimant's counsel is warranted (Dimitra Dimopoulou v. First Unum Life Insurance Co., et al., No. 13-7159, S.D. N.Y., 2017 U.S. Dist. LEXIS 15944).



Claimant Is Entitled To Reduced Attorney Fee Award, Michigan Federal Judge Says
ANN ARBOR, Mich. - A Michigan federal judge on Jan. 17 awarded a disability claimant more than $44,000 in attorney fees after determining that the claimant's request of more than $58,000 was excessive based on the number of hours logged and hourly rate charged by the attorneys (Miguel Mendez v. FedEx Express, et al., No. 15-12301, E.D. Mich.; 2017 U.S. Dist. LEXIS 5948).



New York Federal Magistrate: In Camera Review Of Insurer's Documents Is Necessary
NEW YORK - A New York federal magistrate judge on Feb. 6 found that an in camera review of an insurer's documents requested through discovery by a disability claimant is necessary to determine if the documents are protected under the work product doctrine or if the fiduciary exception to the attorney-client privilege applies (Cherylle McFarlane v. First Unum Life Insurance Co., No. 16-7806, S.D. N.Y., 2017 U.S. Dist. LEXIS 16433).



Plan Administrator Abused Its Discretion In Terminating Benefits, 4th Circuit Affirms
RICHMOND, Va. - The Fourth Circuit U.S. Court of Appeals on Jan. 5 said a district court did not improperly find that a disability plan administrator abused its discretion in terminating a claimant's benefits because the evidence supports a finding that the claimant was disabled and the plan administrator's decision was not reasoned and principled (Stephen Wilkinson v. Sun Life and Health Insurance Co., et al., No. 15-2105, 4th Cir.; 2017 U.S. App. LEXIS 201).



Insurer Did Not Abuse Discretion In Terminating LTD Benefits, Judge Says
SHERMAN, Texas - A disability insurer did not abuse its discretion in terminating a claimant's long-term disability (LTD) benefits because the evidence supported the termination, a Texas federal judge said Dec. 12, noting that the insurer conducted an independent medical exam and four independent peer reviews before terminating benefits (Martha Shindoll v. United of Omaha Life Insurance Co., No. 15-759, E.D. Texas; 2016 U.S. Dist. LEXIS 171166).



7th Circuit Panel Finds Benefits Termination Was Not Arbitrary And Capricious
CHICAGO - A disability insurer's termination of benefits was not arbitrary and capricious because the evidence supported the termination and the insurer minimized any conflict of interest by employing a number of safeguards, the Seventh Circuit U.S. Court of Appeals said Jan. 6 (Donna Geiger v. Aetna Life Insurance Co., No. 16-2790, 7th Cir.; 2017 U.S. App. LEXIS 245).



Claimant Did Not Qualify For Benefits Pursuant To Disability Plan's Terms
PITTSBURGH - A Pennsylvania federal judge on Dec. 28 dismissed two disability insurers from a suit filed by a disability claimant after determining that the insurers' denial of benefits was not unreasonable because the claimant did not qualify for benefits pursuant to the plan's terms (Ronald P. Boyles Jr. v. American Heritage Life Insurance Co., et al., No. 15-274, W.D. Pa.; 2016 U.S. Dist. LEXIS 179063).



North Carolina Federal Judge Says Claimant's Disability Benefits Must Be Reinstated
CHARLOTTE, N.C. - Because a disability insurer did not rebut a claimant's medical evidence with its own substantial evidence, terminating the claimant's disability benefits was not reasonable and the claimant's benefits must be reinstated, a North Carolina federal judge said Dec. 27 (Joseline Montero v. Bank of America Long-Term Disability Plan, et al,, No. 15-519, W.D. N.C.; 2016 U.S. Dist. LEXIS 178724).



Termination Of Benefits Was Arbitrary And Capricious, 6th Circuit Majority Says
CINCINNATI - The majority of the Sixth Circuit U.S. Court of Appeals on Dec. 15 determined that a disability plan administrator acted arbitrarily and capriciously when it terminated a claimant's benefits because the objective medical evidence did not support the administrator's decision (Jack B. Calhoun Jr. v. Life Insurance Company of North America, No. 15-3470, 6th Cir.; 2016 U.S. App. LEXIS 22426).



Appeals Panel Says Evidence Supports Insurer's Denial Of Disability Benefits
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Dec. 23 affirmed a district court's ruling that a disability insurer's denial of benefits was reasonable after determining that the evidence does not support the contention that the claimant was permanently disabled (Fred Arko v. Hartford Life and Accident Insurance Co., No. 14-17287, 9th Cir.; 2016 U.S. App. LEXIS 23207).



California Federal Judge Sets Bench Trial In Suit Seeking Disability Benefits
SAN FRANCISCO - A California federal judge on Dec. 9 scheduled a bench trial in a disability benefits dispute after determining that it is not clear from the available evidence whether a claimant's prior disability claims factored into the insurer's decision to deny a third disability claim (Robert Bosley v. Metropolitan Life Insurance Co., No. 16-139, N.D. Calif.; 2016 U.S. Dist. LEXIS 170872).



Washington Federal Judge: Discretionary Clause Is Not Enforceable In Washington
TACOMA, Wash. - A Washington federal judge on Dec. 22 refused to enforce a disability plan's discretionary clause on the basis that enforcement of the clause would violate a strong public policy in the state of Washington (Anthony Flaaen v. Principal Life Insurance Co. Inc., No. 15-5899, W.D. Wash.; 2016 U.S. Dist. LEXIS 177638).



California Federal Judge Adopts Insurer's Interpretation Of Elimination Period
SAN FRANCISCO - A California federal judge on Dec. 19 determined that a disability claimant's brief return to part-time work does not extend the end of the plan's elimination period for benefits because the claimant's attempt to work in a part-time capacity only bolsters the conclusion that the claimant was still disabled when he returned to part-time work (Marlon Montoya v. Reliance Standard Life Insurance Co., No. 14-2740, N.D. Calif.; 2016 U.S. Dist. LEXIS 175208).



Offset Is Based On Amount 'Payable' To Claimant, 1st Circuit Panel Says
BOSTON - The First Circuit U.S. Court of Appeals on Dec. 16 affirmed that a disability administrator is not required to calculate an offset based on the amount of benefits received after taxes are taken from the claimant's Social Security disability payments, noting that the plan specifically states that the offset is based on the amount "payable" to the claimant (Debra Troiano v. Aetna Life Insurance Co., et al., No. 16-1307, 1st Cir.; 2016 U.S. App. LEXIS 22404).



Negligence Claim Completely Preempted By ERISA, 6th Circuit Panel Affirms
CINCINNATI - Dismissal of a negligence suit filed against a company hired to review a disability claimant's medical records was proper because the negligence claim is completely preempted by the Employee Retirement Income Security Act, the Sixth Circuit U.S. Court of Appeals said Dec. 22 (Samantha Milby v. MCMC LLC, No. 16-5483, 6th Cir.; 2016 U.S. App. LEXIS 23112).



Claimant's Suit Is Time- Barred Under Disability Policy, Appeals Panel Says
NEW ORLEANS - A disability claimant's suit is time-barred under the terms of the policy at issue because the claimant failed to file the suit within three years of the date when written proof of loss was required under the policy, the Fifth Circuit U.S. Court of Appeals said Dec. 13 (Woodrow K. Wilson v. Provident Life & Accident Insurance Co., No. 16-30305, 5th Cir.; 2016 U.S. App. LEXIS 22143).



Plan Defendants Maintain They Are Not Required To Adopt SSA's Onset Date
RICHMOND, Va. - A disability plan and its administrator are not required to adopt the disability onset date determined by the Social Security Administration (SSA), the plan defendants argue in a Dec. 19 reply brief filed in the Fourth Circuit U.S. Court of Appeals, maintaining that a district court erred in finding that the plan defendants are bound by the SSA's disability onset date (Jesse Solomon v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 16-1730, 4th Cir.).



Plan Administrator Did Not Abuse Discretion In Denying Claim, 9th Circuit Says
SAN FRANCISCO - A plan administrator did not abuse its discretion in denying a claim for disability pension benefits because the denial was reasonable based on the evidence and the terms of the plan, the Ninth Circuit U.S. Court of Appeals said Dec. 23 (Eun Sug Cha v. 1199SEIU Health Care Employees Pension Fund, No. 15-55435, 9th Cir.; 2016 U.S. App. LEXIS 23235).



Federal Magistrate Grants Motion To Keep Insurer's Trade Secrets Confidential
OWENSBORO, Ky. - A Kentucky federal magistrate judge on Dec. 14 granted a disability insurer's motion for a protective order of confidentiality, finding that the information it wants to keep confidential qualifies as trade secrets because a competitor could gain an advantage over the insurer if it had access to the information (Paulette Owens v. Liberty Life Assurance Co. of Boston, No. 4:15-cv-00071, W.D. Ky.; 2016 U.S. Dist. LEXIS 172540).



Evidence Shows Claimant Is Not Disabled From Any Occupation, Panel Affirms
CINCINNATI - Because six medical experts unanimously agreed that a disability claimant was not disabled from performing any occupation, the disability insurer did not act arbitrarily and capriciously in terminating the claimant's long-term disability (LTD) benefits, the Sixth Circuit U.S. Court of Appeals said Nov. 29 (Dana Leppert v. Liberty Life Assurance Company of Boston, No. 16-3387, 6th Cir.; 2016 U.S. App. LEXIS 21438).



Termination Of Benefits Under Any-Occupation Standard Was Reasonable, Judge Says
ATHENS, Ga. - A disability insurer's termination of a claimant's long-term disability (LTD) benefits based on the conclusion that the claimant was not disabled from any occupation was not arbitrary and capricious because the insurer's termination was supported by substantial medical evidence, a Georgia federal judge concluded Nov. 10 in granting the insurer's motion for judgment on the administrative record (William David Hallman v. Liberty Life Assurance Company of Boston, et al., No. 15-49, M.D. Ga.; 2016 U.S. Dist. LEXIS 156027).



Dismissal Of Claimant's Declaratory Judgment Claim Is Premature, Judge Says
TAMPA, Fla. - Dismissal of a disability claimant's declaratory judgment claim against a disability insurer is premature, a Florida federal judge said Nov. 14 in denying the insurer's motion to dismiss the claim (Frederick A. Hauber v. Provident Life and Accident Insurance Co., No. 16-2101, M.D. Fla.; 2016 U.S. Dist. LEXIS 156913).



Termination Of Benefits Supported By Evidence, Texas Federal Judge Says
BEAUMONT, Texas - A federal magistrate judge correctly found that a disability insurer's termination of disability benefits was not an abuse of discretion, a Texas federal judge said Dec. 6, noting that the evidence clearly supports the insurer's decision (Troy Arrington v. Unum Life Insurance Company of America, et al., No. 14-549, E.D. Texas; 2016 U.S. Dist. LEXIS 168120).



Insurer Not Required To Complete Independent Medical Exam, Judge Says
LAFAYETTE, La. - A disability insurer did not abuse its discretion in denying a claim for long-term disability benefits because the insurer was not required to complete an independent medical exam of the claimant and was not required to give greater weight to the opinions of the claimant's treating physicians, a Louisiana federal judge said Dec. 5 (Linda Bellard v. Unum Life Insurance Company of America, No. 15-0428, W.D. La.; 2016 U.S. Dist. LEXIS 167714).



Termination Of Benefits Was Not Abuse Of Discretion, Federal Judge Says
LOS ANGELES - A California federal judge on Nov. 30 determined that a disability insurer did not abuse its discretion when it terminated a claimant's short-term disability benefits because the insurer's termination was based on reliable evidence (Greg Martin v. Aetna Life Insurance Co. et al., No. 15-7355, C.D. Calif.; 2016 U.S. Dist. LEXIS 166120).



New York Federal Judge Remands Disability Case To Aetna Life Insurance
ROCHESTER, N.Y. - A New York federal judge in an opinion filed Nov. 18 granted partial summary judgment to a man whose long-term disability claims were denied, saying that the defendants failed to adequately explain all of the reasons for denying the claim in violation of the Employee Retirement Income Security Act (Charles Standish v. Federal Express Corp. Long Term Disability Plan, et al., No. 6:15-cv-6226, W.D. N.Y.; 2016 U.S. Dist. LEXIS 160093).



Insurer Entitled To Accept Opinions Of Its Physicians, Wisconsin Federal Judge Says
MADISON, Wis. - A Wisconsin judge on Nov. 14 determined that a disability insurer did not act arbitrarily and capriciously when it terminated a claimant's long-term disability (LTD) benefits because the insurer was not required to give more weight to the opinions of the claimant's treating physicians than to the insurer's reviewing physicians (Kathy J. Jacowski v. Kraft Heinz Foods Co., et al., No. 15-657, W.D. Wis.; 2016 U.S. Dist. LEXIS 157360).



Kentucky Panel Dismisses Appeal, Says Ruling Was Not Final, Appealable Order
FRANKFORT, Ky. - The Kentucky Court of Appeals on Nov. 23 dismissed a disability claimant's appeal of a trial court's decision to set aside a default judgment entered against a disability insurer because the trial court's ruling on the default judgment was not a final, appealable order (Alanya Hoppius v. Metropolitan Life Insurance Co., No. 2014-CA-001199, Ky. App.; 2016 Ky. App. Unpub. LEXIS 792).



Suit Against Insurer, Former Employer Dismissed For Failure To State Claim
DAYTON, Ohio - An Ohio federal judge on Nov. 14 dismissed a disability claimant's suit against her former employer and its disability insurer after determining that the claimant's suit failed to state a claim upon which relief can be granted (Charlotte S. Thomas v. Progressive Casualty Insurance Co., et al., No. 15-456, S.D. Ohio; 2016 U.S. Dist. LEXIS 157447).



Administrator Correctly Interpreted Terms Of Plan, Arkansas Federal Judge Says
LITTLE ROCK, Ark. - A plan administrator did not abuse its discretion in denying a claim for disability pension benefits, an Arkansas federal judge said Dec. 1 after determining that the plan correctly interpreted the terms of the policy and reasonably applied its interpretation when denying the claim for benefits (Derrick Jones v. Kohler Co. Pension Plan, No. 14-83, E.D. Ark.; 2016 U.S. Dist. LEXIS 165611).



Trust Did Not Have The Authority To Make Claims Decisions, Ky. Panel Says
FRANKFORT, Ky. - The Kentucky Court of Appeals on Dec. 2 affirmed the dismissal of two disability claimants' amended complaints after finding that the claimants could not assert their claims against the trust that administered their employer's disability plan because the trust did not possess the authority to determine a claimant's eligibility for benefits (Vera Furtula v. PNC Bank et al., Nos. 2015-518, 2015-525, Ky. App.; 2016 Ky. App. Unpub. LEXIS 801).



Kentucky Federal Judge Says Breach Of Fiduciary Duty Claim Must Be Dismissed
LOUISVILLE, Ky. - A Kentucky federal judge on Nov. 14 granted a disability insurer's motion for partial summary judgment on a plaintiff's claims for breach of fiduciary duty because the claimant did not prove that there was an injury separate and distinct from the denial of disability benefits (Samantha Milby v. Liberty Life Assurance Company of Boston, No. 13-487, W.D. Ky.; 2016 U.S. Dist. LEXIS 157116).



Pension Rights Center Urges High Court To Review Issue Of Forum-Selection Clauses
WASHINGTON, D.C. - In an amicus curiae brief filed on Dec. 2 in the U.S. Supreme Court, the Pension Rights Center urges the high court to review a decision by the Eighth Circuit U.S. Court of Appeals that enforced a disability plan's forum-selection clause, arguing that the allowance of forum-selection clauses in disability plans does not provide plan participants with ready access to federal courts and forces participants to sue in a court chosen by a plan (Lorna Clause v. U.S. District Court for the Eastern District of Missouri, et al., No. 16-641, U.S. Sup.; 2016 U.S. S. Ct. Briefs LEXIS 4420; 2016 U.S. S. Ct. Briefs LEXIS 4114).



Consent To Removal Was Necessary, Michigan Federal Judge Says In Remanding Suit
DETROIT - A Michigan federal judge on Nov. 15 remanded a disability claimant's suit to Michigan state court after determining that an auto insurer's consent to the disability insurer's notice of removal was required in order for the suit to remain in federal court (Pearlie Askew v. Metropolitan Property and Casualty Insurance Co., et al., No. 16-12130, E.D. Mich.; 2016 U.S. Dist. LEXIS 157595).



Maryland Federal Judge Defers Ruling On Claimant's Motion For Attorney Fees, Costs
BALTIMORE - A Maryland federal judge on Nov. 15 entered an order deferring a ruling on a disability claimant's motion for attorney fees and costs until an appeal filed by the plan defendants in the Fourth Circuit U.S. Court of Appeals regarding the claimant's disability onset date is decided (Jesse Solomon v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 14-3570, D. Md.; 2016 U.S. Dist. LEXIS 157606).