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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®



 



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



Disability Onset Date Is Not Marked By 1st Physician Visit, 7th Circuit Panel Says
CHICAGO - The Seventh Circuit U.S. Court of Appeals on July 27 reversed a district court's ruling against a disability claimant after determining that it was not reasonable for the insurers to conclude that the date of the claimant's first physician visit related to the disability determines the time when the disability commenced (Eric Berg v. New York Life Insurance Co. et al., No. 15-1410, 7th Cir.; 2016 U.S. App. LEXIS 13656).



District Court Erred In Policy Interpretation, 7th Circuit Says In Reversing
CHICAGO - Because a district court erred in interpreting a disability policy and made factual findings unsupported by the evidence, a new trial is warranted, the Seventh Circuit U.S. Court of Appeals said July 27, vacating and remanding the district court's ruling in favor of a disability claimant (Carole Cheney v. Standard Insurance Co., et al., No. 15-1794, 7th Cir.; 2016 U.S. App. LEXIS 13692).



Dismissal Of Claimant's Suit Was Proper, 6th Circuit Appeals Panel Determines
CINCINNATI - A district court did not err in dismissing a disability claimant's suit with prejudice because the decision to terminate the claimant's benefits was reasonable and correct, the Sixth Circuit U.S. Court of Appeals said July 21 (Monica L. Crox v. Unum Group Corp., No. 15-6006, 6th Cir.; 2016 U.S. App. LEXIS 13451).



11th Circuit Panel Says Long-Term Benefits Were Not Wrongfully Terminated
ATLANTA - A district court did not err in determining that a disability plan did not wrongfully terminate a claimant's long-term disability benefits, the 11th Circuit U.S. Court of Appeals said July 11 (Elizabeth Jenkins v. Grant Thornton LLP, et al., No. 14-15695, 11th Cir.; 2016 U.S. App. LEXIS 12729).



Labor Secretary Urges 2nd Circuit To Find Claim Was Properly 'Deemed Denied'
NEW YORK - In a June 9 amicus curiae brief, the U.S. secretary of Labor urged the Second Circuit U.S. Court of Appeals to uphold a district court's ruling that a disability claim was properly "deemed denied," noting that reversing the ruling could significantly undermine the secretary's regulations governing benefit claims (Janet Solnin v. Sun Life and Health Insurance Co., et al., No. 15-3921, 2nd Cir.).



Breach Of Fiduciary Claim Can Move Forward, Mississippi Federal Judge Determines
ABERDEEN, Miss. - A disability claimant is not precluded from pleading a breach of fiduciary duty claim in addition to a claim for denial of benefits under the Employee Retirement Income Security Act when a more expansive approach is applied to the pleadings, a Mississippi federal judge said July 13 (Walter Peterson v. Liberty Life Assurance Company of Boston, No. 15-204, N.D. Miss.; 2016 U.S. Dist. LEXIS 91021).



Insurer's Termination Of Benefits Was Not Arbitrary And Capricious, Judge Says
MIAMI - A disability insurer's decision to terminate a claimant's long-term disability benefits was not arbitrary and capricious because the insurer reasonably concluded that the claimant was not precluded from working in "any occupation," a Florida federal judge said July 19 (Armando Mercado v. Federal Express Corp., et al., No. 15-21472, S.D. Fla.; 2016 U.S. Dist. LEXIS 93786).



Illinois Federal Judge Adopts Additional Findings; Judgment Properly Entered For Insurer
CHICAGO - An Illinois federal judge on July 15 agreed to adopt a disability claimant's proposed additional findings; however, the judge said the judgment in favor of a disability insurer will stand because the claimant still did not prove that he was continuously disabled under the policy at issue (Stephen Dorf v. Standard Insurance Co., as successor to Minnesota Life Insurance Co., No. 13-6479, N.D. Ill.; 2016 U.S. Dist. LEXIS 92538).



Claimant Not Provided With 'Meaningful Opportunity' To Submit Evidence, Panel Says
PORTLAND, Ore. - Because a disability claimant did not have a "meaningful opportunity" to submit additional evidence in support of her claim and because the plan did not explain what "objective medical findings" are, a district court erred in granting the plan's motion summary judgment, the Ninth Circuit U.S. Court of Appeal said July 29 in reversing the district court's ruling (Barbara Scoles v. Intel Corporation Long Term Disability Benefit Plan, No. 13-36167, 9th Cir.; 2016 U.S. App. LEXIS 13819).



3rd Circuit Vacates, Remands Disability Suit, Says Issues Of Fact Exist On Termination
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on July 7 determined that summary judgment in favor of a disability insurer was not appropriate because issues of material fact exist regarding whether the medical evidence supports the insurer's termination of benefits and whether the termination was arbitrary and capricious (Frank Reed v. Citigroup Inc., et al., No. 15-2094, 3rd Cir.; 2016 U.S. App. LEXIS 12523).



Massachusetts Federal Judge Remands Claim For More Thorough Review Of Income Loss
BOSTON - Because a more thorough inquiry is needed about the connection between a disability claimant's injury and his loss of income, a Massachusetts federal judge on July 13 remanded the claim to the plan administrator (Brian Host v. First Unum Life Insurance Co., et al., No. 13-11578, D. Mass.; 2016 U.S. Dist. LEXIS 90967).



No Ambiguity In Policy, Panel Says In Affirming Termination Of Benefits
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on July 7 affirmed a district court's finding that there is no ambiguity in a residual disability policy regarding the policy's use of the term "occupation" and the policy rider's use of the term "insured's occupation" (Daniel S. Bowerman, D.C. v. National Life Insurance Co., No. 15-1129, 3rd Cir.; 2016 U.S. App. LEXIS 12503).



Policy's Limitations Period Is Enforceable, 8th Circuit Panel Determines
ST. PAUL, Minn. - A group disability policy's three-year limitations provision is not unconstitutional or invalid under Minnesota law because Minnesota's statutes pertaining to the statute of limitations for filing suits do not apply to group policies, the Eighth Circuit U.S. Court of Appeals said Aug. 2 (Lora Walker v. Hartford Life and Accident Insurance Co., No. 15-2570, 8th Cir.; 2016 U.S. App. LEXIS 13988).



Depositions Must Be Held Where Witnesses Are Located, Kentucky Federal Judge Says
LOUISVILLE, Ky. - A Kentucky federal judge on July 13 granted a disability insurer's motion for a protective order on depositions after determining that the disability claimant failed to show that special circumstances exist to warrant a departure from the general rule that the party seeking discovery must go where the witnesses are located (Richard E. Davis v. Hartford Life and Accident Insurance Co., No. 14-507, W.D. Ky.; 2016 U.S. Dist. LEXIS 90576).



Penalty Was Correctly Assessed But Must Be Recalculated, Panel Says
SAN FRANCISCO - A district court did not err in assessing a statutory penalty against a disability plan administrator for failing to provide a requested plan document within 30 days, but the district court must recalculate the penalty to assess the penalty based solely on the failure to timely produce the plan document, the Ninth Circuit U.S. Court of Appeals said July 25 (Curtis F. Lee v. ING Groep, N.V., et al., No. 14-15848, 9th Cir.; 2016 U.S. App. LEXIS 13489).



DOL Supports Petitioner Opposing Disability Plan's Forum-Selection Clause
ST. LOUIS - The U.S. Department of Labor (DOL) on June 16 filed an amicus brief in the Eighth Circuit U.S. Court of Appeals in support of a plan participant, saying that a disability plan's forum-selection clause deprives her of the choices afforded by the Employee Retirement Income Security Act's venue provision and requires her to bring suit at a considerable distance from her home (In re Lorna Clause, No. 16-2607, 8th Cir.).



Disability Claimant Was Capable Of Sedentary Work, 11th Circuit Panel Affirms
ATLANTA - A disability insurer's decision to terminate a claimant's long-term disability benefits was not de novo wrong, the 11th Circuit U.S. Court of Appeals affirmed July 1, noting that the insurer's decision was supported by the evidence (Rassekh Sobh v. Hartford Life and Accident Insurance Co., No. 15-15586, 11th Cir.; 2016 U.S. App. LEXIS 12144).



Termination Of Benefits Was Reasonable, California Federal Judge Determines
FRESNO, Calif. - A California federal judge on July 5 determined that a disability claims administrator did not abuse its discretion in terminating a claimant's benefits because the administrator identified two reasonable jobs within the proper zone that could be performed by the claimant (William Barnett v. Southern California Edison Company Long Term Disability Plan, No. 12-130, E.D. Calif.; 2016 U.S. Dist. LEXIS 86828).



Wealth Of Evidence Supports Termination Of Benefits, Illinois Federal Judge Says
CHICAGO - A disability insurer's termination of benefits was not arbitrary and capricious because there is a wealth of evidence in the record to support the decision to terminate the claimant's benefits, an Illinois federal judge said June 24 (Donna Geiger v. Aetna Life Insurance Co., No. 15-3791, N.D. Ill.; 2016 U.S. Dist. LEXIS 82301).



LTD Benefits Reinstated; Insurer's Termination Was Arbitrary, Federal Judge Says
ROCHESTER, N.Y. - A New York federal judge on June 30 ordered a disability insurer to reinstate a claimant's disability benefits and pay past due benefits because the insurer's termination of benefits was arbitrary and capricious (Randi Dunda v. Aetna Life Insurance Co., No. 15-6232, W.D. N.Y.; 2016 U.S. Dist. LEXIS 85549).



Claimant Was Not Disabled Under Terms Of Plan, Ohio Federal Judge Determines
CLEVELAND - A disability plan administrator's denial of short-term disability benefits was not arbitrary and capricious because the claimant did not have a disability as defined by the plan and the medical evidence supported the denial, an Ohio federal judge said June 28 (Bruce Corey v. Sedgwick Claims Management Services et al., No. 15-1736, N.D. Ohio; 2016 U.S. Dist. LEXIS 84351).



Claimant Failed To Prove He Was Disabled Under Policy, Michigan Federal Judge Says
GRAND RAPIDS, Mich. - A disability insurer's decision to terminate a claimant's long-term disability benefits is supported by the evidence, a Michigan federal judge said June 17 after determining that the claimant failed to prove by a preponderance of the evidence that his depression prevented him from performing the duties of his occupation (Les A. Gilewski v. Provident Life and Accident Insurance Co., No. 15-238, W.D. Mich.; 2016 U.S. Dist. LEXIS 79056).



Claimant Treated For Same Condition 3 Months Before Joining Plan, Judge Says
LOS ANGELES - A disability insurer's denial of long-term disability benefits based on a plan's pre-existing conditions provision was reasonable because the evidence shows that the claimant was treated for the same condition in the three months before becoming a participant in the plan, a California federal judge said June 28 (Oluwaremilekun Fagbemi Abubakar v. Aetna Life Insurance Company, et al., No. 15-1517, C.D. Calif.; 2016 U.S. Dist. LEXIS 83982).



New Hampshire Federal Judge Says Denial Of Long-Term Claim Is Questionable
CONCORD, N.H. - A New Hampshire federal judge on June 29 determined that remanding a long-term disability benefits claim is the only appropriate remedy because it is not clear if the claimant is entitled to benefits and because the disability insurer's denial was questionable (Elizabeth Senechal v. Aetna Life Insurance Co., No. 14-186, D. N.H.; 2016 U.S. Dist. LEXIS 84618).



Issue Of Fact Exists About Receipt Of Claimant's Appeal, Ala. Federal Judge Says
BIRMINGHAM, Ala. - An Alabama federal judge on June 29 denied a disability insurer's motion for summary judgment after determining that a genuine issue of material fact exists regarding whether the insurer received the claimant's letter appealing the termination of disability benefits (Cheryl Hitt v. United of Omaha Life Insurance Co., No. 15-1790, N.D. Ala.; 2016 U.S. Dist. LEXIS 84119).



Offset Was Not Abuse Of Discretion, California Federal Judge Determines
SAN JOSE, Calif. - A disability plan administrator did not abuse its discretion in offsetting a claimant's long-term disability benefits to account for Social Security disability income (SSDI) benefits that she receives for her dependents, a California federal judge said June 14 in granting the plan's motion for summary judgment (Susan Rene Jones v. Life Insurance Company of North America et al., No. 08-3971, N.D. Calif.; 2016 U.S. Dist. LEXIS 77409).



Plan Administrator Failed To Consider All Evidence, Calif. Federal Judge Says
SAN JOSE, Calif. - A plan administrator abused its discretion by failing to consider a disability claimant's functional capacity evaluation and an award of Social Security disability benefits before terminating the claimant's long-term disability benefits, a California federal judge said June 30 in remanding the benefits claim to the plan administrator (Olga Gorbacheva v. Abbott Laboratories Extended Disability Plan et al., No. 14-2524, N.D. Calif.; 2016 U.S. Dist. LEXIS 85702).



No Abuse Of Discretion, Missouri Federal Judge Says In Dismissing Complaint
ST. LOUIS - A disability claimant's complaint was dismissed July 1 because the claims administrator did not abuse its discretion in terminating the claimant's benefits, a Missouri federal judge said, noting that the claims administrator consulted with a number of independent physician advisers before terminating the benefits (Maria Domenica Moore v. Ascension Long-Term Disability Plan, No. 15-328, E.D. Mo.; 2016 U.S. Dist. LEXIS 85900).



No Error In Denial Of Claim For Short-Term Benefits, Federal Judge Says
MINNEAPOLIS - A disability claims administrator did not abuse its discretion in denying a claim for short-term disability benefits because the decision was reasonable based on the available medical evidence, a Minnesota federal judge said June 29 (Cheryl L. Schultz, v. 3M Co. et al., No. 15-3062, D. Minn.; 2016 U.S. Dist. LEXIS 85493).



Complaint Was Properly Dismissed, 3rd Circuit Panel Says In Affirming
PHILADELPHIA - A district court did not err in dismissing a disability claimant's suit because the Employee Retirement Income Security Act preempts his state law contract and fraud claims, the Third Circuit U.S. Court of Appeals said June 16 (Andre D. Butler v. Liberty Mutual Life Assurance Company of Boston, No. 16-1316, 3rd Cir.; 2016 U.S. App. LEXIS 10889).



Indiana Federal Judge Says Additional Briefing Needed To Decide Standard Of Review
INDIANAPOLIS - An Indiana federal judge on June 20 directed the parties in a disability benefits suit to file additional briefing to address how a recent decision by the Second Circuit U.S. Court of Appeals applies to a determination of the applicable standard of review (Donald Fessenden v. Reliance Standard Life Insurance Co., et al., No. 15-370, N.D. Ind.; 2016 U.S. Dist. LEXIS 79690).