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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®



 



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



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the claimant's position as an assistant news editor in the Department of Labor's Dictionary of Occupational Titles is outdated and does not accurately describe the duties of the claimant's position (Kenneth Popovich v. Metropolitan Life Insurance Co., et al., No. 15-9791, C.D. Calif.,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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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



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).