Preview: LexisNexis® Mealey's™ Disability Insurance Legal News
LexisNexis® Mealey's™ Disability Insurance Legal News
Headline Disability Insurance Legal News from LexisNexis®
LTD Plan Was Not Granted Discretionary Authority, 1st Circuit Panel Determines
BOSTON - The First Circuit U.S. Court of Appeals on March 1 reversed a federal court's ruling that a disability insurer was delegated with discretionary authority and directed the lower court to review a claimant's termination of benefits under a de novo standard of review (Nilda Rodriguez-Lopez v. Triple-S Vida, Inc., No. 15-2413, 1st Cir., 2017 U.S. App. LEXIS 3729).
High Court Denies Cert In Case Over Termination Of Long-Term Benefits
WASHINGTON, D.C. - The U.S. Supreme Court on Feb. 21 denied a petition for a writ of certiorari in a case in which the 11th Circuit U.S. Court of Appeals said a district court did not err in determining that a disability plan did not wrongfully terminate a claimant's long-term disability benefits (Elizabeth Jenkins v. Grant Thornton LLP, et al., No. 16-682, U.S. Sup.).
Denial Of Benefits Was Not Arbitrary Or Capricious, Tennessee Federal Judge Says
KNOXVILLE, Tenn. - Because there was evidence supporting the conclusion that a disability claimant was able to perform a material and substantial duty of her occupation, a disability insurer's denial of her claim for benefits was not arbitrary or capricious, a Tennessee federal judge said March 1 in adopting a magistrate judge's report and recommendation (Kimberly D. Buchanan v. Sun Life and Health Insurance Co., No. 15-202, E.D. Tenn., 2017 U.S. Dist. LEXIS 28513).
Substantial Evidence Supports Plan Denial Of LTD Benefits, Ohio Federal Judge Says
COLUMBUS, Ohio - The denial of a claim for long-term disability (LTD) benefits was not arbitrary and capricious because the claimant was provided with a fair review procedure and substantial evidence supports the denial of benefits, an Ohio federal judge said Feb. 14 in granting the plan's motion for judgment on the administrative record (Angela Schofield v. Nationwide Insurance Cos., et al., No. 16-371, S.D. Ohio, 2017 U.S. Dist. LEXIS 20687).
California Federal Judge OKs Settlement In Dispute Over Offset Of Veterans' Benefits
OAKLAND, Calif. - A California federal on March 1 approved a class action settlement between former U.S. veterans and Liberty Life Assurance Company of Boston after determining that the terms of the settlement, which provides compensation to class members whose disability benefits were offset or reduced by Liberty Life, are reasonable (James L. Bush v. Liberty Life Assurance Company of Boston, et al., No. 14-1507, N.D. Calif.).
9th Circuit Panel Upholds Plan's Offset Of Disability Benefits
SAN FRANCISCO - Plan language clearly allowed an insurer to offset permanent partial disability benefits by the amount of long-term disability benefits the employee received, a Ninth Circuit U.S. Court of Appeals panel held Feb. 16 (John Del Gallego v. Wells Fargo & Co. Long Term Disability Plan, et al., No. 15-15294, 9th Cir., 2017 U.S. App. LEXIS 2753).
Decision To Terminate Partial Benefits Was Reasonable, Judge Says
CHARLOTTE, N.C. - A disability insurer's decision to terminate a claimant's partial disability benefits was reasonable because the insurer worked with the claimant when prorating the claimant's quarterly bonus and the claimant did not object to the method used by the insurer to prorate the bonus, a North Carolina federal judge said March 2 (Frederick Sutherland v. Sun Life Assurance Company of Canada, No. 16-182, W.D. N.C., 2017 U.S. Dist. LEXIS 29628).
Federal Judge Says Claimant Is Residually Disabled, Not Totally Disabled As Required
ATLANTA - A disability claimant is not entitled to benefits under a policy's lifetime sickness rider because the claimant is residually disabled and not totally disabled as required for benefits under the rider, a Georgia federal judge said Feb. 15 (William F. Nefsky v. Unum Life Insurance Company of America, No. 15-2119, N.D. Ga., 2017 U.S. Dist. LEXIS 21152).
Alabama Federal Judge Says Insurer's Interpretation Was Arbitrary And Capricious
MONTGOMERY, Ala. - A disability insurer's interpretation of a tolling provision to extend the 45-day time deadline to decide an administrative appeal was arbitrary and capricious, an Alabama federal judge said March 7 in partially adopting a magistrate judge's recommendation to deny the insurer's motion for summary judgment (Melissa Stevens v. Sun Life and Health Insurance Co. [U.S.], No. 16-76, M.D. Ala., 2017 U.S. Dist. LEXIS 31734).
New York Federal Judge Says Administrator Failed To Prove Extension Was Warranted
NEW YORK - Because a plan administrator failed to prove that special circumstances existed when it extended the allowable time to issue a decision on appeal, a New York federal judge on Feb. 28 concluded that a de novo standard of review is appropriate (Katherine Salisbury v. Prudential Insurance Company of America, No. 15-9799, S.D. N.Y., 2017 U.S. Dist. LEXIS 27983).
6th Circuit Finds Disability Coverage Claims Preempted By ERISA
CINCINNATI - After finding that a former marketing director's claims for coverage against a medical review company were completely preempted by the Employee Retirement Income Security Act, the Sixth Circuit U.S. Court of Appeals on Feb. 17 affirmed dismissal of the claims and found that a previous lawsuit filed against a plan administrator was the proper recourse (James Hackney v. Allmed Healthcare Management Inc., No. 16-5651, 6th Cir., 2017 U.S. App. LEXIS 2877).
Disability Plan Is Governed By ERISA, California Federal Judge Determines
LOS ANGELES - A California federal judge on Feb. 10 denied a plaintiff's motion to remand a disability suit to state court because the disability plan at issue is not a "church plan" and is governed by the Employee Retirement Income Security Act (Melvyn L. Durham v. The Prudential Insurance Company of America et al., No. 16-8202, C.D. Calif., 2017 U.S. Dist. LEXIS 19402).
Judge Converts Motion To Dismiss, Orders Further Briefing In Bad Faith Suit
ALBUQUERQUE, N.M. - Unable to determine from the evidence provided whether an insured's disability benefits plan is governed by the Employee Retirement Income Security Act of 1974 (ERISA), a federal judge in New Mexico on Feb. 14 converted the insurer's motion to dismiss to a motion for summary judgment and ordered supplemental briefing (Sherry Evans-Carmichael v. Liberty Mutual Group Inc., No. 16-276, D. N.M., 2017 U.S. Dist. LEXIS 20599).
Claimant's Suit Was Timely Filed, California Federal Judge Says
SAN FRANCISCO - A disability claimant's suit alleging wrongful termination of benefits was timely filed, a California federal judge said Feb. 13 after determining that the plan's three-year limitations period did not begin to run until after the 180-day deadline to appeal the termination of benefits ended (Nancy Hart v. UNUM Life Insurance Company of America, No. 15-5392, N.D. Calif., 2017 U.S. Dist. LEXIS 20198).
Georgia Federal Judge Says Beneficiary Has Adequate Remedy Under ERISA
ATLANTA - Because a beneficiary seeking supplemental life insurance benefits for a plan participant's disability has an adequate remedy under Section 502(a)(1)(B) of the Employee Retirement Income Security Act and failed to provide support for a separate breach of fiduciary duty claim, a Georgia federal judge on Feb. 27 dismissed the breach of fiduciary claim alleged against the plan (Stephanie D. Vaughn v. Aetna Life Insurance Co., No. 16-1107, N.D. Ga., 2017 U.S. Dist. LEXIS 26743).
10th Circuit Panel Finds No Evidence That Employer Created Hostile Environment
DENVER - The 10th Circuit U.S. Court of Appeals on Feb. 24 affirmed that an employer did not create a hostile work environment after learning of an employee's disability because the employee failed to submit sufficient evidence that he was subject to a hostile work environment as a result of his disability (Steven R. Williams v. FedEx Corporate Services, et al., No. 16-4032, 10th Cir., 2017 U.S. App. LEXIS 3364).
New York Federal Judge Awards Attorney Fees To Disability Claimant
ROCHESTER, N.Y. - A New York federal judge on March 6 determined that a disability claimant is entitled to more than $34,000 in attorney fees because the claimant was the prevailing party on motions for summary judgment (Charles Standish v. Federal Express Corp. Long Term Disability Plan, et al., No. 6:15-cv-6226, W.D. N.Y., 2017 U.S. Dist. LEXIS 31400).
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).