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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®



 



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).



Evidence Shows Claimant Not Able To Work In Sedentary Position, Panel Says
SAN FRANCISCO - A district court erred in determining that a disability claimant was capable of working in a sedentary position because the evidence shows that the claimant was able to sit for only four hours in an eight-hour workday, the Ninth Circuit U.S. Court of Appeals said Nov. 4 (Avery Armani v. Northwestern Mutual Life Insurance Co., No. 14-56866, 9th Cir.; 2016 U.S. App. LEXIS 19925).



Claimant Capable Of Working In Sedentary Position, Panel Affirms
ATLANTA - A district court did not err in granting summary judgment in favor of an employer and a disability insurer because the evidence supported the disability insurer's conclusion that the disability claimant was capable of working in a sedentary position, the 11th Circuit U.S. Court of Appeals said Oct. 21 (Andrew Ramdeen v. Prudential Insurance Company of America, et al., No. 16-11179, 11th Cir.; 2016 U.S. App. LEXIS 18962).



Evidence Supports Finding That Claimant Could Perform Duties Of Usual Occupation
SAN FRANCISCO - A district court did not err in concluding that a disability claimant was not totally disabled by fibromyalgia because the evidence supports the insurer's determination that the claimant could perform the material and substantial duties of her usual occupation, the Ninth Circuit U.S. Court of Appeals said Oct. 26 (Cheryl Leslie v. United of Omaha Life Insurance Co., No. 14-56775, 9th Cir.; 2016 U.S. App. LEXIS 19348).



Termination Of Benefits Was Reasonable, Majority Of 9th Circuit Panel Determines
SAN FRANCISCO - The majority of a Ninth Circuit U.S. Court of Appeals panel on Oct. 28 denied a disability claimant's motion for rehearing and reiterated that the termination of the claimant's benefits was reasonable because the claimant did not undergo an independent medical exam as requested by the insurer and as required under the plan (Curtis F. Lee v. ING Groep, N.V., et al., No. 14-15848, 9th Cir.; 2016 U.S. App. LEXIS 19513).



Denial Of Benefits Was Reasonable Based On Evidence, 6th Circuit Panel Says
CINCINNATI - A disability insurer's denial of long-term disability benefits was reasonable based on the substantial amount of evidence showing that the claimant was not disabled until after he was no longer covered under the disability plan at issue, the Sixth Circuit U.S. Court of Appeals said Oct. 4 (James J. Connelly v. Standard Insurance Co., No. 16-3036, 6th Cir.; 2016 U.S. App. LEXIS 18214).



Insurer's Termination Of Benefits Supported By Evidence, Federal Judge Says
HARRISBURG, Pa. - A disability insurer's termination of a claimant's benefits was not unreasonable because the evidence supports the insurer's conclusion that the claimant was not disabled after her discharge from an inpatient program at a mental health facility, a Pennsylvania federal judge said Oct. 17 (Cheryl Gailey v. Life Insurance Company of North America, No. 15-564, M.D. Pa.; 2016 U.S. Dist. LEXIS 143110).



Termination Of Benefits Supported By Medical Evidence, Federal Judge Says
LITTLE ROCK, Ark. - The termination of a claimant's long-term disability (LTD) benefits was reasonable based on the evidence considered by the disability plan prior to terminating benefits, an Arkansas federal judge said Oct. 7 (Evelyn Thompson v. ConAgra Foods Inc., et al., No. 14-41, E.D. Ark.; 2016 U.S. Dist. LEXIS 140149).



Mississippi Federal Judge: Request To Reopen Disability Benefits Suit Is Premature
OXFORD, Miss. - A Mississippi federal judge on Oct. 26 denied a former National Football League (NFL) player's request to reopen his disability benefits case on the basis that the request is premature because the plan administrator has yet to render a final decision on his claim (Christopher Hudson v. Retirement Board, as the administrator of the Bert Bell/Pete Rozelle NFL Player Retirement Plan, No. 15-128, N.D. Miss.; 2016 U.S. Dist. LEXIS 151115).



Monthly Benefits Payable Based On Most Current Benefit Increase, Federal Judge Says
WINSTON-SALEM, N.C. - A North Carolina federal judge on Oct. 6 rejected a disability insurer's argument that a monthly disability benefit should be based on the last benefit increase accepted by the insured before the disability claim and said the claimant is entitled to the current monthly benefit payable under the policy (Jessica Slice-Sadler v. Principal Life Insurance Co., No. 15-216, M.D. N.C.; 2016 U.S. Dist. LEXIS 138990).



Insurer's Termination Of Long-Term Care Benefits Was Correct, Federal Judge Says
TAMPA, Fla. - A disability insurer correctly determined that a claimant was no longer eligible for long-term care disability benefits because it is clear from the evidence that the claimant no longer qualified for benefits under the policy's cognitive-impairment or functional-disability provisions, a Florida federal judge said Oct. 17 (David Carr v. John Hancock Life Insurance Co. [USA], No. 14-2867, M.D. Fla.; 2016 U.S. Dist. LEXIS 143050).



Plan Defendants Argue Plan Is Not Bound By SSA's Disability Onset Date
RICHMOND, Va. - A district court misinterpreted a disability plan's provisions when it determined that the plan and its administrator are bound by the disability onset date determined by the Social Security Administration (SSA), the plan defendants argue in a Nov. 2 brief filed in the Fourth Circuit U.S. Court of Appeals (Jesse Solomon v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 16-1730, 4th Cir.).



Complaint Seeks Finding That Insurer Wrongfully Offset Veterans' Benefits
BOSTON - A U.S. Army veteran filed a class action suit on Oct. 25 in Massachusetts federal court against a disability insurer, alleging that the insurer wrongfully offset disability benefits payable under the insurer's policy by disability benefits received from the U.S. Department of Veterans Affairs because the policy does not list veterans disability benefits as income eligible for an offset under the policy (Marco Martinez v. Sun Life Assurance Company of Canada, No. 16-12154, D. Mass.).



Insurer Is Not Entitled To Collect Attorney Fees, Florida Federal Judge Says
TAMPA, Fla. - A disability insurer is not entitled to collect more than $48,000 in attorney fees against a claimant because the claimant's suit was not frivolous and the claimant was partially successful in his bid to recover disability benefits, a Florida federal judge said Oct. 20 (Kristian Horneland v. United of Omaha Life Insurance Co., No. 15-1703, M.D. Fla.; 2016 U.S. Dist. LEXIS 145405).



Information About Medical Reviewers Is Relevant, Kentucky Federal Judge Says
OWENSBORO, Ky. - A Kentucky federal judge on Oct. 21 rejected a disability insurer's objections to a magistrate judge's discovery order and the insurer's motion for a protective order regarding information about the medical reviewers used by the insurer in evaluating a disability claim because the information sought by the claimant is relevant and not unduly burdensome (Paulette Owens v. Liberty Life Assurance Company of Boston, No. 15-71, W.D. Ky.; 2016 U.S. Dist. LEXIS 145941).



Claimant Should Not Be Permitted To Conduct Discovery, Plan Argues
INDIANAPOLIS - A disability claimant should not be permitted to conduct discovery to determine if a plan operated under a conflict of interest because the claimant failed to prove that the discovery sought is necessary, the plan argues in a Nov. 3 response brief filed in Indiana federal court (Donald Fessenden v. Reliance Standard Life Insurance Co., et al., No. 15-370, N.D. Ind.).



Montana Federal Judge Denies Motion To Remand, Says Removal Was Proper
MISSOULA, Mont. - A Montana federal judge on Oct. 11 denied a disability claimant's motion to remand a suit to Montana state court on the basis that jurisdiction in federal court is proper and none of the relevant factors weighs in favor of remanding the suit (Philip Cardan v. New York Life Insurance Co., No. 16-102, D. Mont.; 2016 U.S. Dist. LEXIS 140731).



Diversity Of Citizenship Does Not Exist; Suit Must Be Remanded, Federal Judge Says
LOS ANGELES - Because it is possible for a disability claimant to amend a complaint to plead claims with more particularity against a California doctor who conducted an independent medical exam for the disability insurer and the hospital who employed the doctor, a California federal judge on Oct. 11 said the suit must be remanded to state court as complete diversity of citizenship does not exist (Mayna Chau-Barlow v. Provident Life and Accident Insurance Co. et al., No. 16-1694, C.D. Calif.; 2016 U.S. Dist. LEXIS 140833).



Federal Magistrate Judge Denies Motion To Order IME For Failure To Serve Motion
TAMPA, Fla. - Because a disability plan administrator was not served with a claimant's motion seeking an order requiring the plan administrator to reschedule and videotape an independent medical exam (IME), a Florida federal magistrate judge on Oct. 21 denied the claimant's motion without prejudice and allowed the claimant to refile and serve the motion on the plan administrator (Alexander Stratigos v. Prudential Insurance Company of America, No. 16-2780, M.D. Fla.; 2016 U.S. Dist. LEXIS 146094).



Claimant Failed To Prove That He Suffered From Bipolar Disorder, Panel Says
SAN FRANCISCO - A district court did not err in determining that a disability insurer's termination of a claimant's benefits was reasonable based on the plan's mental illness limitation because the claimant failed to carry his burden of proving that he suffered from bipolar disorder, the Ninth Circuit U.S. Court of Appeals affirmed Sept. 26 (David Hoffmann v. Life Insurance Company of North America, et al., No. 15-55093, 9th Cir.; 2016 U.S. App. LEXIS 17491).



Claimant Failed To Show She Was Incapable Of Performing Duties Of Own Occupation
PHILADELPHIA - A Pennsylvania federal judge on Sept. 30 granted a disability insurer's motion for summary judgment and denied a claimant's motion for summary judgment after finding that the insurer's denial of claims for short-term and long-term disability benefits based on its determination that she was capable of performing the duties of her own occupation was reasonable and supported by substantial evidence (Anna Ackaway v. Aetna Life Insurance Co., No. 14-1300, E.D. Pa.; 2016 U.S. Dist. LEXIS 135368).



Kentucky Federal Judge: Evidence Shows Claimant Could Perform Other Occupations
OWENSBORO, Ky. - A disability insurer did not act arbitrarily and capriciously in terminating a claimant's long-term disability (LTD) benefits because the evidence shows that the claimant was not totally disabled and was able to perform other occupations, a Kentucky federal judge said Sept. 26 (Sabrina Austin-Conrad v. Reliance Standard Life Insurance Co., No. 14-127, W.D. Ky.; 2016 U.S. Dist. LEXIS 131047).



Termination Under Plan's Any-Occupation Standard Is Supported, Federal Judge Says
ALLENTOWN, Pa. - A disability insurer's termination of a claimant's benefits under the plan's any-occupation standard was not arbitrary and capricious because the evidence clearly supports the insurer's decision, a Pennsylvania federal judge said Sept. 26 (Calvin Shatto v. Liberty Life Assurance Company of Boston, No. 14-5653, E.D. Pa.; 2016 U.S. Dist. LEXIS 131097).



Claimant's Evidence Supports Inability To Work, Michigan Federal Judge Determines
DETROIT - A Michigan federal judge on Sept. 30 reinstated a disability claimant's long-term disability (LTD) benefits after determining that the claimant submitted sufficient medical evidence supporting his inability to work (Mohamed Ahmed Mokbel-Aljahmi v. United of Omaha Life Insurance Co., No. 15-12537, E.D. Mich.; 2016 U.S. Dist. LEXIS 135100).



Claim Denial Supported By Available Medical Evidence, Michigan Federal Judge Says
DETROIT - A federal magistrate judge did not err in recommending that a defendant's motion for summary judgment be granted because the available medical evidence supports the denial of a disability claimant's long-term disability claim, a Michigan federal judge said Sept. 13 in adopting the magistrate judge's report and overruling the claimant's objections to the report (Scott M. Bennetts v. AT&T Umbrella Plan No. 1, No. 15-10087, E.D. Mich.; 2016 U.S. Dist. LEXIS 123583).



Denial Of Benefits Was Reasonable Based On Plan Provisions, Federal Judge Says
MIAMI - A disability insurer did not act arbitrarily and capriciously in denying long-term disability (LTD) benefits to a claimant because the insurer's denial was reasonable based on the plan's provisions, a Florida federal judge said Sept. 30 (Myles German v. Metropolitan Life Insurance Co., No. 15-60392, S.D. Fla.; 2016 U.S. Dist. LEXIS 135845).



Washington Federal Judge: Additional Briefing Needed On Discretionary Clause
SEATTLE - A Washington federal judge on Sept. 19 ordered parties involved in a disability benefits dispute to submit additional briefing on whether a discretionary clause, included in a disability plan that was issued in the State of Texas, is valid in the State of Washington where the claimant resides (Anthony Flaaen v. McLane Co. Inc., et al., No. 15-5899, W.D. Wash.; 2016 U.S. Dist. LEXIS 127448).



Plan Administrator Not Granted Discretionary Authority, Federal Judge Says
SAN FRANCISCO - A de novo standard of review should be applied in a disability benefits suit because the plan at issue did not confer discretionary authority to the disability plan administrator, a California federal judge said Oct. 3 (Cathleen Murphy v. California Physicians Service, et al., No. 14-2581, N.D. Calif.; 2016 U.S. Dist. LEXIS 137159).



Denial Of Claims Was Not An Abuse Of Discretion, 9th Circuit Panel Says
PHOENIX - The denial of two short-term disability claims was not an abuse of discretion because the medical evidence did not support a finding that the claimant was disabled from performing the duties of her job, the Ninth Circuit U.S. Court of Appeals said Sept. 19 (Carol Molanick v. United Services Automobile Association, No. 14-16404, 9th Cir.; 2016 U.S. App. LEXIS 17087).



Michigan Federal Judge Says Prejudgment Interest Owed For Wrongful Benefits Denial
DETROIT - On remand from the Sixth Circuit U.S. Court of Appeals, a Michigan federal judge on Sept. 29 ordered a disability insurer to calculate the amount of prejudgment interest it owes to the estate of a disability claimant for the time period of July 2002 through September 2016 after determining that prejudgment interest is warranted based on the insurer's wrongful denial of benefits (Todd R. Rochow, et al. v. Life Insurance Company of North America, No. 04-73628, E.D. Mich.; 2016 U.S. Dist. LEXIS 134229).



Award Of Attorney Fees Denied; Claimant's Arguments Were Reasonable, Judge Says
CHICAGO - A disability insurer is not entitled to recoup $40,000 in attorney fees because the disability claimant's arguments were reasonable and not so lacking in merit as to justify an award of attorney fees, an Illinois federal judge said Sept. 27 (Donna Geiger v. Aetna Life Insurance Co., No. 15-3791, N.D. Ill.; 2016 U.S. Dist. LEXIS 131807).



Claimant Is Permitted To Pursue Discovery Outside Of Administrative Record
LOUISVILLE, Ky. - A Kentucky federal judge on Sept. 29 determined that a disability claimant is entitled to pursue discovery outside of the administrative record on her claim alleging that the disability plan administrator operated under a conflict of interest because the discovery is permitted under the Employee Retirement Income Security Act (Suzette Scott-Warren v. Liberty Life Assurance Company of Boston, No. 14-738, W.D. Ky.; 2016 U.S. Dist. LEXIS 136513).



8th Circuit Denies Petitioner Who Opposed Disability Plan's Forum-Selection Clause
ST. LOUIS - An Eighth Circuit U.S. Court of Appeals panel on Sept. 27 denied a disability plan participant's petition for writ of mandamus directing a Missouri federal judge to disregard the plan's forum-selection clause and transfer her case to Arizona, where she has lived and worked for more than a decade (In re Lorna Clause, No. 16-2607, 8th Cir.).