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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®



 



Panel Says Refusal To Conduct In-Person Medical Exam Was Arbitrary And Capricious
CINCINNATI - The Sixth Circuit Court of Appeals on March 30 remanded a claim for short-term disability (STD) benefits to the plan administrator for a full and fair review of the claim because the plan administrator's refusal to conduct an in-person medical exam was arbitrary and capricious (Kimberly J. Guest-Marcotte v. Life Insurance Company of North America, et al., No. 17-1233, 6th Cir., 2018 U.S. App. LEXIS 8105).



Panel Majority Says Disability Claimant Was Not Deprived Of A Full And Fair Review
CINCINNATI - The majority of the Sixth Circuit U.S. Court of Appeals on March 26 determined that a disability plan administrator did not deprive a disability claimant of a full and fair review under the Employee Retirement Income Security Act because the administrator consulted with more than one physician before denying the claimant's appeal (Katherine Castor v. The AT&T Umbrella Benefit Plan No. 3, No. 17-3400, 6th Cir., 2018 U.S. App. LEXIS 7494).



Federal Judge Remands NFL Player's Disability Claim For Re-Evaluation Of Benefits
SAN FRANCISCO - A California federal judge on March 12 remanded a former National Football League player's claim for disability benefits after determining that the plan failed to provide support for its denial of the player's claim (Charles Dimry v. The Bert Bell/Pete Rozelle NFL Player Retirement Plan, et al., No. 16-1413, N.D. Calif., 2018 U.S. Dist. LEXIS 41359).



Denial Of Disability Benefits Was Based On Deliberate, Principled Reasoning Process
COLUMBUS, Ohio - A disability administrator's denial of benefits to a claimant for a diagnosis autism spectrum disorder is supported by substantial evidence in the administrative record, an Ohio federal judge said March 27, noting that the administrator's denial was based on a deliberate and principled reasoning process (John R. Chartkoff v. American Electric Power, et al., No. 16-1186, S.D. Ohio, 2018 U.S. Dist. LEXIS 50762).



Disability Insurer's Termination Of Benefits Was Not Abuse Of Discretion
LYNCHBURG, Va. - A disability insurer did not abuse its discretion in terminating a claimant's long-term disability (LTD) benefits because the evidence supports the insurer's conclusion that the claimant was not disabled as an engineer under the plan's any-occupation standard, a Virginia federal judge said March 23 (Melvin Moore v. Life Insurance Company of North America, No. 17-030, W.D. Va., 2018 U.S. Dist. LEXIS 48313).



Disability Claimant Failed To Prove He Is Disabled From His Own Occupation
CHICAGO - An Illinois federal judge on March 14 determined that a disability claimant is not entitled to disability benefits because the claimant failed to prove by a preponderance of the evidence that he is disabled from his own occupation as a plan administrator (Jonas Daniliauskas v. Reliance Standard Life Insurance Co., No. 16-9278, N.D. Ill., 2018 U.S. Dist. LEXIS 42805).



Man Tells 7th Circuit Judge Erred When Making Disability Determination
CHICAGO - A man who suffering from invasive basal cell carcinoma in the right ear tells the Seventh Circuit U.S. Court of Appeals in a Jan. 19 brief that a federal judge in Illinois erred when finding that he was not entitled to total disability benefits from his insurer because he cannot complete the duties that his work requires (Henry Fiorentini v. Paul Revere Life Insurance Co., No. 17-3137, 7th Cir.).



Disability Insurer's Denial Of STD Benefits Supported By Substantial Evidence
SALT LAKE CITY - A Utah federal judge on March 29 granted a disability insurer's motion for summary judgment after determining that the insurer's denial of short-term disability benefits was supported by substantial medical evidence (Shawna Jennings v. Hartford Life and Accident Insurance Co., et al., No. 15-683, D. Utah, 2018 U.S. Dist. LEXIS 55016).



Panel Finds No Error In Decision To Terminate Partial Disability Benefits
RICHMOND, Va. - The Fourth Circuit U.S. Court of Appeals on March 28 agreed with a district court that 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 (Frederick Sutherland v. Sun Life Assurance Company of Canada, No. 17-1293, 4th Cir., 2018 U.S. App. LEXIS 7761).



Disability Benefits Properly Terminated Based On Plan's Mental Health Limitation
GRAND RAPIDS, Mich. - A disability insurer's termination of a claimant's benefits pursuant to the disability plan's 24-month mental health limitation is supported by the evidence in the administrative record, a Michigan federal judge said March 19 in granting judgment in favor of the insurer (Timothy O'Neill v. Unum Life Insurance Company of America, No. 16-1061. W.D. Mich., 2018 U.S. Dist. LEXIS 43878).



Denial Of Disability Claim To Be Reviewed Under Arbitrary, Capricious Standard
LOUISVILLE, Ky. - The denial of a claim for disability benefits must be reviewed under the arbitrary and capricious standard of review because the disability plan at issue clearly grants the insurer the discretionary authority to construe the terms of the plan and to make benefit eligibility decisions, a Kentucky federal judge said March 7 (Jack Ritter Jr. v. Liberty Life Assurance Company of Boston, No. 17-445, W.D. Ky., 2018 U.S. Dist. LEXIS 36932).



Disability Claimant Properly Exhausted Administrative Remedies, Federal Judge Says
BRIDGEPORT, Conn. - A disability claimant exhausted all administrative remedies under a disability plan by appealing the insurer's initial termination of benefits and was not required to file an additional appeal after the insurer granted the claimant an additional two days of disability benefits following the review of the claimant's appeal, a Connecticut federal judge said March 9 in denying the insurer's motion to dismiss (Gary Tuttle v. Prudential Insurance Company of America, No. 17-100, D. Conn., 2018 U.S. Dist. LEXIS 38830).



Fiduciary Exception To Attorney-Client Privilege Applies, Magistrate Says
MINNEAPOLIS - A disability insurer cannot assert that the attorney-client privilege applied to a number of withheld documents because the communications arising out of a claimant's request for plan documents were a matter of plan administration and fall under the fiduciary exception, a Minnesota federal magistrate judge said March 15 (Michael Christoff v. Unum Life Insurance Company of America, No. 17-3512, D. Minn., 2018 U.S. Dist. LEXIS 43535).



Disability Claimant Can Supplement Record With Additional Medical Evidence
PORTLAND, Ore. - A disability claimant is permitted to supplement the administrative record with evidence in support of her disability because the disability insurer failed to provide the claimant with the opportunity for a full and fair review when it issued a new basis for its decision on appeal, an Oregon federal judge said March 12 (Alison Gary v. Unum Life Insurance Company of America, No. 17-1414, D. Ore., 2018 U.S. Dist. LEXIS 40672).



Discovery Not Warranted In Disability Claimant's Suit, Federal Judge Says
AKRON, Ohio - Discovery pertaining to a potential conflict of interest between a disability plan and the plan's claims administrator is not warranted because the disability claimant failed to provide any factual support for the allegation that a conflict of interest influenced the termination of her long-term disability benefits, an Ohio federal judge said March 12 (Kristina L. Alekna v. The AT&T Service Inc. et al., No. 17-400, N.D. Ohio, 2018 U.S. Dist. LEXIS 40063).



Disability Insurer Is Not Plan Administrator; Penalties Not Available, Federal Judge Says
ST. LOUIS - A Missouri federal judge on March 23 determined that a disability claimant cannot recover damages from a disability insurer for failure to produce requested plan documents because the insurer was not the plan administrator (Rebecca Dunivin v. Life Insurance Company of North America, et al., No. 17-1530, E.D. Mo., 2018 U.S. Dist. LEXIS 48164).



Massachusetts Federal Judge Transfers Disability Suit To Kansas Federal Court
WORCESTER, Mass. - A Massachusetts federal judge on March 12 transferred a disability claimant's suit to the U.S. District Court for the District of Kansas after determining that Kansas has a greater interest in resolving the claim and that Kansas is the more convenient forum for the parties and witnesses (Anne R. Rosenthal, M.D. v. Unum Group, et al., No. 17-40064, D. Mass., 2018 U.S. Dist. LEXIS 40025).



Plan Administrator's Denial Of Disability Benefits Not Supported By Evidence
BALTIMORE - A plan administrator's denial of long-term disability benefits for two periods of time was not supported by substantial evidence and must be remanded to the plan administrator for a determination of the date of the claimant's onset of disability, a Maryland federal judge said March 6 (Leslie R. Vetter v. American Airlines Inc., et al., No. 16-2833, D. Md., 2018 U.S. Dist. LEXIS 36057).



Federal Judge Says Fact Issues Remain On Denial Of Disability Claimant's Appeal
NEW YORK - After determining that a de novo standard of review applies in a disability benefits dispute, a New York federal judge on March 5 found that the insurer's initial denial of long-term disability (LTD) benefits was justified but said that a question of fact exists as to whether the insurer properly denied the claimant's administrative appeal (Alexander Sigal v. Metropolitan Life Insurance Co., No. 16-3397, S.D. N.Y., 2018 U.S. Dist. LEXIS 35534).



9th Circuit Reverses, Remands Denial Of Benefits For Woman With MS, Fatigue
PASADENA, Calif. - A woman proved that her multiple sclerosis (MS) caused debilitating fatigue, rendering her totally disabled under the Employee Retirement Income Security Act, the Ninth Circuit U.S. Court of Appeals ruled Feb. 13, reversing and remanding a federal court's conclusion that Aetna Life Insurance Co. properly denied benefits (Margueritte Kibel v. Aetna Life Insurance Company, No. 16-56169, 9th Cir., 2018 U.S. App. LEXIS 3367).



7th Circuit: Sales Manager Waived Untimeliness Argument In LTD Dispute
CHICAGO - An employee seeking long-term disability (LTD) benefits effectively waived his right to challenge the untimeliness of the initial denial of his claim as he chose to pursue an appeal first rather than filing suit, a Seventh Circuit U.S. Court of Appeals panel ruled Feb. 14 (John Dragus v. Reliance Standard Life Insurance Company, No. 17-1752, 7th Cir., 2018 U.S. App. LEXIS 3444).



Disability Insurer's Termination Of Benefits Supported By Evidence
NEW YORK - The Second Circuit U.S. Court of Appeals on Feb. 21 affirmed a district court's ruling in favor of a disability insurer, noting that the insurer's decision to terminate a claimant's long-term disability (LTD) benefits was reasonable in light of the substantial evidence supporting the termination (Marybeth M. Donlick v. Standard Insurance Co., No. 17-1593, 2nd Cir., 2018 U.S. App. LEXIS 4348).



Claimant Failed To Prove Back Pain Was Sole Cause Of Disability
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on Feb. 12 affirmed a district court's ruling that a disability insurer's termination of benefits was not arbitrary and capricious because the claimant failed to prove that she suffered solely from a physical disability that precluded her from performing the duties of any occupation (Serilyn Krash v. Reliance Standard Life Insurance Group, No. 17-1814, 3rd Cir., 2018 U.S. App. LEXIS 3240).



Disability Plan Administrator Must Address Treating Doctor's Opinion, Judge Says
YOUNGSTOWN, Ohio - An Ohio federal judge on Feb. 28 remanded a long-term disability (LTD) claim to a plan administrator after determining that the plan administrator acted arbitrarily and capriciously by failing to consider the treating physician's opinion that the claimant was disabled as a result of emotional lability following the death of her son (Shelley Westfall v. Liberty Life Assurance Company of Boston, No. 16-2921, N.D. Ohio, 2018 U.S. Dist. LEXIS 32641).



Work Incentive Benefit Was Properly Applied To Offset Disability Benefits
SAN FRANCISCO - A work incentive benefit included in a disability policy's summary plan description does not violate the disclosure requirements of the Employee Retirement Income Security Act and was properly applied to offset a disability claimant's monthly benefits, the Ninth Circuit U.S. Court of Appeal said March 7 (Howard Lyle Abrams v. Life Insurance Company of North America, et al., No. 16-55858, 9th Cir., 2018 U.S. App. LEXIS 5780).



Judge Rules For Insurer In Suit Alleging It Wrongfully Offset Veterans' Benefits
BOSTON - A Massachusetts federal judge on Feb. 14 granted summary judgment in favor of a disability insurer in a U.S. Army veteran's class action suit alleging that the insurer wrongfully offset disability benefits payable under its policy by disability benefits received from the U.S. Department of Veterans Affairs (Marco Martinez v. Sun Life Assurance Company of Canada, No. 16-12154, D. Mass.).



Long-Term Disability Claim Was Properly Denied As Time-Barred, Judge Rules
SAN DIEGO - Dismissal of an insured's insurance breach of contract and bad faith lawsuit is necessary because her claims were not brought within the applicable statute of limitations and she has failed to show that the limitations period was tolled by the discovery rule, a federal judge in California ruled Feb. 20 in granting an insurer's motion to dismiss (Laurel Davis v. Liberty Life Assurance Company of Boston, No. 17-0738, S.D. Calif., 2018 U.S. Dist. LEXIS 27045).



8th Circuit Affirms Dismissal Of Disability Benefits Claim Due To Limitations Period
ST. LOUIS - A panel of the Eighth Circuit U.S. Court of Appeals on Feb. 13 affirmed a district court's ruling that a woman's Employee Retirement Security Act claim for long-term benefits from a disability insurance plan was barred by the limitations period on the policy (Estelean Jeannette Dodge v. Hartford Life and Accident Insurance Company, No. 17-1417, 8th Cir., 2018 U.S. App. LEXIS 3310).



Federal Judge Seals Administrative Record In Disability Insurance Dispute
SEATTLE - A Washington federal judge on Feb. 12 granted a motion jointly filed by both parties to seal the entire administrative record of a disability insurance dispute, finding that the plaintiff's right to medical privacy and the inability to redact portions of the record outweigh the public's right to access the information (David Alan Anderson v. Unum Life Insurance Company of America, No. C17-0659-JCC, W.D. Wash., 2018 U.S. Dist. LEXIS 22661).



Disability Claimant Is Judicially Estopped From Pursuing Benefits Claim
SALT LAKE CITY - A disability claimant is judicially estopped from pursuing a claim for long-term disability benefits because the claimant failed to disclose her interest in the disability policy as an asset in her bankruptcy filings, a Utah federal judge said Feb. 28 in granting the disability insurer's motion to dismiss (Dawna Lane v. Prudential Insurance Co., No. 17-998, D. Utah, 2018 U.S. Dist. LEXIS 33646).



Federal Judge Dismisses ERISA Claim For Failure To Provide Discovery
CLARKSBURG, W.Va. - A West Virginia federal judge on Feb. 12 found that a benefits plan and insurer were not obligated to provide a plan participant with documents in relation to his discovery request because they are not the plan administrators, granting them summary judgment on his claim for violation of the Employee Retirement Income Security Act of 1974 (Figlioli v. Liberty Life Assurance Company of Boston, et al., No. 1:17CV171, N.D. W.Va., 2018 U.S. Dist. LEXIS 22155).



Magistrate Judge Finds Disability Claimant Entitled To Reduced Fee Award
CENTRAL ISLIP, N.Y. - A New York federal magistrate judge on Feb. 28 recommended that a disability claimant be awarded attorney fees and costs of approximately $168,000, rather than more than $500,000 requested by the claimant, because the billing hours submitted by the claimant's attorneys appeared to be excessive (Janet Solnin v. Sun Life and Health Insurance Co., et. al., No. 08-2759, E.D. N.Y., 2018 U.S. Dist. LEXIS 33823).



Colorado Supreme Court: Disability Claimants Served, Sued The Wrong Parties
DENVER - The Colorado Supreme Court on Feb. 12 affirmed the dismissal of two long-term disability insurance lawsuits, finding that the plaintiffs failed to sue and to serve the proper parties (Caroline Burton, et al. v. Colorado Access, et al., No. 2018 CO 11, Colo. Sup., 2018 Colo. LEXIS 128).



Preemption Is Preemption. Or Is It? A Recent Fifth Circuit Decision Sheds Light On The Differences Between Conflict And Compete ERISA Preemption.
By Ian S. Linker A recent decision out of the United States Court of Appeals for the Fifth Circuit highlights the distinction between conflict preemption and complete preemption under the Employee Retirement Income Security Act of 1974 ("ERISA"), and should help to eliminate at least some of the historical confusion existing between these two doctrines. (By way of background, conflict preemption is a litigation defense and it arises under the ERISA statute, itself, and it exists when a state law relates to an ERISA-governed plan and is not otherwise saved from preemption. Complete preemption provides a basis to remove a state-law cause of action to federal court and it exists when a state law cause of action duplicates or interferes with a remedy provided by ERISA or provides an additional remedy unavailable under ERISA.) The Fifth Circuit's decision also demonstrates how blurred the line can be between the two doctrines. State law yields to federal law under each doctrine, though when one applies the other one does not necessarily apply. And there often is considerable overlap between the two. Understanding how these doctrines relate to each other and how they each impact various state laws will ensure clarity in the law, as it continues to develop.



Panel Remands Disability Claim After Finding Questions Of Fact Exist Regarding Denial
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on Jan. 24 determined that a district court properly applied an abuse-of-discretion standard of review in a disability benefits dispute but remanded the suit after determining that questions of facts exist regarding the disability insurer's decision not to conduct an independent medical evaluation and disregard of the claimant's fatigue and pain complaints (Renee Killebrew v. The Prudential Insurance Company of America, No. 17-2137, 3rd Cir., 2018 U.S. App. LEXIS 1672).



Denial Of Disability Benefits Was Not Arbitrary, Capricious, Federal Judge Says
LEXINGTON, Ky. - A Kentucky federal judge on Feb. 5 affirmed a disability plan's denial of long-term disability benefits after determining that the evidence supports the denial of benefits for the claimant's injury and that the plan provided a reasoned explanation for its denial of benefits (Tracy Kellar v. Aetna Life Insurance Co., et al., No. 17-81, E.D. Ky., 2018 U.S. Dist. LEXIS 18065).



Indiana Federal Judge Says Plan's Denial Of Disability Benefits Must Be Affirmed
SOUTH BEND, Ind. - Noting that an arbitrary and capricious standard of review applies in a disability benefits dispute based on a district court's prior decision, an Indiana federal judge on Jan. 17 affirmed the disability insurer's denial of benefits on the basis that there is rational support for the insurer's denial of benefits (Donald Fessenden v. Reliance Standard Life Insurance Co., et al., No. 15-370, N.D. Ind., 2018 U.S. Dist. LEXIS 7754).



Disability Benefits Claim Was Properly Denied, California Federal Judge Determines
SAN FRANCISCO - A claim for pension disability benefits was properly denied because the disability claimant failed to submit medical records detailing his disability as requested on multiple occasions by the plan at issue, a California federal judge said Feb. 6 (Vanmark Strickland v. AT&T Pension Benefit Plan, No. 17-01393, N.D. Calif., 2018 U.S. Dist. LEXIS 19566).



Disability Claimant Is Owed Benefits Under Any-Occupation Standard, Federal Judge Says
TUCSON, Ariz. - An Arizona federal judge on Jan. 19 determined that a disability claimant is entitled to current and retroactive long-term disability (LTD) benefits because the evidence supports a finding that the claimant is clearly disabled from performing the duties of any occupation (Rebecca Brown v. Life Insurance Company of North America, et al., No. 16-162, D. Ariz., 2018 U.S. Dist. LEXIS 9759).



Disability Insurer Must Reimburse Claimant For Amount Of Offset Benefits
MISSOULA, Mont. - A Montana federal judge on Jan. 30 reinstated a disability claimant's long-term disability benefits and ordered the disability insurer to reimburse the claimant for the amount offset by the insurer after determining that a settlement received by the claimant was not subject to offset because the settlement was not for the same disability for which the claimant was receiving disability benefits (Dawn Rustad-Link v. Providence Health and Services, et al., No. 16-136, D. Mont., 2018 U.S. Dist. LEXIS 14928).



9th Circuit Panel Denies Petition For Rehearing In Disability Offset Suit
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Jan. 9 refused to reconsider its ruling that 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 (Susan Rene Jones v. Life Insurance Company of North America, et al., No. 16-16172, 9th Cir., 2018 U.S. App. LEXIS 565).



Disability Insurer's Denial Of Claim Warranted Based On Pre-Existing Condition
JACKSON, Miss. - A disability claimant is not entitled to long-term disability (LTD) benefits because the plan's pre-existing condition limitation bars benefits because the claimant was treated for back pain within the plan's look-back period, a Mississippi federal judge said Jan. 24 (Gary Bales v. Hartford Life & Accident Insurance Co., No. 15-790, S.D. Miss., 2018 U.S. Dist. LEXIS 11180).



Texas Federal Judge Dismisses Remaining Bias Claim In Gender Dysphoria Suit
DALLAS - A Texas federal judge on Jan. 26 dismissed the remaining discrimination claim in a disability claimant's suit seeking benefits under a short-term disability (STD) plan for breast augmentation surgery to treat the illness of gender dysphoria after determining that the claimant failed to prove that the employer discriminated against her under Title VII of the Civil Rights Act (Charlize Marie Baker v. Aetna Life Insurance Co., et al., No. 15-3679, N.D. Texas; 2018 U.S. Dist. LEXIS 12854).



Disability Claimant Failed To Exhaust Administrative Remedies, 6th Circuit Says
CINCINNATI - A claim alleging that a disability insurer violated the Employee Retirement Income Security Act when it offset a plan participant's disability benefits was properly dismissed because the claim arose under the disability plan and the claimant was required to administratively exhaust the plan's remedies or plead futility, neither of which the claimant did, the Sixth Circuit U.S. Court of Appeals said Jan. 23 (Oliver H. Barber III, et al. v. Lincoln National Life Insurance Co., No. 17-5588, 6th Cir., 2018 U.S. App. LEXIS 1560).



Statute Of Limitations Bars Disability Claimant's Suit, Maryland Federal Judge Says
BALTIMORE - A Maryland federal judge on Feb. 1 determined that a disability claimant's breach of contract suit is barred by the applicable statute of limitations because the statute of limitations began to run when the insurer issued its denial letter and not when the insurer denied the claimant's appeal (Nancy F. George v. Massachusetts Mutual Life Insurance Co., No. 17-1073, D. Md., 2018 U.S. Dist. LEXIS 16528).



District Court Erred By Reducing Attorney Fees, 1st Circuit Panel Determines
BOSTON - The First Circuit U.S. Court of Appeals on Jan. 18 affirmed a district court's ruling that a disability claimant is entitled to disability benefits but vacated the lower court's calculation of attorney fees and prejudgment interest awarded to the claimant after determining that the court's downward adjustment in the attorney fee award was not appropriate (Diahann L. Gross v. Sun Life Assurance Company of Canada, Nos. 16-2002, 16-1958, 1st Cir., 2018 U.S. App. LEXIS 1190).



Magistrate Judge Says Discovery Not Warranted In Disability Dispute
INDIANAPOLIS - An Indiana federal magistrate judge on Feb. 2 denied a disability claimant's motion to compel discovery on the basis that the claimant failed to meet her burden of proving that the plan operated under a conflict of interest that would entitle her to conduct discovery (Angel Allen v. The Lilly Extended Disability Plan, et al., No. 16-2224, S.D. Ind., 2018 U.S. Dist. LEXIS 17290).



Disability Claimant's Suit Dismissed; Nevada Not Proper Venue, Federal Judge Says
LAS VEGAS - A Nevada federal judge on Jan. 24 dismissed a disability claimant's suit against a disability insurer after determining that the claimant failed to prove that Nevada is the proper jurisdiction for the suit (Edgar Ortiz v. Reliance Standard Life Insurance Co., No. 17-580, D. Nev., 2018 U.S. Dist. LEXIS 11374).



Motion To Transfer Disability Suit Denied; Suit Remains In California
LOS ANGELES - A California federal judge on Feb. 6 denied a motion to transfer a disability claimant's suit to Pennsylvania federal court because the defendants failed to prove that transferring the suit would serve the convenience of the parties and would promote the interests of justice (Stephanie Stefan v. Life Insurance Company of North America, et al., No. 17-6165, C.D. Calif., 2018 U.S. Dist. LEXIS 20356).