Mealey's Disability Insurance : Mealey's : Legal News & Analysis

Mealey's Disability Insurance

June 06, 2024
Disability Claimant, Insurer Stipulate To Dismissal After Reaching Settlement

KNOXVILLE, Tenn. — A disability insurer and a disability claimant filed a joint stipulation of dismissal in Tennessee federal court following the settlement of the claimant’s long-term disability (LTD) benefits suit.
June 06, 2024
Parties Settle Disability Benefits Suit Stemming From Long COVID Diagnosis

MIAMI — A Florida federal judge ordered the parties in a long-term disability (LTD) benefits suit stemming from a claimant’s diagnosis with long COVID to file a joint stipulation of dismissal and administratively closed the case after the parties notified the court that they reached a settlement.
June 05, 2024
Disability Claimant Seeks De Novo Review, Says Additional STD Benefits Are Owed

TULSA, Okla. — A de novo standard of review should be applied to the review of the denial of a short-term disability (STD) claim because the disability plan administrator committed a number of procedural irregularities in handling the claimant’s second appeal of the denial of his claim, the claimant says in an opening brief filed in Oklahoma federal court.
June 05, 2024
Ex-NFL Player Granted Extension To Petition High Court In Disability Suit

WASHINGTON, D.C. — The deadline for a former National Football League player to file a petition for writ of certiorari in the U.S. Supreme Court was extended by a month, giving the former player until July 13 to seek review of the Fifth Circuit U.S. Court of Appeals’ ruling that he failed to prove that he is entitled to additional disability benefits under the NFL’s benefits plan.
May 22, 2024
Complete Administrative Record Needed To Review Denial Of LTD Claim, Judge Says

PORTLAND, Ore. — A disability claimant’s motion for judgment on the pleadings must be denied because the claimant submitted only portions of the administrative record, an Oregon federal judge said, noting that the complete administrative record, as reviewed by the plan administrator, is necessary to judicially review the plan administrator’s long-term disability (LTD) benefits decision.
May 21, 2024
Insured Is Not Entitled To 2 Monthly Disability Payments, Massachusetts Panel Says

BOSTON — A trial court properly found that an insured is not entitled to both total disability benefits and lifetime total disability benefits under a disability income policy because the policy clearly provides that lifetime total disability benefits are not payable until the maximum amount of total disability benefits is paid or until the insured’s 65th birthday, the Massachusetts Appeals Court said May 21 in affirming the trial court’s summary judgment order in favor of the insurer on breach of contract and bad faith claims.
May 21, 2024
Insured Failed To Show Disability Insurer Acted With Reckless Disregard, Judge Says

LOUISVILLE, Ky. — A Kentucky federal judge granted a disability insurer’s motion to dismiss an insured’s claims for violation of the Kentucky Unfair Claims Settlement Practices Act (KUCSPA) and breach of the covenant of good faith and fair dealing because the insured failed to show that the insurer acted with reckless disregard when it determined that the insured was entitled to only residual disability benefits and not total disability benefits.
May 14, 2024
Life Insurance Benefit Not Available Based On Failure To Prove Total Disability

PASADENA, Calif. — The Ninth Circuit U.S. Court of Appeals on May 13 affirmed a district court’s finding that a life insurance waiver-of-premium benefit was properly terminated because the claimant failed to show that he was totally disabled from working in any occupation as required by the life insurance plan to retain the waiver-of-premium benefit.
May 10, 2024
Claim For Disability Benefits Is Time-Barred, 5th Circuit Panel Says In Affirming

NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on May 9 affirmed the dismissal of a disability claimant’s breach of contract suit because the claimant failed to filed suit within three years of the initial denial of her claim, as required by the plan at issue, and failed to file suit within four years of the denial of her appeal pursuant to the four-year statute of limitations under Texas law for breach of contract suits.
May 10, 2024
Attorney Says Termination Of Disability Benefits Was Arbitrary, Capricious

PHILADELPHIA — A disability insurer acted arbitrarily and capriciously when it terminated an attorney’s long-term disability (LTD) benefits because the insurer failed to consider the actual duties of the claimant’s occupation when it determined that the claimant was no longer disabled from her own occupation as an attorney, the attorney says in a complaint filed in Pennsylvania federal court.
May 08, 2024
Spinal Conditions Continued To Render Claimant Disabled, Calif. Federal Judge Says

LOS ANGELES — Following remand from the Ninth Circuit U.S. Court of Appeals, a California federal judge found that additional long-term disability (LTD) benefits are owed to a disability claimant because the medical evidence shows that the claimant’s degenerative spinal conditions continued to render him disabled following the claimant’s recovery from a cardiac procedure.
May 07, 2024
Disability Claimant Failed To Show Longer Shift Was Essential Duty Of Occupation

CHICAGO — The Seventh Circuit U.S. Court of Appeals on May 6 affirmed a district court’s ruling that a disability claimant failed to show that the denial of a long-term disability (LTD) benefits claim was arbitrary and capricious because the claimant failed to show that working a longer shift was an essential duty of his occupation with his current employer.
May 07, 2024
Claimant Files Complaint, Says LTD Benefits Owed For Long COVID Diagnosis

PHOENIX — A denial of long-term disability (LTD) benefits was arbitrary and capricious and an abuse of discretion because the disability insurer failed to properly consider the restrictions and limitations set by the claimant’s treating physicians as a result of the claimant’s diagnosis with long COVID, the claimant contends in a complaint filed in Arizona federal court.
May 03, 2024
Ophthalmologist’s Disability Suit Settled; Parties File Stipulation Of Dismissal

ROANOKE, Va. — A disability claimant and disability insurer filed a stipulation of dismissal in Virginia federal court after reaching a settlement pertaining to the claimant’s long-term disability (LTD) benefits.
May 03, 2024
Disability Claimant Seeks Rehearing Of Preexisting Condition Exclusion Ruling

PASADENA, Calif. — A disability claimant filed a petition for panel rehearing and rehearing en banc in the Ninth Circuit U.S. Court of Appeals, contending that rehearing is warranted because the Ninth Circuit panel’s decision that a long-term disability (LTD) policy’s preexisting condition exclusion bars coverage creates an intracircuit conflict with a prior ruling of the Ninth Circuit.
May 03, 2024
Disability Insurer Files Notice Of Settlement In LTD Benefits Suit

KNOXVILLE, Tenn. — Less than a week after filing a notice of appeal to the Sixth Circuit U.S. Court of Appeals of a Tennessee federal judge’s ruling entered in favor of a disability claimant, the disability insurer notified the district court that it reached a settlement with the disability claimant.
May 03, 2024
Disability Insurer Awarded More Than $11,000 In Costs In Bad Faith Benefits Suit

FRESNO, Calif. — A California federal magistrate judge awarded a disability insurer more than $11,000 in costs that the insurer incurred in successfully defending a breach of contract and bad faith suit lodged against it by an oral surgeon who stopped working to reduce the risk of contracting COVID-19 and suffering complications from the virus based on his comorbid conditions of asthma and hypertension.
May 02, 2024
Disability Claimant Failed To Show Any Error In District Court’s Benefits Ruling

WASHINGTON, D.C. — The District of Columbia Circuit U.S. Court of Appeals granted a motion for summary affirmance filed by the Pension Benefit Guaranty Corp. (PBGC), named as the statutory trustee for a disability benefits plan, because the disability claimant failed to demonstrate any error in a district court’s ruling in favor of the PBGC.
May 02, 2024
Disability Insurer, Claimant Settle Dispute Over Policy’s Monthly Benefit Rider

SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals entered an order staying a disability claimant’s appeal and directing the parties to file a joint status report following the disability insurer’s filing of a notice of a settlement between the parties.
April 25, 2024
Question Of Fact Exists About Disability Insurer’s Knowledge Of Pension Benefits

OPELIKA, Ala. — An Alabama federal judge denied a motion for judgment on the pleadings filed by a disability claimant after determining that it is not clear whether the applicable six-year statute of limitations bars the disability insurer’s suit seeking to recover an overpayment of long-term disability (LTD) benefits because a question of fact exists regarding when the disability insurer learned that the claimant failed to disclose her receipt of pension benefits.
April 23, 2024
Disability Insurer’s Benefits Termination Not Supported By Medical Evidence

MINNEAPOLIS — A disability insurer’s termination of long-term disability (LTD) benefits is not supported by the medical evidence, a Minnesota federal judge said in granting the claimant’s motion for judgment on the administrative record and denying the insurer’s motion for judgment on the administrative record.
April 18, 2024
Judge Says Claims Against Disability Plan, Claims Administrator Can Proceed

KANSAS CITY, Mo. — A Missouri federal judge denied a motion to dismiss filed by disability plan defendants after determining that the claim for wrongful denial of benefits against the claims administrator can proceed because the plan delegated fiduciary discretion to the claims administrator and the claim for breach of fiduciary duty alleged against the plan and the claims administrator can proceed because the claim is not duplicative of the wrongful denial of benefits claim.
April 17, 2024
LTD Claim Excluded By Policy’s Preexisting Condition Exclusion, 9th Circuit Says

PASADENA, Calif. — A district court did not err in entering judgment in favor of a disability insurer because the long-term disability (LTD) policy’s preexisting condition exclusion barred coverage as the disability claimant received medical treatment for symptoms related to the claimed disability within three months prior to the effective date of coverage of the policy, the Ninth Circuit U.S. Court of Appeals said.
April 12, 2024
Failure To Offer Proof Of Continued Disability Supports Termination, Plan Says

PHILADELPHIA — A disability claimant’s failure to provide proof of a continued disability when her long-term disability (LTD) benefits were terminated supports the reasonableness of the disability plan’s termination of benefits and warrants the reversal of a district court’s judgment in favor of the claimant, the disability plan maintains in its appellant reply brief filed in the Third Circuit U.S. Court of Appeals.
April 10, 2024
District Court Must Hold Bench Trial Based On Fact Issues In Disability Suit

RICHMOND, Va. — The Fourth Circuit U.S. Court of Appeals on April 9 vacated and remanded a district court’s summary judgment ruling in favor of a disability insurer after determining that the lower court was required to hold a bench trial based on a Fourth Circuit ruling, issued after the district court’s decision, that clarifies the need for a bench trial in cases where issues of material fact are in dispute.