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

Mealey's Disability Insurance

February 10, 2022
Question Of Fact Exists As To Whether Disability Insurer Waived Payment Deadline

PHOENIX — An Arizona federal judge on Jan. 31 determined that questions of fact exists as to whether a disability income insurer waived its right to cancel an insured’s policy based on a late payment because a fact finder could find that the insurer’s prior acceptance of premium payments made after the 31-day grace period is evidence of the insurer’s waiver of the premium payment deadline.
February 10, 2022
Disability Insurers Did Not Act In Bad Faith In Denying LTD Claim

PHILADELPHIA — A Pennsylvania federal judge on Feb. 9 dismissed a bad faith claim alleged against two disability insurers after determining that the insurers had a reasonable basis to deny the insured’s claim for additional long-term disability (LTD) benefits.
February 09, 2022
Good Cause Exists To Extend Discovery Deadline In Disability Benefits Suit

ASHEVILLE, N.C. — A North Carolina federal judge on Feb. 8 granted a disability claimant’s request to extend a discovery deadline after determining that good cause exists for extending the deadline and allowing the disability insurer to respond to the claimant’s discovery requests.
February 09, 2022
Federal Judge Awards Prejudgment Interest, Attorney Fees In Disability Suit

CINCINNATI — An Ohio federal judge on Jan. 31 determined that a disability claimant is entitled to a 3.5% prejudgment interest rate on the claimant’s long-term disability (LTD) benefits incurred after Jan. 24, 2020, and determined that the claimant is entitled to more than $130,000 in additional attorney fees following a 33% reduction in the amount requested by the claimant.
February 08, 2022
Judge Denies Disability Claimant’s Motion To Supplement Record

DENVER — A Colorado federal judge on Feb. 7 denied a disability claimant’s motion to supplement the administrative record with documents received after the insurer denied the claimant’s appeal because the claimant failed to meet her burden of proving that supplementing the administrative record is warranted.
January 31, 2022
Editor’s Note

The journalists and staff of Mealey’s Litigation Reports are saddened by the passing of co-founder Michael P. Mealey. He was a respected member of the newsletter community, being named publisher of the year by the National Newsletter Association and president of the National Newsletter Association. Mike and Judy Mealey started Mealey Publications Inc. in 1984. As president, Mike grew the Mealey’s Litigation Report portfolio, introduced email news bulletins and electronic CD formats and launched a continuing legal education conference business. Mealey’s was sold to LexisNexis in 2000. We hope to carry on his journalistic curiosity and integrity in the titles we continue to publish today under his name.
January 28, 2022
District Court Correctly Denied Disability Claimant’s Motion To Amend Complaint

NEW YORK — The Second Circuit U.S. Court of Appeals on Jan. 27 affirmed a district court’s denial of a disability claimant’s motion to amend a complaint to assert a cause of action under the Employee Retirement Income Security Act, agreeing with the lower court’s conclusion that amendment would be futile as the claimant failed to exhaust all administrative remedies prior to filing suit.
January 27, 2022
State Law Claims Are Not Preempted By ERISA; Policy Not Part Of ERISA Plan

TACOMA, Wash. — A disability claimant’s state law claims for breach of contract, breach of the duty of good faith, negligent claims handling and violations of Washington law can proceed because the individual disability income policy at issue is not a plan governed by the Employee Retirement Income Security Act, a Washington federal judge said Jan. 19 in rejecting the insurer’s argument that the state law claims are preempted by ERISA.
January 27, 2022
Disability Claimant Claims Benefits Owed For Long COVID Symptoms

SAN FRANCISCO — A disability claimant suffering from symptoms of long COVID following a battle with COVID-19 asks a California federal court in a Jan. 19 complaint to order a disability insurer to reinstate her short-term disability (STD) benefits and approve her long-term disability (LTD) benefits claim because she remains unable to perform the duties of her own occupation.
January 27, 2022
Disability Claimant Entitled To Award Of More Than $120K For Attorney Fees, Costs

MINNEAPOLIS — A Minnesota federal judge on Jan. 13 granted a disability claimant’s motion for attorney fees and costs and awarded the claimant, who prevailed on her claim seeking long-term disability (LTD) benefits, more than $120,000 in attorney fees and costs after determining that the amount sought by the claimant was reasonable.
January 27, 2022
Disability Plan Did Not Accurately Describe Available Benefits, Judge Says

GREENEVILLE, Tenn. — A Tennessee federal judge on Jan. 24 determined that a plan sponsor breached its fiduciary duty because the employer’s long-term disability plan description did not accurately describe the amount of benefits available to an employee if an employee elected the buy-up coverage for additional benefits.
January 21, 2022
Judge: 3 Of 4 Fraud Elements Of Disability Insurer’s Rescission Claim Pass Muster

FORT MYERS, Fla. — A federal judge in Florida on Jan. 11 substantially granted an insurer’s motion for summary judgment in a lawsuit seeking to rescind a doctor’s disability policy based on material misrepresentations the doctor made in his policy application, ruling that the insurer partially pleaded certain elements of its rescission claim.
January 14, 2022
2nd Circuit Affirms Dismissal Of Claimant’s Disability Suit Under ERISA

NEW YORK — Concluding that there was no clear error in the factual findings and declining to apply a less deferential standard of review, the Second Circuit U.S. Court of Appeals in a Jan. 11 summary order affirmed the judgment of a New York federal court that dismissed a disability claimant’s suit under the Employee Retirement Income Security Act of 1974 following determination on the papers.
January 12, 2022
Policy’s Other Limited Conditions Limitation Properly Applied To Disability Claim

MADISON, Wis. — A disability insurer did not act arbitrarily or capriciously in terminating a claimant’s long-term disability (LTD) benefits because the claimant failed to show that his disability was not subject to the plan’s other limited conditions limitations, a Wisconsin federal magistrate judge said Dec. 27.
January 12, 2022
Bad Faith Claim Against Disability Insurer Cannot Proceed, Judge Says

SAN FRANCISCO — A California federal judge on Dec. 21 granted a disability insurer’s motion for summary judgment on a bad faith claim after determining that there is no evidence showing that the insurer’s investigation was unreasonable and after determining that a question of fact exists as to whether the claimant’s disability was caused by sickness or injury.
January 12, 2022
Judgment Entered In Favor Of Disability Claimant; Attorney Fees, Costs Awarded

SANTA ANA, Calif. — In a Jan. 3 amended judgment, a California federal judge entered judgment in favor of a disability claimant and awarded the claimant approximately $226,097 in attorney fees and $4,489 in costs after he prevailed on a claim for long-term disability benefits.
January 12, 2022
Disability Policy’s 3-Year Limitations Provision Is Enforceable, Judge Says

BALTIMORE — A three-year limitations provision in a disability policy is enforceable and bars a disability claimant’s lawsuit seeking a declaration that he is entitled to additional long-term disability benefits, a Maryland federal judge said Jan. 4.
January 12, 2022
Termination Of Disability Benefits Was Not Arbitrary, Capricious, Judge Says

DETROIT — A disability insurer’s decision to terminate a claimant’s benefits was not arbitrary and capricious because the insurer properly found that the claimant was able to perform the duties of a sedentary occupation, a Michigan federal judge said Dec. 28 in granting the insurer’s motion to affirm its decision.
January 12, 2022
Disability Claim Remanded To Determine If Pre-Existing Condition Exclusion Applied

NEW ORLEANS — A Louisiana federal judge on Dec. 29 upheld a disability insurer’s determination that a disability claimant is not entitled to long-term disability benefits for migraine headaches but remanded the disability insurer’s determination that the plan’s pre-existing condition exclusion barred benefits for other medical ailments because there is a discrepancy as to when the claimant was hired and whether the pre-existing condition exclusion applied.
January 12, 2022
Disability Plan Is Not Church Plan; Claimant’s Suit To Remain In Federal Court

COVINGTON, Ky. — A Kentucky federal judge on Jan. 11 denied a disability claimant’s motion to remand after determining that federal jurisdiction exists because the plan at issue is governed by the Employee Retirement Income Security Act and does not qualify as an exempted church plan under ERISA.
January 11, 2022
District Court Properly Found Claimant Not Disabled From Any Occupation

CINCINNATI — The Sixth Circuit U.S. Court of Appeals on Dec. 13 affirmed a district court’s ruling in favor of a disability insurer after determining that the lower court correctly found that the disability claimant failed to prove by a preponderance of the evidence that he is disabled from performing the duties of any occupation.
January 10, 2022
District Court Erred In Entering Judgment For Disability Insurer, Panel Says

ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on Dec. 27 reversed a district court’s judgment entered in favor of a disability insurer after determining that the insurer failed to show that there was any new information or evidence to support its decision to terminate benefits after almost 10 years.
January 07, 2022
Panel Says Any-Occupation Ruling Not Supported; Remand Necessary

PASADENA, Calif. — The Ninth Circuit U.S. Court of Appeal on Dec. 27 affirmed a district court’s finding that a disability claimant is entitled to own-occupation benefits but reversed and remanded the lower court’s ruling that the claimant is entitled to any-occupation benefits because the evidence in the administrative record did not conclusively show that the claimant was disabled from performing the duties of any occupation.
January 06, 2022
Insurer Waives Right To Respond To Petition Seeking Review Of Disability Ruling

WASHINGTON, D.C. — A disability insurer on Jan. 5 waived its right to respond to a disability claimant’s petition for writ of certiorari filed in the U.S. Supreme Court seeking a “uniform rule enforcing an ERISA plan’s choice of law and applying the chosen law to all plan participants” and a ruling that the Employee Retirement Income Security Act does not preempt state law prescribing de novo judicial review for challenged benefit determinations.
January 04, 2022
Federal Judge Finds Attorney Fees Reasonable In Physician’s ERISA Disability Suit

WILMINGTON, Del. — A Delaware federal judge on Dec. 17 granted a disability claimant’s request for attorney fees, finding that the claimant met the burden of showing that the fees were not excessive.