Mealey's Disability Insurance
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February 08, 2024
Limited Benefit Provision Properly Applied But Remand On Portion Of Claim Warranted
ALEXANDRIA, Va. — A disability insurer reasonably applied a limited benefit provision in finding that a claimant’s migraine headaches entitled her to only 24 months of benefits; however, the insurer’s explanation for its denial of benefits for the claimant’s cervical radiculopathy was not consistent, a Virginia federal judge said in determining that remand of claimant’s cervical radiculopathy claim is warranted.
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February 07, 2024
Disability Claimant’s Breach Of Fiduciary Duty Claims To Proceed, Judge Says
BALTIMORE — A Maryland federal judge on Feb. 6 denied a plan administrator’s motion to dismiss claims for breach of fiduciary duty after determining that a disability claimant sufficiently alleged facts in support of the claims pertaining to the long-term disability (LTD) and life insurance plans at issue.
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February 07, 2024
Disability Benefits Suit Settled; Parties File Stipulation Of Dismissal
DALLAS — Following a Texas federal judge’s ruling that a disability claimant’s long-term disability (LTD) benefits must be reinstated, the parties reached a settlement of the LTD benefits dispute and filed a joint stipulation of dismissal with prejudice.
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February 07, 2024
Disability Claimant Says Insurer Fails To Show Policy Rider Is Clear, Unambiguous
SAN FRANCISCO — A disability insurer fails to show that a rider included in its disability income policy is not ambiguous and should be enforced, a disability claimant says, maintaining in his appellant reply brief filed in the Ninth Circuit U.S. Court of Appeals that a district court incorrectly interpreted the policy’s monthly benefit rider.
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February 06, 2024
Disability Insurer Breached Fiduciary Duty In Terminating Benefits, Claimant Says
DENVER — A disability insurer breached its fiduciary duty in terminating a claim for long-term disability (LTD) benefits because the insurer mischaracterized the claimant’s medical condition and failed to follow the plan’s guidelines and procedures in handling the claim, a disability claimant alleges in a complaint filed Feb. 5 in Colorado federal court.
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February 06, 2024
Disability Insurer Improperly Terminated Benefits, Claimant Alleges In Complaint
DENVER — A disability claimant alleges in a Feb. 5 complaint filed in Colorado federal court that a disability insurer acted improperly, arbitrarily and capriciously in terminating her long-term disability (LTD) benefits based on a finding that she was not disabled from performing the duties of any occupation.
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February 01, 2024
LTD Claim Remanded To Plan Administrator To Complete Full, Fair Review
CEDAR RAPIDS, Iowa — An Iowa federal judge remanded a disability claimant’s long-term disability (LTD) claim to the disability plan administrator after determining that the claimant was deprived of a full and fair review because the claimant was not afforded the opportunity to respond to new information used by the disability insurer in denying the claimant’s appeal.
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February 01, 2024
Denial Of Disability Benefits Claim Was Not Arbitrary, Capricious, Judge Says
MADISON, Wis. — A disability insurer’s denial of benefits was not arbitrary and capricious because the medical evidence supports the insurer’s finding that the claimant was not disabled from performing the duties of her own occupation, a Wisconsin federal judge said in entering summary judgment in favor of the insurer.
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January 31, 2024
Claimant Failed To Provide Objective Findings In Support Of Disability, Judge Says
LOS ANGELES — A disability claimant failed to prove by a preponderance of the evidence that she is entitled to short-term disability (STD) and long-term disability (LTD) benefits because she failed to provide any objective findings in support of her claimed disability, California federal judge said in granting judgment in favor of the disability insurer.
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January 25, 2024
Denial Of LTD Benefits Was Not Arbitrary, Capricious, Federal Judge Determines
MADISON, Wis. — A disability insurer did not act arbitrarily and capriciously in denying a claim for long-term disability (LTD) benefits because the evidence in the record supports the insurer’s conclusion that the claimant failed to provide objective medical evidence in support of her LTD claim, a Wisconsin federal judge said.
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January 24, 2024
Disability Insurer Did Not Act Arbitrarily, Capriciously In Offsetting Benefits
PORTLAND, Maine — A federal judge in Maine granted a disability insurer’s motion for judgment on the administrative record after determining that the insurer did not act arbitrarily or capriciously or abuse its discretion by offsetting a claimant’s benefits to recover an overpayment because the plan terms clearly permitted the insurer to offset the benefits.
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January 23, 2024
Disability Claimant’s 2nd Suit Not Barred By Res Judicata, Panel Majority Says
PASADENA, Calif. — A disability claimant’s suit seeking long-term disability (LTD) benefits is not barred by the doctrine of res judicata because the claim pertaining to the denial of the claimant’s LTD benefits had not accrued when the claimant filed her first suit, the majority of the Ninth Circuit U.S. Court of Appeals said Jan. 22 in reversing a district court’s ruling in favor of the disability insurer.
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January 12, 2024
Denial Of STD Benefits Was Not Arbitrary, Capricious, Magistrate Judge Says
WEST PALM BEACH, Fla. — A disability insurer reasonably weighed conflicting medical evidence regarding a claimant’s ability to work in her own occupation before denying her claim for short-term disability (STD) benefits, a Florida federal magistrate judge said in finding that the insurer’s denial of benefits was not arbitrary and capricious.
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January 12, 2024
Washington Federal Judge Awards Disability Claimant Attorney Fees, Costs
SEATTLE — A Washington federal judge awarded a disability claimant more than $94,000 in attorney fees based on the claimant’s success in showing that she is entitled to long-term disability (LTD) benefits under a disability plan.
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January 12, 2024
STD Claim Remanded; Plan Administrator Must Clarify Why Claim Was Denied
TULSA, Okla. — An Oklahoma federal judge remanded a short-term disability (STD) claim to a plan administrator for clarification on the issue of why the plan administrator denied a disability claimant’s second appeal following the termination of his STD benefits.
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January 12, 2024
Disability Claimant Awarded $312,000 For Attorney Fees In Benefits Calculation Dispute
SANTA ANA, Calif. — Following a disability claimant’s successful appeal on a breach of fiduciary duty claim and subsequent settlement with the disability insurer, a California federal judge entered final judgment in the suit and awarded the claimant more than $312,000 in attorney fees after applying a reduction to the number of hours billed by the claimant’s counsel.
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January 11, 2024
Unfair Trade Practices Claim Against Disability Insurer Is Not Actionable Claim
ALLENTOWN, Pa. — A insured’s claim for violation of Pennsylvania’s Unfair Trade Practices and Consumer Protection Law (UTPCPL) alleged against a disability insurer must be dismissed because the claim is not actionable under the UTPCPL as it alleges only a refusal to pay a disability insurance claim, a Pennsylvania federal judge said in granting the insurer’s motion to dismiss the claim without prejudice.
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January 11, 2024
District Court Erred In Limiting Award Of LTD Benefits, 9th Circuit Says
PASADENA, Calif. — A district court erred in finding that a claimant was not disabled beyond a certain date because the medical evidence does not show that there was any improvement in the claimant’s heart-related condition, the Ninth Circuit U.S. Court of Appeals said in reversing the lower court’s ruling.
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January 11, 2024
Disability Suit Barred By Utah’s Statute Of Limitations For Insurance Claims
SALT LAKE CITY — A disability claimant’s suit is barred by Utah’s three-year statute of limitations for claims stemming from insurance contracts because the claimant failed to filed suit within three years as required by the statute, a Utah federal judge said, noting that it was not necessary to interpret the policy’s three-year limitations provision based on the claimant’s argument that she never received a final claims denial letter from the insurer.
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January 11, 2024
Disability Suit Must Be Remanded To Minnesota State Court, Judge Says
MINNEAPOLIS — A disability claimant’s suit must be remanded to state court because the federal jurisdictional amount-in-controversy requirement of $75,000 has not been met, a Minnesota federal judge said after determining that the only amount that could be considered when calculating the amount in controversy is $6,000, which represents the amount the claimant alleges he was owed under the policy when the suit was removed to federal court.
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January 10, 2024
Evidence Supports Finding That Claimant Is Disabled From Own Occupation
DALLAS — A disability insurer must reinstate a claimant’s long-term disability (LTD) benefits because the preponderance of the evidence supports a finding that the claimant is disabled from performing the material and substantial duties of her own occupation as an insurance agent, a Texas federal judge said in granting the claimant’s motion for judgment on the administrative record.
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January 10, 2024
Disability Claimant Is Entitled To LTD Benefits Based On Evidence, Judge Says
ROANOKE, Va. — A Virginia federal judge awarded a claimant long-term disability (LTD) benefits after determining that the disability insurer abused its discretion in denying the claim because sufficient evidence supports a finding that the claimant was disabled prior to the expiration of the disability plan and fulfilled the plan’s terms before filing a claim for LTD benefits.
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January 09, 2024
Disability Claimant Awarded More Than $488K In Fees, Costs, Prejudgment Interest
NEW YORK — Following a finding that a disability claimant is owed benefits under a supplemental disability plan, a New York federal judge awarded the claimant more than $488,000 in attorney fees, costs and prejudgment interest after determining that the amounts requested by the claimant were reasonable.
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January 09, 2024
Claimant Failed To Show He Was Disabled For Entirety Of Elimination Period
PASADENA, Calif. — A disability insurer properly denied a claim for long-term disability (LTD) benefits because the claimant failed to meet his burden of showing that he was disabled throughout the entire 90-day elimination period as required by the policy and because the record contains no medical evidence contradicting the date for the onset of disability, the Ninth Circuit U.S. Court of Appeals said in affirming a district court’s judgment in favor of the disability insurer.
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January 09, 2024
Disability Pension Plan Did Not Act Arbitrarily In Setting Onset Date, 6th Circuit Says
CINCINNATI — A district court did not err in ruling in favor of a disability pension plan trust on the issue of a claimant’s disability onset date because the plan trust correctly determined the disability onset date based on the applicable plan terms, the Sixth Circuit U.S. Court of Appeals said.