You already know that when a claimant brings suit alleging wrongful denial of ERISA-governed disability benefits, the first issue the court looks at is: what standard of review applies. If the plan or policy includes...more
You already know that the primary responsibility for providing medical proof of disability undoubtedly rests with the claimant.
But does the plan administrator sometimes have an obligation to obtain medical records and...more
Can the Plan get reimbursed even when the beneficiary’s settlement funds have been disbursed or commingled?
Yes in the 11th Circuit. But watch out in the 9th Circuit....more
You already know that in ERISA cases a court may, in its discretion, award attorney fees if a party achieved “some degree of success on the merits.”...more
Here is a recent news item showing the scope of the employee disability problem.
In a nutshell...more
But what happens when the claimant refuses to perform tasks requested, or does not try hard enough during the FCE?...more
Steve Jobs and Bill Gates were interns. Best companies use internships to win the war to recruit talent. The website Internships.com indicates that 56 percent of employers plan to hire more interns this year, up 9 percent...more
Medical providers often have a patient/ERISA plan participant assign rights under an ERISA health care plan to allow the medical provider to seek payment for medical services provided....more
You already know that the Defense of Marriage Act (DOMA), which prohibited recognition of same-sex marriages, was declared unconstitutional. United States v. Windsor, 133 S.Ct. 2675 (2013)....more
Sometimes determining the correct beneficiary for ERISA-governed life insurance benefits can present real challenges.
Can the deceased’s will prove the deceased’s intent designating the correct beneficiary? It...more
You already know that plans that contain “discretionary language” should enjoy a more deferential review by the trial court.
But when the plan administrator decides and funds the benefit decision, courts view this as a...more
Does the claim administrator waive the timeliness defense if it failed to deny the claim on that basis during administrative review? YES!
Here is a nice case that summarizes the point, and the status of waiver in the...more
Are you seeing more ERISA Plaintiffs asserting claims seeking penalties for delayed production of ERISA-related documents?
29 U.S.C. 1132(c)(1) allows the Court to impose penalties of up to $110 per day for delays in...more
ERISA claims administrators sometimes are asked to “reopen” a claim, after appeal denial, to consider additional information.
How does “reopening” a claim affect the statute of limitations defense?
You have seen this one before: The ERISA plan pays hundreds of thousands of dollars in medical bills and secures an equitable lien. Then, the ERISA plan beneficiary settles a tort claim, but refuses to reimburse the ERISA...more
Can a court deny a successful ERISA claimant’s attorney fees solely because there is no evidence of bad faith? NO....more
How do you defeat two arguments frequently used to challenge an ERISA-governed disability claim denial?
Argument (1) the rationale for the claim denial changed, or
Argument (2) the denial letter failed to tell...more
What happens when a long term disability claimant declares bankruptcy, and fails to list the long term disability claim in the bankruptcy estate?
Is he judicially estopped from bringing the lawsuit alleging wrongful...more
You already know that a Social Security disability (SSDI) decision should be considered in the context of deciding whether the claimant is disabled under the terms of the disability policy....more
You already know that a “church plan” is exempt from ERISA, unless the Plan specifically elects to be governed by ERISA under Internal Revenue Code Section 410(d).
But what does it take to become a “church plan”?...more
Are those three year suit limitations provisions in ERISA-governed long term disability plans enforceable? YES!
Here’s today’s case, Heimeshoff v Hartford Life & Accident Insurance Co., __ U.S. __ (December 16, 2013)...more
Wow—You need to know what happened last week in the Sixth Circuit:
Disgorgement of profits as a remedy in an ERISA long term disability case?
Rochow v. LINA, __ F.3d __, 2013 WL 6333440 (6th Cir. December 6,...more
PROBLEM: During the claim process your claims administrator mistakenly tells the claimant that the ERISA-governed plan is NOT governed by ERISA. Uh oh.
Do you lose ERISA as the governing law over the policy and claim?...more
What language is needed in the ERISA plan to confer discretion?
The bar was just raised in the 4th Circuit.
Here’s the case of Cosey v. Prudential Insurance Company of America, [PDF] __F.3d__ (November 12,...more
What does it take to assert an effective exhaustion of remedies defense in ERISA cases? Properly drawn plan documents that expressly impose the duty upon the claimant to exhaust remedies before bringing a lawsuit....more