In Judge v. Metropolitan Life Insurance Company [PDF], 710 F.3d 651 (6th Cir. 2013), the Sixth Circuit rejected plaintiff’s proposed bright-line rule requiring plan administrators to obtain vocational evidence and an IME before…more
You already know that an employee benefit plan qualified as a “government plan” is exempt from ERISA’s framework…more
You already know that an individual disability policy may nevertheless be governed by ERISA, even when the employee pays her own premium. This can occur when the employees benefit from a rate structure or premium discount the…more
The U.S. Supreme Court yesterday strengthened the ability of employer health insurance plans to recoup payments for medical expenses paid for an injured plan participant who later sues to recover damages from a third…more
The claimant seeking long term disability benefits under your ERISA Plan was found to be disabled by the Social Security Administration…more
What does “full and fair” review during an ERISA appeal mean?
Before the appeal decision is made, does the administrator have to disclose to the claimant medical opinions obtained during an appeal? Not if that opinion…more
Originally published in Westlaw in March 25, 2013.
What happens when the claimant refuses to seek and accept medical care that might enable the claimant to return to work?
Does the claimant have a duty to seek out…more
That subrogation claim you have might be governed by ERISA, at least in some circuits…
Here’s the case of Thurber v. Aetna Life Insurance Company, __F.3d__ (2nd Cir. March 13, 2013) (Insurer’s counterclaim for return of…more
Yesterday, Jordan Weissman’s excellent article, “Disability Insurance: America’s $124 Billion Secret Welfare Program,” published March 25, 2013 in The Atlantic, explains how the number of former workers enrolled in Social…more
You know already that a plan administrator can be liable for statutory penalties under ERISA for failing to provide requested plan documents…more
Can ERISA apply to the claims made on individual policies purchased with discounted premiums? YES…more
Here’s a unique twist:
Does that workers’ compensation settlement agreement release the ERISA disability claim? Probably not, unless the release explicitly mentions ERISA claims and the ERISA Plan…more
How does an ERISA claimant start an administrative appeal?
Can a mere request for medical records, and a reference to an “appeal in the future tense,” trigger the appeal? No…more
What happens when an ERISA claimant submits contradictory statements to the Social Security Administration and the ERISA plan administrator? Can these contradictory statements be used to deny the ERISA claim? YES…more
Will courts enforce Plan language even when a 24 month limitation is “not what a reasonable employee would expect” to see in a disability plan? YES…more
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