Denial of Benefits

News & Analysis as of

Bad Faith Sentinel - August 2014

In This Issue: - Northern District of Texas Dismisses Bad Faith Claims in Well-Control Policy Dispute - District of South Dakota: Denying a Claim for Reasons Known to be False is Not a Reasonable Basis to Deny...more

Northern District of Ohio: No Reasonable Jury Could Conclude That Insurer’s Denial of Coverage For Two Arsons Was Not Justified

Givens v. West Bend Mut. Ins. Co., No. 4:13 CV 1287, 2014 WL 2946672 (N.D. Ohio Jul. 1, 2014) - The Northern District of Ohio concludes that insurer was justified in denying claim for two fires that were undisputedly...more

District of South Dakota: Denying a Claim for Reasons Known to be False is Not a Reasonable Basis to Deny a Claim

Lewison v. W. Nat’l Mut. Ins. Co., Civ. No. 13-4031-KES, 2014 WL 3573403 (D.S.D. July 21, 2014). The District of South Dakota grants in part and denies in part an insurer’s motion for summary judgment on two...more

New York’s High Court Holds That An Insurer’s Delay in Disclaiming Coverage Could Be Excused When The Delay Resulted From...

Until recently, New York’s Insurance Law presented something of a dilemma for insurance companies concerning how quickly they were required to inform their policyholders that they were denying coverage for a claim. On the one...more

ERISA: 6th Circuit — Benefit Denial Letters: Include The Time Limit For Judicial Review Or Lose Contractual Limitations Defense

Does your ERISA claim benefit denial letter preserve the contractual limitations defense? If your denial letter fails to expressly state the contractual limitations timeframe, it might not preserve that defense. ...more

Mediation of Insurance Coverage Cases

Resolving insurance coverage disputes through mediation requires careful assessment of three unique elements: the insurance policy, the rules applicable to the application of the policy and the cases construing the policy....more

Eleventh Circuit Dials Back The Specificity Required In An Insurer’s Reservation of Rights—Will Georgia Courts Agree?

The U.S. Court of Appeals for the Eleventh Circuit recently held under Georgia law that an insurance company does not waive a coverage defense by defending the policyholder in an underlying case without reserving its rights...more

Northern District of Alabama: No Bad Faith Where Insured Made Misrepresentations in Court Filings and Insurer Reasonably Relied on...

The Northern District of Alabama finds that an insurer did not act in bad faith by denying coverage for damage caused by a house fire where investigators suspected arson, the insured made misrepresentations in bankruptcy...more

Amlin v Austcorp – It’s all in the wording

In Amlin Corporate Member Ltd v Austcorp Project No 20 Pty Limited [2014] FCAFC 78, the Full Court of the Federal Court rejected the insurers’ argument that certain policies did not respond because the claim was made before...more

Welcome To The Jungle

What happens when a plan administrator relies on information received from a third party to make a denial of benefits decision under an ERISA plan? Does the plan administrator bear the burden of weighing the relative...more

Failure to File a Proof of Loss is Fatal, and the Defense Does Not Require a Showing of Prejudice

On June 3, Connecticut’s intermediate level appellate court held that the failure of a policyholder to file a sworn statement in proof of loss was fatal to his claim....more

First Circuit: Proof of Death Prerequisite to Payment of Life Benefits

The U.S. Court of Appeals for the First Circuit has confirmed that proof of death is a reasonable requirement for payment under a life insurance policy, and is a prerequisite to monies becoming “payable” under unclaimed...more

Despite Windsor, Federal Court Rejects Challenge to a Self-Insured ERISA Health Plan’s Denial of Coverage for Same-Sex Spouses

Following the U.S. Supreme Court’s decision in US v. Windsor, the requirement that an ERISA health plan provide health coverage for same-sex spouses has often hinged on whether an employee benefit plan was insured or...more

Time To Reconsider The Assignability Of Certain Claims

If an insurance company refuses to settle a claim, once liability has become reasonably clear and there is an opportunity to settle within limits, the defending insurer runs the risk of an excess verdict. Once the verdict is...more

Legislature clarifies ‘misconduct’ definition for denial of unemployment claims

For the second time in two years, the Oklahoma Legislature has passed reform related to the definition of “misconduct” as defined in the Employment Security Act. The reform provides clarification to employers as to which...more

Ninth Circuit Says Disability Plan Participant’s Claim Is Time-Barred

The Ninth Circuit in Gordon v. Deloitte & Touche, LLP Group Long Term Disability Plan, 2014 WL 1394962 (9th Cir. Apr. 11, 2014) affirmed summary judgment in favor of a long term disability plan on the ground that the...more

Sixth Circuit Revisits Controversial ERISA Decision

The Sixth Circuit Court of Appeals voted to rehear an ERISA action that awarded an unprecedented remedy for the alleged denial of long term disability benefits. The order, granting en banc rehearing, vacates a controversial...more

New York Court: Insurer's Failure To Defend Does Not Waive Coverage Defenses

New York’s highest court recently held that an insurer that does not defend its insured may, if later sued by the policyholder seeking coverage, plead policy exclusions as a defense to the coverage claim....more

High Tide for Lapse Cases? New York Federal Court Holds That Investor Lawsuit Is Not Barred by Statute of Limitations

On March 28, 2014, a New York federal court issued an opinion that may have a significant impact on the already increasing number of lapse-related lawsuits in the life insurance industry. In Lebovits v. PHL Variable Insurance...more

District of Colorado: Insurer Entitled To Summary Judgment on Bad Faith Claim Where Insured Repeatedly Failed To Provide Requested...

Keeney v. Auto-Owners Ins. Co., No. 13-CV-00796-RPM, 2014 WL 622509 (D. Colo. Feb. 18, 2014) - District Court in Colorado grants defendant Insurer’s Motion for Summary Judgment where Insured’s failure to provide...more

4th Circuit Holds Insurer Not Equitably Estopped From Denying Coverage

In an unpublished opinion, the 4th Circuit Court of Appeals reversed a South Carolina District Court judge’s finding that an insurer was equitably estopped from denying coverage to a new owner of the insured business for a...more

Sixth Circuit to Revisit Unprecedented Expansion of ERISA Wrongful Denial of Benefits Remedies

On December 6, 2013, in Rochow v. Life Insurance Company of North America, 737 F.3d 415 (6th Cir. 2013), the Sixth Circuit affirmed a district court ruling that an insurance company that improperly denied ERISA disability...more

ERISA: 10th Circuit — How to Win Two Frequent Challenges to ERISA Benefit Denials

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

ERISA – 11th Cir. — Social Security Determinations Issued AFTER Initial Claim Denial Must Be Considered?

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

Employee Benefits Developments - January 2014

CASES - Court Finds Former NFL Player’s First Wife Is Surviving Spouse - A recent decision by the U.S. Court of Appeals for the Third Circuit demonstrates once again the importance of divorcing your first spouse...more

51 Results
|
View per page
Page: of 3