Disability Benefits

News & Analysis as of

ERISA (6th Circuit): Mental Nervous Limitations and Dealing with Arguments of “Organic Cause”

You know that most ERISA disability plans contain a 24-month limitation related to mental/nervous disabilities. But what happens when the claimant alleges the mental illness is “organically caused”? Is that enough to...more

New York Budget Deal Will Bring $15 Minimum Wage and Broad Paid Leave Legislation

On April 4, 2016, New York Governor Andrew Cuomo signed legislation to phase in an increased minimum wage and guarantee paid family leave to all eligible employees throughout New York State. The legislation was part of the...more

Paid Family Leave and $15 Minimum Wage Coming to New York

New York has enacted legislation that, over the next several years, will phase in 12 weeks of paid family leave for all employees, as well as a $15 minimum wage in New York City and other parts of New York State. The...more

New Law Expands California’s Paid Family Leave and State Disability Insurance

Approximately 15 years ago California became the first state to provide paid time off to workers to care for a new child or ailing family member. The law, which is funded by required worker contributions, provides for up to...more

California Governor Signs Paid Family Leave Expansion Into Law

On April 11, 2016, California Governor Jerry Brown signed legislation that will increase the wage replacement rate under the Paid Family Leave program for California workers from its current level of 55 percent to 60 or 70...more

Judge Garland’s ERISA Jurisprudence Reflects His Methodical and Moderate Reputation

With President Obama’s recent nomination of Judge Merrick B. Garland of the U.S. Court of Appeals for the D.C. Circuit to the U.S. Supreme Court, we thought our loyal readers would be interested to learn a little about Judge...more

Health Alert (Australia) - April 11, 2016

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: New South Wales 6 April 2016 - Fan v South Eastern Sydney Local Health District [2016] NSWCA 64 Mr Fan...more

ERISA (9th Circuit): Denial Letters — Sometimes Forgotten Arguments to Enforce Contractual Limitations Provisions

Must denial letters inform the claimant, seeking ERISA-governed benefits, about the contractual limitations provision? A recent court trend, like with the First, Third and Sixth Circuits, requires denial letters to...more

Statutory and Contractual Limitations Periods and the Events that Trigger Them: Insight from the Fourth Circuit

The Employee Retirement Income Security Act of 1974 (ERISA) does not contain a statute of limitations provision, and courts generally apply the most analogous state law statutory limitation. However, some plans fill the void...more

Appellate Court Notes

Appellate Court Advance Release Opinions: AC38454 - In re Daniel N. AC36701 - State v. Adams - AC36701 Dissent - State v. Adams - AC37362 - Deutsche Bank National Trust Co. v. Thompson...more

What is a Permanent Partial Disability Award?

After an employee returns to work after time off from a work-related injury, an employer may be tempted to believe they are off the hook for future payments. Many employers, however, are surprised to find that several months...more

ERISA: Sixth Circuit — No Conflict of Interest with Multi-Employer Benefit Plan, Saving Abuse of Discretion Standard of Review

You already know that evidence of a “conflict of interest” can change the standard of review the court applies in ERISA claims. But proper structuring of multi-employer benefit plans can avoid an inherent conflict of...more

ERISA — 10th Circuit: What Happens When a “Procedural Irregularity” Occurs in an Appeal Denial?

You know that procedural irregularities in an appeal denial of a claim for ERISA-governed benefits can change the standard of review from arbitrary and capricious to de novo review. But not all the time. The claimant should...more

Der Urlaubsabgeltungsanspruch ist vererbbar

Mit einer kurz vor Jahresende veröffentlichten Entscheidung hat das BAG (bereits am 22. September 2015 – Az: 9 ARZ 170/14) festgestellt, dass der Urlaubsabgeltungsanspruch vererbbar ist. Geklagt hatten die Erbinnen eines...more

Workers compensation benefits decrease, disability insurance increases

Over the past few decades, there has been dramatic increase in the number of Social Security disability insurance claims filed. This increase could be linked to the problems workers find when claiming workers compensation...more

The ERISA Litigation Newsletter - December 2015

Editor's Overview - In this month's newsletter, we focus on the recent wave of guidance and case law related to the Affordable Care Act. We also discuss IRS Notice 2015-86, which provides guidance on the application of...more

“How Long Will They Get Paid?” — Temporary Total Disability Benefits for Injured Workers

A frequent question employers ask is how long an injured employee is eligible for disability benefits after an injury. If an employee is unable to work following an injury, the employee may request temporary total disability...more

ERISA (6th Circuit): So How Many Hours Is Working “Full-time,” Anyway?

What happens when the ERISA long term disability benefit plan does not define “full-time”? The Department of Labor says “full-time” is defined by the employer....more

DOL Proposes to Bring ERISA Disability Denials in Line with the Affordable Care Act

On November 18, 2015, the Department of Labor (the “Department”) published a notice of Proposed Rulemaking at 80 Fed. Reg. 222 (the “Proposed Rule”) to amend ERISA’s claims procedures (29 C.F.R. 2560.503-1) as they apply to...more

DOL’s New Disability Claim Rules Add to a Plan Administrator’s Duties under Welfare and Retirement Benefit Plans

Now, faced with an aging baby-boomer generation and increased costs related to disability litigation, the U.S. Department of Labor’s Employee Benefit Security Administration (DOL) has proposed new rules that would revise and...more

Be On The Lookout: New Proposed Claims Procedures For ERISA-Governed Disability Benefits Are Coming

The Employee Benefits Security Administration (EBSA) announced plans to publish, on November 18, 2015, new proposed claims procedures for handling ERISA-governed disability benefits. ...more

DOL Tightens Disability Claim Processing Rules

“Isn’t this an ACA blog?” Yes, it is. “So, why are you writing about disability plan administration?” Because they said so. The preamble to the proposed rules explains – Inasmuch as disability and lost earnings can be sources...more

DOL Issues Proposed Revisions to Disability Plan Claims Regulations

The Department of Labor published proposed changes to its regulations governing disability claims and appeals in the Federal Register on November 18, 2015, and invited comments. The stated purpose of the proposed changes is...more

Monday Briefing: why retire, best practices for employer-sponsored health, document dump

How many of you are tired of ACA reporting questions? Here are a few other things to take your mind off Forms 1094 and 1095...more

ERISA: Shutting Down Equitable Relief Claims — Disgorgement Claim Dismissed On Rule 12(c) Motion

You already know that in March 2015, the 6th Circuit issued an en banc decision rejecting disgorgement of profits claims. Rochow v. Life Ins. Co. of N. Am., 780 F.3d 364, 372 (6th Cir. 2015)(en banc) (rejecting $3.8 million...more

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