News & Analysis as of

Disability Benefits

Plotting A Course To Defeat Claims Of Insurer Bias

by Seyfarth Shaw LLP on

Seyfarth Synopsis: In a strong decision for insurers, the Eighth Circuit affirmed summary judgment for the administrator, rejected plaintiff’s conflict of interest argument, and found that it was not arbitrary for the...more

ERISA: Winning Early Motions to Dismiss Breach of Fiduciary Claims — the Ministerial Defense

Plaintiffs in ERISA employee benefit cases are frequently asserting breach of fiduciary duty claims, and then seeking broader discovery. So, consider early motions to dismiss the breach of fiduciary duty claims....more

Disability Claims Procedures Should be Updated for New Regulations

As open enrollment approaches for many benefit plans, employers and plans sponsors should check to make sure their claims procedures for disability claims are consistent with regulations that become effective for plan years...more

Employee Benefits Developments - July 2017

by Hodgson Russ LLP on

The Employee Benefits practice group is pleased to present the Benefits Developments Newsletter for the month of July, 2017. Class Action Plaintiffs Target University 403(b) Plans - In June, an ERISA action – a proposed...more

As If Leave Laws Aren’t Complicated Enough – Don’t Forget That Leave Can Be a Reasonable Accommodation

by Foley & Lardner LLP on

The myriad of leave laws and requirements often make employee leave requests an area of confusion, concern and risk for employers. If an employee has a medical condition and must take leave from their job, there may be...more

Participants who roll their pension benefits into IRAs do not ‘receive’ them

by Thompson Coburn LLP on

Metropolitan Life lost a case in the 5th Circuit on July 18, 2017, that probably surprised MetLife and may surprise you. The case is Thomason v. Metro. Life Ins. Co., 2017 WL 3049528 (5th Cir. July 18, 2017), and you may want...more

Work Now, Party Later: The Case for Tackling the New Disability Claims Procedures Before Year-End

by Bryan Cave on

Plan sponsors are typically forced to wait for last minute guidance to satisfy year-end compliance obligations. As a result, those of us who work with these plans spend the last days of the year frantically ensuring plans are...more

ERISA: Whether the Ability to Work Only Part-Time Disqualifies Claimant from “Any Occupation” Benefits?

You know that in typical ERISA disability benefit claims, the claim administrator first determines whether claimant’s disability prevents the claimant from performing claimant’s current, “own occupation.”...more

Pennsylvania Supreme Court Decision in Protz Marks Major Change in Workers’ Compensation Law

Prior to June 20, 2017, a powerful tool was available to employers and workers’ compensation carriers to cap exposure on long term workers’ compensation claims. That tool, provided by the Act 44 amendments in 1996, was...more

ERISA 2nd Cir.: Four Things to Know When Trying to Offset Personal Injury Lump Sum Settlements — It Can Be Off-Putting and Tricky

You already know that most ERISA plans allow the Plan to reduce or offset long term disability payments by amounts the disabled worker receives from workers compensation or Social Security....more

IREs Held as Unconstitutional in Workers’ Compensation Cases

by Barley Snyder on

The Pennsylvania Supreme Court last week drastically altered the landscape for workers’ compensation carriers and created future uncertainties when it struck down aspects of the Workers’ Compensation Act....more

Impairment Rating Evaluations Declared Unconstitutional

Over 20 years after Section 306(a.2) of the Pennsylvania Workers’ Compensation Act was enacted, employers will no longer be able to limit partial disability benefits to 500 weeks based on an Impairment Rating Evaluation...more

ERISA Plan Choice-of-Law Provisions: Dog Whisperer’s Disability Claim Reviewed Under Abuse of Discretion Standard of Review

An issue dogging claims administrators is: What effect do choice-of-law provisions have on the standard of review of ERISA benefit decisions?...more

Department of Labor Finalizes Claims and Appeals Regulations for Disability Benefits

by Franczek Radelet P.C. on

The Department of Labor’s (DOL) Employee Benefits Security Administration has issued final regulations that change the claims and appeals procedures for disability benefits provided by ERISA plans. The final rules are...more

Time Bars for Medical Compensation and Evidence Bars for Indemnity Benefits

Capen Trucer Carl Anders, II v. Universal Leaf North America - In Capen Trucer Carl Anders, II v. Universal Leaf North America, No. COA 16-910, the Plaintiff appealed an Industrial Commission decision denying his claim for...more

Supreme Court Determines the Burden of Causation is on Employers and Carriers in Compensable Claims

In Wilkes v. City of Greenville, __ S.E.2d __, (2017) the North Carolina Supreme agreed with the Court of Appeal’s determination that when compensability is admitted an injured worker is entitled to a presumption that future...more

ERISA: 4 Quick Responses to Claimant’s Typical Challenges to Disability Benefit Denials

How do you respond to typical arguments by those seeking ERISA-governed disability benefits that the claim administrator: -“cherry-picked the record”; -ignored the social security disability determination; -improperly...more

Legal Issues Surrounding Traumatic Brain Injuries and Social Security

by Varnum LLP on

Those with traumatic brain injuries often find it difficult to return to work and support themselves or their families. We often support our clients by clarifying the complex legal issues surrounding Social Security...more

Federal Bill Seeks to Create Portable Benefits for Gig Economy Workers

by Littler on

Senator Mark Warner (D-VA), a lawmaker known for closely monitoring the changing nature of work, has introduced in the Senate legislation to promote innovative ways to offer portable benefits to workers in the on-demand...more

What the First-Ever Bill Promoting Portable Benefits for Independent Contractors Does – And Does Not Do

by Pepper Hamilton LLP on

Independent contractors and other contingent workers are not currently eligible for workers’ compensation, disability benefits, health insurance coverage, and pension benefits under federal and most state laws. This may well...more

Paid Parental Leave One Step Closer To Reality- President’s Proposed Budget Seeks 6 Weeks Of Paid Leave For All Families

by Fisher Phillips on

The White House released the details of President Trump’s proposed budget today, and if the president has his way, employees will be eligible to receive up to six weeks of paid parental leave by the year 2020. However,...more

Back to Basics – Costly Consequences of Ignoring Process in Benefits Administration

The stories of an employer and a long-term disability insurer and claims fiduciary for an ERISA plan, defendants in two recent cases, ring so true. In the first case, the insurer was designated as claims fiduciary for an...more

ERISA Benefits and a Claimant’s Bankruptcy: When Judicial Estoppel Requires Dismissal of Lawsuits Seeking Long Term Disability...

Don’t forget that... judicial estoppel can require dismissal of a claimant’s suit for ERISA-governed long term disability (LTD) benefits if the claimant failed to list the “potential cause of action” in bankruptcy filings....more

Eighth Circuit Jimmies The Lid On Pandora’s Box

by Seyfarth Shaw LLP on

Seyfarth Synopsis: In an opinion that may result in increasingly complex ERISA benefits litigation, the Eighth Circuit has allowed a breach of fiduciary duty claim premised on alleged faulty claims handling practices to...more

Veterans’ Claims Move to the Head of the Class

by Carlton Fields on

In an issue of first impression, the United States Court of Appeals for the Federal Circuit addressed whether the Court of Appeals for Veterans Claims (“Veterans Court”) has the authority to certify class actions. ...more

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