Disability Benefits

News & Analysis as of

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

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

ERISA — ATTORNEY FEES: What Happens When The Plan And The Insurer Don’t Agree On The Benefit Denial?

You already know that under ERISA the court has discretion to award attorney fees to a party that has “some success on the merits.”...more

The ERISA Litigation Newsletter - October 2015

Editor's Overview - This month, we review the Second Circuit's ruling in New York State Psychiatric Ass'n, Inc. v. UnitedHealth Grp. wherein the Second Circuit ruled that: (i) a provider association has associational...more

Seventh Circuit Rules ERISA Does Not Preempt State Law Prohibiting Discretionary Clauses

In Fontaine v. Metropolitan Life Ins. Co., No. 14-1984, 2015 U.S. App. (7th Cir. Sept. 4, 2015), the Seventh Circuit affirmed a U.S. District Court for the Northern District of Illinois decision holding that Illinois’s...more

A Legislative El Niño for California?: New 2016 Employment Laws for the State’s Private Sector Employers

Experts are predicting a 95% chance of heavier-than-usual seasonal rainfall this year in Southern California based on the phenomenon known as “El Niño.”  Did the California Legislature and its Governor produce a comparable...more

Transferring Assets Could Create a Long Waiting Period When It Comes Time to Apply for SSI

Supplemental Security Income (SSI) is a federal program that helps people with disabilities and very low incomes pay for food, clothing and shelter. Unlike some other disability benefits, SSI is a "needs-based" program, which...more

Recent Case Spotlights Problem of Excluding People with Special Needs From Gifting Plans

In an effort to preserve government benefits for a child with special needs, parents giving gifts to children will sometimes provide nothing to the child with special needs while giving substantial amounts to the child’s...more

ERISA — 7th Circuit: Illinois State Law Ban On Discretionary Clauses Upheld

You already know about the big trend in states to ban discretionary clauses in insurance policies that fund ERISA benefits. Chalk up another circuit deciding to enforce the ban....more

State Law Claims for Short-Term Disability Benefits Not Preempted By ERISA

A federal district court in Tennessee ruled that ERISA did not preempt state law claims for short-term disability benefits because the short-term disability plan fell under the “payroll practice” exception of ERISA. LeBlanc...more

Eleventh Circuit Addresses Statutory Penalty Claims under ERISA

The ERISA statute authorizes a court to award a penalty of up to $110 per day based on the failure of an Administrator to respond to a participant’s or a beneficiary’s request for plan documents. The term “Administrator” is...more

New Jersey Bill Seeks to Guarantee Job Protections to Organ and Bone Marrow Donors

A bill (A4360), which was introduced on May 8, 2015, seeks to amend the Temporary Disability Benefits Law (TDBL) (N.J.S.A. 43:21-25 et seq.) to require that individuals disabled in connection with donating organs or bone...more

New Jersey Bill Seeks to Guarantee Job Protections to Organ and Bone Marrow Donors

A bill (A4360), which was introduced on May 8, 2015, seeks to amend the Temporary Disability Benefits Law (TDBL) (N.J.S.A. 43:21-25 et seq.) to require that individuals disabled in connection with donating organs or bone...more

What You Need to Know About Applying for Disability Benefits

Applying for disability benefits from the federal government through the Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) programs can be a daunting task. Here is a brief overview of how the...more

Lump Sum PPD Awards Not RIght in Nevada

Question: Why is the PPD lump sum so much less than the total installment amount? Answer: An injured worker may take up to a 25% whole person permanent partial disability award in a lump sum reduced to present value...more

Expect Focus - ONLINE HEALTH CARE: NOT SO FAST Telemedicine Hits A Few Speed Bumps, Volume II, Spring 2015

In This Issue: - IN THE SPOTLIGHT • Risky Business: Common Cyber Security Risks, Expensive Consequences - LIFE INSURANCE • Ninth Circuit Finds Bonus Indexed Annuity Delivers Exactly...more

Sixth Circuit Holds No Disgorgement of Profits Based on Wrongfully Denied ERISA Disability Benefits

The Sixth Circuit Court of Appeals, sitting en banc, recently decided a closely-watched case regarding the scope of "other appropriate equitable relief" under ERISA Section 502(a)(3). In Rochow v. LINA, the court held that...more

ERISA 11th Circuit: Claimant Has “Duty to Investigate” When Asserting Equitable Tolling of a Contractual Limitations Provision

You already know that contractual limitations provisions in ERISA plans are generally enforceable and can bar untimely claims. But when does the court apply “equitable tolling” to extend the time by which a claimant may...more

How Do Impairment-Related Work Expenses Affect My Federal Disability Benefits?

Social Security Disability Income (SSDI) and Supplemental Security Income (SSI) are the two primary federal disability benefits that provide monetary assistance for people with special needs. Both programs allow working...more

Ninth Circuit Extends ERISA Deadline, Revives Untimely Appeal

Last week, the Ninth Circuit Court of Appeals issued its opinion in LeGras v. AETNA Life Insurance Company, No. 12-56541 (May 28, 2015), holding that the 180-day period to appeal a denial of a long-term disability claim was...more

Standard of Review is Important – Again

I recently blogged about the importance the standard of review can make when a court decides whether a claims decision made under an employer plan will be upheld. My recent blog post dealt with the standard of review under a...more

ERISA (9th Cir.) A Day Late, But Not A Dollar Short — Counting The 180 Day Appeal Period Gets Easier For Claimants

You know that under ERISA regulations a claimant has at least 180 days to appeal a benefit denial. ERISA plans set out contractual timelines for appeals. But what happens when that 180 day period runs out on a weekend?...more

Merkens v. Federal - Injured Worker Who Failed To Challenge Termination Of Workers’ Comp Benefits In Industrial Commission Cannot...

The court of appeals affirmed. A workers’ compensation carrier can commit the tort of bad faith in two ways: (1) the intentional and unreasonable denial of a claim (“bad faith denial of benefits”); or (2) the intentional and...more

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