Disability Insurance

News & Analysis as of

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

Best in Law: Tax Ruling Confirms Protocol on Job-Related Judgments

The California Court of Appeal recently confirmed that employment-related settlements or judgments are wages from which employers must withhold payroll taxes. In Cifuentes v. Costco Wholesale Corp., Cifuentes...more

Seventh Circuit Finds that State Insurance Law Applies, Resulting in De Novo Review of Benefit Claim

On September 4, 2015, the U.S. Court of Appeals for the Seventh Circuit ruled in Fontaine v. Metropolitan Life Insurance Company that the Employee Retirement Income Security Act of 1974, as amended (ERISA), does not preempt...more

Court Finds Against EEOC And Holds Charging Party Who Represented Herself As Being “Totally Disabled” Was Not Qualified To Perform...

In EEOC v. Vicksburg Healthcare LLC, et al., Case No. 13-CV-895 (S.D. Miss. Aug. 27, 2015), Judge Keith Starrett of the U.S. District Court for the Southern District of Mississippi recently rejected the EEOC’s lawsuit. He...more

Health Alert (Australia) - August 31, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpts from Judgments New South Wales (NSW) 28 August 2015 - Smith v Pennington [2015] NSWSC 1168 The Supreme Court gave judgement for the...more

Starting a New Job? Consider These Tips When Signing Up for Employee Benefits

When you start a new job you may be offered a wide range of employee benefits, from retirement accounts to life insurance. If you are the parent of a child with special needs, the decisions you make when signing up for these...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

ERISA Participant’s Supplemental Submission Doesn’t Restart Exhaustion Clock

A federal district court in New Jersey held that supplemental documentation submitted by a participant in connection with the claims review process did not restart the clock for a claims administrator to decide the...more

RMF Litigators Obtain Reversal Of Denial Of Long-Term Disability Benefits

When a private insurance company denies a claim for long-term disability benefits, one appeals that decision through that same insurance company’s appeal process. This does not bode particularly well for the appealing...more

4th Cir. Sides with Surgeon in Disability Policy Dispute

On May 5 the Fourth Circuit reversed a District Court decision upholding Lloyd’s of London’s rescission of a Maryland surgeon’s disability policies. Lloyd’s had rescinded the policies because the surgeon gave false answers...more

ERISA: Public School Teacher’s Employee Benefits Governed by ERISA? Yes!

When you see a claim for disability or life insurance benefits by a public school teacher, you might assume the claim is not governed by ERISA because of the governmental plan exception....more

En Banc Sixth Circuit Rules Against Disgorgement Remedy in Benefits Case

In Rochow v. Life Insurance Company of North America, No. 12-2074 (6th Cir. March 5, 2015), the U.S. Court of Appeals for the Sixth Circuit, sitting en banc, ruled that an insurance company that wrongfully denied benefits to...more

Disgorgement of Profits Not Available for Arbitrary and Capricious Benefits Denial – This Time

Wrongful denial of employee benefits will not expose plan fiduciaries to equitable remedies – such as disgorgement of profits – where restoration of benefits is adequate to make the claimant whole, says the Sixth Circuit in...more

Ninth Circuit Rules That Harmless Procedural Violation Does Not Alter Standard of Review

The Ninth Circuit held that a plan administrator’s failure to render a decision on a long-term disability benefits claim within the period mandated by the plan and ERISA did not alter the standard of review that the court...more

2014 Pension Plan Regulatory Highlights

The start of the new year is as good a time as any to look back at some of the employee benefits regulatory developments of 2014 that were not previously covered in this column. Originally published in Employee Benefit...more

Court Holds That Physician’s State Law Claim For Disability Benefits Is Preempted by ERISA: Hershan v. Unum Group Corporation

A federal court has held that a radiologist’s state law contract claim for certain disability insurance benefits arose under a welfare benefit plan governed by ERISA and was therefore preempted by ERISA. In Hershan v. Unum...more

3 Insurance Pitfalls That Can Put Your Law Practice At Risk

In 2011, I had to deal with a house fire that destroyed my entire home. Traumatic as that was, I learned some valuable lessons from that experience. So many, if act, that they cannot easily be covered in just one article....more

The ERISA Litigation Newsletter - October 2014

Editor's Overview - The first article in this month's newsletter focuses on whether specific language in ERISA employer-provided disability insurance plans confer discretionary authority to plan administrators to...more

U.S. District Court Judge Bars Plaintiff’s Individual Disability Claims in Their Entirety by Application of the Doctrine of...

In the Eastern District of Pennsylvania, applying the doctrine of collateral estoppel, a judge adopted the Report and Recommendation of her magistrate judge and granted an individual disability insurer summary judgment on its...more

Pennsylvania Magistrate Judge Recommends That Plaintiff’s Claims Be Barred in Their Entirety by Application of the Doctrine of...

In the Eastern District of Pennsylvania, applying the doctrine of collateral estoppel, a Magistrate Judge issued a Report and Recommendation granting an individual disability insurer summary judgment on an insured’s claims...more

ERISA ATTORNEY FEES – 1st Circuit: Court Remand to Claims Administrator “because the record is insufficient for de novo review” is...

You have seen this issue before: The court remands the ERISA-governed long term disability claim for further consideration by the claims administrator because the administrative record was insufficient for de novo review....more

Private Disability Insurance: Know the Coverage Details

Many employers provide short- and long-term disability insurance for their employees as an important part of their benefits packages. These policies often make an enormous difference in an employee's quality of life if she is...more

More Disabled Employees But Fewer Employees Covered With Long Term Disability Coverage

Here is a recent news item showing the scope of the employee disability problem. In a nutshell...more

What Happens When The Limitations Provision in the Plan As Applied Creates An Impossible Accrual Date?

Approximately six months ago, the Supreme Court of the United States, in Heimeshoff v. Hartford Life & Accident Insurance Co., 134 S. Ct. 604 (2013), addressed whether an employee benefit plan covered by the Employee...more

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