This month’s Friday Five discusses cases addressing the effect of continuing to receive benefits during the period of alleged disability, reliance on an employer’s records in making a disability determination, the...more
This month’s Friday Five explores decisions from around the country discussing differences between the scope of discovery and ability to add documents to the record on a claim for review challenging the denial of LTD...more
This month’s Friday Five explores decisions addressing the burden of proving accidental death, policy language and “any occupation” disability, an interpleader case where the insurer was not dismissed from the case, the...more
7/15/2024
/ Beneficiaries ,
Disabilities ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Insurance Litigation ,
Life Insurance ,
Long Term Disability Insurance ,
Medical Records ,
Policy Terms
This month’s Friday Five explores recent decisions with issues spanning physician power of attorney to preexisting exclusions and the fiduciary duty of an insurance company....more
6/7/2024
/ Compensation & Benefits ,
Disability ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Group Health Plans ,
ERISA Litigation ,
Fiduciary Duty ,
Health Insurance ,
Insurance Industry ,
Power of Attorney ,
Reimbursements
This month’s Friday Five explores decisions from around the country discussing differences between LTD and LWOP policies, the breadth of discretion available to claims administrators and the always important topic of timely...more
This month’s Friday Five covers the treatment of job-related stress in assessing an attorney’s disability, the requirements surrounding the qualifications of a medical professional to review a claimant’s medical records in...more
4/5/2024
/ Coronavirus/COVID-19 ,
Denial of Benefits ,
Disabilities ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Insurance Industry ,
Long Term Disability Insurance ,
Medical Records ,
Plan Administrators
This month’s Friday Five explores decisions regarding the transfer of an ERISA action that was filed in a state where an insurer did not maintain sufficient minimum contacts, an award of attorneys’ fees, costs, and...more
2/2/2024
/ Attorney's Fees ,
Denial of Benefits ,
Disabilities ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Insurance Industry ,
Life Insurance ,
Long Term Disability Insurance ,
Overpayment ,
Transfer of Venue
On Halloween, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) announced a $100,000 settlement under the Health Insurance Portability and Accountability Act (HIPAA) with Doctors’...more
This month’s Friday Five explores a decision ordering an IME prior to a ruling on summary judgment motions, the extent claims reporting records can be sealed, the scope of ERISA preemption in the context of removal, and two...more
12/1/2023
/ Denial of Benefits ,
Disabilities ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Insurance Industry ,
Medical Leave ,
Plan Administrators ,
Whistleblowers ,
Wrongful Termination
This month’s Friday Five explores decisions regarding the timeliness of appeals, the support necessary to sustain an LTD termination decision, a court’s discretion to credit and discredit expert opinions, the circumstances...more
This month’s Friday Five explores two recent decisions that discuss limitations on benefits when both physical disability and disability arising from mental illness are alleged, whether remand of a claim by the court...more
This month’s Friday Five explores recent decisions that reflect the precise nature of rules and definitions in the context of ERISA claims. For example, effective dates of CFR code provisions and contractually defined...more
This month's Friday Five covers cases relating to issue preclusion, coverage where the policy terms are inconsistent with the parties’ behavior, application of the abuse of discretion standard of review, applicability of a...more
This month’s Friday Five covers cases relating to augmentation of the administrative record following new rationales, attempted alternative ERISA causes of action, untimely ERISA claims, plans governed by ERISA even in the...more
This month’s Friday Five covers cases relating to the interpretation of time periods for claims under life insurance and disability plans, a situation where three separate administrators handled a disability benefits claim...more
This month’s Friday Five covers cases relating to interpretation of ambiguous policy terms, evaluation of claimant’s expert witness, inclusion of law firms as appropriate parties from whom plan administrators may seek...more
This month’s Friday Five covers cases relating to: (1) whether claim administrators can recover overpayments through a breach of contract claim under state law; (2) whether claim administrators can rely solely on a claimant’s...more
4/4/2022
/ Breach of Contract ,
Disability Benefits ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
ERISA Litigation ,
Insurance Claims ,
Insurance Litigation ,
Medical Examinations ,
Mental Health ,
Overpayment ,
Policy Terms
This month’s Friday Five covers cases relating to: (1) whether an insurer may seek reimbursement of LTD benefits after a plaintiff obtains a tort settlement, and the scope of discovery on class claims regarding the same; (2)...more
This month’s Friday Five covers cases relating to the exhaustion of administrative remedies set forth only in a denial of benefits letter, the scope of information required to be provided to medical reviewers, whether...more
This month’s Friday Five highlights both circuit and district court opinions on the scope of ERISA preemption, discretionary review and exhaustion of administrative remedies....more
This month’s Friday Five discusses cases that address the meaning of “active, full-time employee,” whether remand is required where an improper standard of review was applied, the standard for capacity in reference to a...more
This month’s Friday Five covers recent cases addressing: (1) the validity of a judgment that includes retroactive “any occupation” benefits where no administrative determination on those benefits has been made; (2) the...more
This month’s Friday Five discusses cases that address the admissibility of an expert opinion, the calculation of pre-disability earnings, the definition of disability earnings, circumstances where a court will transfer venue...more
This month’s Friday Five covers recent cases addressing: (1) a fiduciary’s right to bring an ERISA § 502(a)(3) equitable relief claim against a beneficiary; (2) when a life insurer may avail itself of Florida’s “facility of...more