News & Analysis as of

Disability Insurance

District Court Applies Texas Ban on Discretionary Clauses in Insurance Contracts

A federal district court in Louisiana upheld a Texas state law prohibiting insurers from granting themselves discretion to interpret benefit plans when deciding benefit claims. These so-called “discretionary clauses” are...more

My Supreme Court Debut: A Birthday I’ll Never Forget

by WilmerHale on

As the end of the year draws near, all eyes are turning to the U.S. Supreme Court and the decisions it will issue during its October 2017 term. In this Expert Analysis, Catherine Carroll reflects on her very first time...more

Time to Prepare for the End of the Year - Part Three

by Poyner Spruill LLP on

The year-end is rapidly approaching! To avoid costly penalties from inadvertent errors in the year-end rush, plan sponsors should begin talking with their service providers now about what must be done by year-end. Our first...more

Puerto Rico Employers May Pay Their Outstanding Workers' Compensation Debts Owed to the State Insurance Fund Corporation with a...

by Littler on

The Puerto Rican government recently enacted Act 92, which establishes a debt payment incentive plan (the “Plan”) for employers in Puerto Rico that have outstanding debts with the Puerto Rico State Insurance Fund Corporation...more

Winter Is Coming: Paid Family Leave Arrives in New York State

While New York State’s Paid Family Leave Benefits Law (the PFL) becomes effective as we ring in the new year on Jan. 1, 2018, employers should spend the remainder of 2017 scrambling to determine how to minimize its disruptive...more

New York Paid Family Leave Benefits Law Deadline for Employers to Apply for Approval as a Self-Insured Employer Rapidly...

by Littler on

The New York Paid Family Leave Benefits Law requires all employers covered by the New York Workers’ Compensation Law to provide coverage for paid family leave (PFL) benefits for their employees on or before January 1, 2018....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

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

The Future of Discretionary Clauses in California Life and Disability Insurance Agreements

by McDermott Will & Emery on

On May 11, 2017, the United States Court of Appeals for the Ninth Circuit reversed a district court ruling, and upheld a California law that invalidates a plan provision that assigns the final determination on benefit payout...more

Grounding Deferential Review in California – No Preemption for Discretionary Clause Ban

by Seyfarth Shaw LLP on

Seyfarth Synopsis: In a decision with wide ranging implications, the Ninth Circuit has ruled that a discretionary clause in an employer drafted plan document is subject to, and invalidated by, California’s insurance...more

Health Alert (Australia) March 6, 2017

by DLA Piper on

In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Commonwealth . Administrative Appeals Tribunal 28 February 2017 - Nairn and National Disability Insurance Scheme...more

ERISA: Winning Tactic on Summary Judgment to Prove Claimant Received the Policy: Get Key Evidence into the Administrative Record

You know that to apply an exclusion in a policy, the claims administrator must show that the claimant received the policy. But what happens when the claimant submits a declaration disputing your proof that she received...more

Illinois Supreme Court Holds Occupational Disease Pension Does Not Trigger Health Insurance Benefits

by Sedgwick LLP on

In 2003, the Illinois Supreme Court held that anyone who qualified for a line-of-duty pension under section 4-110 of the Illinois Pension Code qualified as having a “catastrophic injury” within the meaning of Section 10(a) of...more

What’s Next Under the Congressional Review Act?

As we reported, the House and Senate have passed a joint resolution under the Congressional Review Act disapproving the SEC Resource Extraction Rule and that President Trump was expected to sign the legislation that...more

CPP Disability Benefits: To Deduct or Not to Deduct

by Field Law on

The standard form SEF 44 endorsement (The Endorsement) was recently interpreted by the Supreme Court of Canada in the case of Sabean v. Portage La Prairie Mutual Insurance Co., 2017 SCC 7. The Endorsement indemnifies an...more

The New ERISA Claims and Appeals Regulations for Disability Benefits

by Jackson Lewis P.C. on

The Employee Benefits Security Administration of the U.S. Department of Labor recently published final regulations governing the ERISA claims and appeals process that will apply to all claims for disability benefits filed on...more

New California Labor and Employment Laws for 2017

by Holland & Knight LLP on

Continuing a trend from recent years, the California Legislature passed, and Gov. Jerry Brown signed into law, numerous labor and employment bills in 2016. Each becomes effective on Jan. 1, 2017, unless otherwise...more

A Question of Timing – Social Security Disability Determinations and the Administrative Record

by Seyfarth Shaw LLP on

Seyfarth Synopsis: Court excludes evidence of Social Security disability award issued after the final decision issued on plaintiff’s claim for plan disability benefits. The decision accentuates the importance of fighting to...more

California Court Finds That Discretionary Clauses in Health Insurance Policies Are Enforceable

In 2011, the California legislature passed Insurance Code Section 10110.6 which bans the use of discretionary clauses in any policy, contract, certificate, or agreement offered, issued, delivered, or renewed, whether or not...more

“Takin’ Care of Business” at Home: Hiring California Household Help

by Seyfarth Shaw LLP on

Seyfarth Synopsis: Have you pondered the implications of hiring help around the house? Here are some legal requirements regarding employment of domestic helpers. Household workers or “domestic helpers” are people who...more

Senate Bill 667 Extends Claim Period Under State Disability Insurance Program

by Ervin Cohen & Jessup LLP on

Effective July 1, 2016, Senate Bill 667 extends from 2 weeks to 60 days the period of time that an employee can reopen a disability insurance claim without having a new 7 day consecutive day waiting period of wage loss. This...more

Defence & Indemnity - April 2016: I. INSURANCE ISSUES

by Field Law on

General information of claims practices and company personnel obtained by an insurer’s in-house counsel is not the type of confidential information that will disqualify the lawyer from acting as Plaintiff’s counsel against...more

San Francisco Enacts Nation’s First Fully Paid Parental Leave Ordinance

Effective January 1, 2017, San Francisco is scheduled to become the first city in the United States to require fully paid parental leave. The Paid Parental Leave Ordinance (the Ordinance) was passed unanimously by San...more

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

by Ervin Cohen & Jessup LLP on

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 Brown Signs Legislation to Expand Paid Family Leave

by Seyfarth Shaw LLP on

Seyfarth Synopsis: Starting Jan 1, 2017, the amount of benefits paid to employees on paid family leave and state disability will increase substantially, depending on an employee’s income level. The Legislature and...more

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