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
To be insured against a loss or some other event, we pay premiums to an insurance company. If a loss or triggering event actually occurs, we expect our insurance company to compensate us according to our insurance policy....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
In 2023, legislatures in five “Southeastern Conference” states passed statutes creating options for employers to voluntarily provide paid family and medical leave (PFML) through insurance benefits purchased from the private...more
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
No matter the size of your organization, at some point in time employees leave. As we noted previously, it behooves human resources and other departments to provide departing employees with an exit letter that includes...more
In Steigleman v. Symetra Life Ins. Co., 2023 WL 7413668 (D. Ariz. 2023), a court considered whether a package of various welfare benefit insurance policies an individual business owner arranged for herself and her employees...more
This month’s Friday Five covers cases relating to an alleged conflict of interest leading to discovery, two courts’ opposite treatments of subjective pain complaints, a decision that claims of fraud and misrepresentation were...more
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
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 recent decisions that range from the effect on disability benefits when medical records are not provided after two appeals, to a case that examines how an award of death benefits is...more
This month’s Friday Five covers cases relating to a plaintiff’s attempts to seal a complaint seeking disability benefits, an administrator’s uncommunicated decision to discontinue its investigation into certain medical...more
In Soave v. Stahle Construction Inc., 2023 ONCA 265, the Ontario Court of Appeal (OCA) allowed an employer’s appeal of the trial judge’s finding that an employee who was on a temporary leave at the time of an injury was...more
Recently, the Ninth Circuit addressed and further clarified the requirement of a “full and fair review” in the context of a long-term disability benefit case under the Employee Retirement Income Security Act (ERISA). In...more
In Rayonier v Unifor, Locals 256 and 89, 2022 CanLII 75226 (ON LA), a union filed an individual grievance on behalf of an employee who died at age 66 while still an active employee. This grievance alleged that the employer...more
In Rayonier v. Unifor, Locals 256 and 89 (the “Decision”) the long-term disability (“LTD”) coverage provided by Rayonier (the “Employer”) under the parties’ collective agreement was challenged by Unifor, Locals 256 and 89...more
In Rayonier v Unifor, Locals 256 and 89 arbitrator Paula Knopf dismissed a union policy grievance which alleged that an age 65 cut-off for long-term disability (LTD) benefits coverage under the parties' collective bargaining...more
In McQuillin v. Hartford Life and Accident Ins. Co., 36 F.4th 416 (2d Cir. 2022), the U.S Court of Appeals for the Second Circuit restored a claimant’s action for disability benefits due to the plan administrator’s failure to...more
We want to bring you some highlights from the in-person LTCi EX Task Force meeting we attended August 12 during NAIC’s Summer National Meeting in Portland. The Commissioners principally discussed the next steps in the...more
On Wednesday, June 22, the Senate Finance Committee advanced the Enhancing American Retirement Now (EARN) Act, including an amendment containing retiring Sen. Pat Toomey’s Long-Term Care Affordability Act. The Amendment would...more
In Newsom v. Reliance Standard Life Insurance Company, 2022 U.S. App. LEXIS 4505 (5th Cir. Feb. 18, 2022), the United States Court of Appeals for the Fifth Circuit clarified the difference between an eligibility determination...more
After months of confusion about whether to begin withholding premiums from employees’ paychecks on January 1, 2022, employers and employees in Washington state have gotten a reprieve from the controversial payroll tax for the...more
On January 27, 2022, Washington Governor Jay Inslee signed House Bills 1732 and 1733, delaying and amending the Washington Cares Act (WA Cares). Notably, for employers, the bills delay the obligation to withhold WA Cares...more