Discretionary Clauses Under Heavy Fire
The future of discretionary clauses in ERISA cases is uncertain, as they have come under heavy fire in recent years.
Author: Mark Debofsky
Ruling shows courts must take more responsibility
A recent ruling from the 6th U.S. Circuit Court of Appeals, DeLisle v. Sun Life Assurance Company of Canada, 2009 U.S.App.LEXIS 4251 (March 4), illustrates how courts are now engaging in a more probing and thorough review of ERISA benefit denials. Sherry DeLisle, who sustained significant injuries in an automobile accident, was fired from her […]
Ruling exposes defects in insurer’s determination
Functional capacity evaluations are frequently used in disability insurance evaluations. While some courts have deemed such testing reliable, Alfano v. Cigna Life Ins.Co. of N.Y., 2009 U.S.Dist.LEXIS 7688 (S.D.N.Y. Jan. 30), offers an object lesson as to why courts need to be careful in assessing such tests. The plaintiff in Alfano worked in an administrative […]
Consider this Before Wrongfully Denying a Claim
A recent 2d U.S. Circuit Court of Appeals ruling, Slupinski v. First Unum Life Insur. Co., 2009 U.S.App.LEXIS 1157 (Jan. 23), offers a textbook lesson on attorney’s fee awards as well as the propriety of prejudgment interest awards under ERISA.
Court Right to Look at Big Picture in Benefits Case
A thoughtful examination of the underpinning of a disability benefit termination resulted in a reversal of the insurer’s decision in Anderson v. Nationwide Mut.Ins.Co., 2009 U.S.Dist.LEXIS 1859 (S.D.Iowa Jan. 12). The claim arose when the plaintiff had to cease working after failed back surgery. Before her claim was approved, Nationwide had Anderson undergo an independent medical examination which supported the benefit claim. The independent physician reported that Anderson was incapable of working at any job because pain prevented her from sustaining a position for a long enough time to accomplish any productive tasks.