Author: Mark Debofsky

Is expediency more important than accuracy?

The saga of this case, which involved a claim of disability due to complications of diabetes, is a long one that began in 2002 when Unum initially denied the claim for benefits and upheld its decision when the plaintiff submitted her pre-suit appeal. The case, Metzger v. Unum Life Ins.Co. of America, 2007 U.S.App.LEXIS 3755, […]

Ruling on scope, standard of review disturbing

The plaintiff, Gary Rittenhouse, won this case in the district court; however, he suffered a crushing defeat in the Court of Appeals. Rittenhouse, an officer of UnitedHealth Group, began experiencing progressive hearing loss beginning in the 1980s. In 2002, Rittenhouse’s hearing loss had advanced from moderate to severe, and further deterioration occurred in 2003 at […]

Right result, but confusing reasoning

The plaintiff in this case initially became disabled in 1985 as the result of a work accident when a hydraulic door fell on him and fractured his C3 vertebra. Rehabilitation efforts were unsuccessful; and Sloan began receiving long-term disability benefits in the late 1980s. After 24 months, the definition of disability changed from one in […]

Insurer can’t ‘cherry pick’ medical report

The plaintiff in this case was involved in a tragic sledding accident in 1997 that resulted in the death of the plaintiff’s grandson and severe injuries to himself. Fulayter v. Prudential Insur. Co. of America, 2007 U.S.Dist.LEXIS 8394 (D.Ariz. Feb. 6). After a significant period of rehabilitation, Fulayter was able to return to work; however, […]

Insurer can’t keep manual from claimant

In a short, but highly instructive ruling, U.S. District Judge Gerard Lynch ordered that CIGNA disclose its disability insurance claim manual without a protective order, overruling an objection that the insurer might suffer ”competitive injury” if such information was disclosed. Levy v. INA Life Insur.Co. of N.Y., 2006 U.S.Dist.LEXIS 83060 (S.D.N.Y. Nov. 14, 2006). Because […]