Court Throws Back Red Herring in Fibromyalgia Disability Case
A federal court in Michigan recently issued a ruling accusing an insurance company of committing a logical fallacy in adjudicating a disability benefit claim involving fibromyalgia.
Good Intentions Lead to Less Than Positive Outcome for Plaintiff
A cynical observer once commented that “no good deed goes unpunished.” Unfortunately for the plaintiff in Boyles v. American Heritage Life Insurance Co., 2016 WL 7489048 (W.D. Pa. Dec. 28, 2016), that expression dictated the outcome in this case. The plaintiff, Robert P. Boyles Jr., worked as a commercial insurance producer for an agency that had […]
The problem with file reviews in disability benefit cases
The practice by insurance companies of hiring doctors to review disability benefit claim files has been coming under increasing fire.Doctors are hired to assess a claimant’s disability based on a review of records rather than examining the claimant or even speaking with the claimant or the treating doctors.A recent ruling from Tennessee, Carty v. Metro. […]
New ERISA disability rules look to level playing field for all
Claims for employee benefits governed by the Employee Retirement Income Security Act are extremely complex. Congress directed the U.S. Labor Department to issue regulations to streamline the claim process and the department has striven to fulfill that mandate to make the process “full and fair” as required by statute (29 U.S.C. Section 1133). The regulations […]
“Claims procedure for plans providing disability benefits,” 81 FR 92316
The Employee Benefits Security Administration of the U.S. Department of Labor has issued final regulations published in the Federal Register on December 19, 2016 (81 Fed. Reg. 92316) relating to disability benefit claims governed by ERISA.Proposed regulations were initially published for comment on November 18, 2015 at 80 Fed.Reg. 72014; and after considering over 100 […]
Inconclusive medical tests should not undermine benefits claim, court rules
If a disability benefit claim is submitted without a specific diagnosis, does that prevent the claimant from qualifying for benefits? That was the question answered by Graham v. Life Insurance Company of North America, 2016 WL 6958151 (N.D. Ga., Nov. 28, 2016), which ruled the absence of a definitive diagnosis does not necessarily pose an […]