Disability Benefits

New wine in an old bottle: the Department of Labor’s revised regulations applicable to disability benefit claims

by Mark Debofsky | Mar 3, 2017 | Disability Benefits

Shortly before the new year began, the Employee Benefits Security Administration of the U.S. Department of Labor (DOL) published final regulations on December 19, 2016, relating to disability benefit claims governed by ERISA: “Claims Procedure for Plans Providing Disability Benefits.” The regulations are effective January 18, 2017, and generally applicable to claims for disability benefits […]

Can a disability insurer rely on a treating doctor’s outlier opinion?

by Mark Debofsky | Feb 25, 2017 | Disability Benefits, ERISA

The recent ruling in Broderick v. Hartford Life and Acc. Ins. Co., 2017 WL 652451 (D. Minn. February 16, 2017) presents an interesting challenge – if a doctor gives an opinion that his patient can work which contradicts the doctor’s treatment notes and other contemporaneous statements, would that be a sufficient basis to deny benefits?

Court Throws Back Red Herring in Fibromyalgia Disability Case

by Mark Debofsky | Feb 16, 2017 | Disability Benefits, Pain and Disability

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

by Mark Debofsky | Jan 11, 2017 | Disability Benefits, Long Term Disability

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

by Mark Debofsky | Jan 8, 2017 | Disability Benefits, ERISA

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

by Mark Debofsky | Jan 4, 2017 | Disability Benefits

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 […]