Crime, punishment and paying restitution to victims
Paying restitution to victims is an important aspect of the criminal justice system.
What an occupation assessment entails
In evaluating a disability insurance claim from the perspective of whether the claimant can perform his or her own occupation, what must an insurer consider? That question was recently answered by the 1st U.S. Circuit Court of Appeals. In McDonough v. Aetna Life Insurance Co., 2015 WL 1684079 (1st Cir., April 15), plaintiff Joseph McDonough […]
Insurers should not conflate risk factors with pre-existing conditions
Although health plan exclusions for pre-existing conditions are no longer permissible under the Affordable Care Act, disability insurers may still lawfully invoke such exclusions in their policies. But the exclusions must be applied narrowly. This was illustrated in Meyer v. Unum Life Insurance Company of America, 2015 U.S. Dist. LEXIS 42092 (D.Kan., March 31). John […]
What are pre-disability earnings?
A recent ruling received by DeBofsky, Sherman & Casciari examined the issue of how to determine pre-disability earnings. In Cheney v. Standard Ins. Co., 2015 WL 2015 U.S.Dist.LEXIS 30918 (N.D.Ill. March 13, 2015)(Issue: Pre-Disability Earnings). In an earlier ruling (Cheney v. Standard Ins. Co., No. 13 C 4269, 2014 WL 4259861 (N.D. Ill. Aug. 28, […]
In ERISA, removal of deterrence incentivizes negative behavior
In 2013, the 6th U.S. Circuit Court of Appeals electrified the ERISA world when it ruled that in addition to paying benefits due after a wrongful rejection of a disability insurance claim, the Life Insurance Company of North America (LINA), a Cigna Corp. subsidiary, would also have to disgorge the profits it earned on the […]
Releases of employment-related claims may unintentionally release ERISA benefit claims
Signing a severance agreement or settlement agreement with an employer that contains a general release may unintentionally bar a claimant from pursuing a disability benefit claim under ERISA. That was the lesson learned by Dr. Thomas Gonda, Jr., who worked as a thoracic surgeon at Kaiser Permanente until he became disabled due to cognitive impairments […]