There is currently a circuit split as to whether district court rulings remanding Employee Retirement Income Security Act (ERISA) employee benefit claims to plan administrators are appealable. In Young v. Prudential Ins.Co. of America, 2012 U.S.App.LEXIS 3387 (11th Cir. Feb. 21, 2012), the 11th U.S. Circuit Court of Appeals held that a remand order is […]
A recent opinion issued by the 1st U.S. Circuit Court of Appeals suggests a new approach for assessing the reasonableness of benefit claim determinations under the Employee Retirement Income Security Act (ERISA) abuse of discretion standard of review.
A controversial issue in disability benefit evaluations is whether benefits are due to someone whose medical condition, while presently in remission, would be aggravated to such an extent by a return to work that the claimant’s life or health would be jeopardized. The issue is commonly referred to as “risk of disability” or “common care […]
Despite significant medical advances in recent years, many debilitating impairments remain impossible to diagnose through imaging such as x-ray or MRI, electrodiagostic testing, or blood tests. Consequently, due to potential uncertainty as to the legitimacy of such conditions, disability insurers have adopted policy provisions that purport to limit payments for conditions such as fibromyalgia, chronic […]
One of the most confusing aspects of ERISA litigation is the determination of when a cause of action accrues. As the defendant learned to its detriment in’ Withrow v. Bache Halsey Stuart Shield Inc. Salary Protection Plan, 2011 U.S.App.LEXIS 17526 (9th Cir. August 23, 2011), the failure to effectively trigger an accrual of a cause of action prevented a statute of limitations from running for about 25 years. The case involved a stockbroker, Valerie Withrow, who became employed by Bache (now Prudential Securities) in 1979
The U.S. Supreme Court admonished the lower courts in Metropolitan Life Insurance Company v. Glenn, 554 U.S. 101 (2008), that in adjudicating Employee Retirement Income Security Act (ERISA) benefit cases, courts must take into consideration the conflict of interest inherent in circumstances where the same party, such as an insurance company, both administers benefits and […]