Is a significant risk of relapse, if a disability benefit claimant were to return to work, a current disability? That was the question answered in Colby v. Union Security Ins. Co., 2013 U.S.App.LEXIS 1149 (1st Cir. Jan. 17, 2013). Although the court acknowledged that another court of appeals had decided the issue differently, in this […]
All disability insurance policies contain provisions requiring that insureds receive regular care from a physician. However, such clauses are usually liberally interpreted. For example in Heller v. Equitable Life Ins. Soc’y, 833 F.2d 1253, 1257 (7th Cir. 1987), the court ruled that such a clause could not be read to require an insured to undergo […]
As the recent case of White v. Prudential Ins.Co., 2012 U.S.Dist.LEXIS 160773 (E.D.Pa. Nov. 9, 2012) illustrates, whether a disabling condition is psychiatric or physical is not easily determined. The plaintiff in this case, James White, worked as the chief operating officer, chief financial officer and director of risk management at Holt Oversight & Logistical Technologies. In 2007, White was seriously injured in a rollover car accident that occurred when his vehicle was struck by another car.
A federal court has ruled that an insurance company’s use of surveillance in denying a claim for disability benefits was an abuse of discretion. In Spooner v. Reliance Standard Life Insurance Co., 2021 WL 2720302 (E.D.N.Y. July 1, 2021), the plaintiff was a former account executive with a media company who stopped working due to chronic pain from fibromyalgia, a sleep disorder and a psychiatric condition.
Executive Summary: I am an experienced practitioner in the field of representing claimants in disability benefit disputes. In my practice, I have encountered a number of problems with ERISA claims and litigation that need to be examined by the Department of Labor: ERISA claimants are denied the last word in claim appeals, which permits insurers […]
A recent ruling from the 3rd U.S. Circuit Court of Appeals is a wake-up call to professionals who are paying both for disability insurance coverage at their place of work and also maintaining supplemental disability coverage purchased through a professional association. Fleisher v. Standard Ins.Co., 2012 U.S.App.LEXIS 9907 (3d Cir. May 17, 2012) ruled that […]