Calculating disability benefits for owners of businesses can be very complicated, especially in situations where the insured continues working and receives both a salary as well as a share of the profits from the business. How is the insurer to know whether the insured is manipulating business earnings and under-reporting W-2 earnings from the business? […]
A fascinating new ruling from the 7th U.S. Circuit Court of Appeals on the issue of Social Security disability points out many of the difficulties inherent in assessing disability. In Martinez v. Astrue, 2011 U.S.App.LEXIS 960 (7th Cir. 2011), the court issued an opinion incorporating its ruling on three cases all argued on the same […]
Can a disability insurer force its insured to undergo surgery? That was the issue raised in the recent ruling in Paul Revere Life Ins.Co. v. DiBari, 2010 U.S.Dist.LEXIS 122906 (D.Conn. Nov. 19, 2010); and while the answer to the question is no, the court ruled in DiBari that the insurance company did have the right […]
One of the key requirements under ERISA is that litigation of denied benefit claims is generally deemed premature unless the claimant has exhausted pre-suit appeal rights and been given a “full and fair review.” The basis of that requirement is found in 29 U.S.C. § 1133, which mandates that denied claims receive a full and […]
Because group disability insurance policies coordinate the benefits payable with benefits paid by other sources such as Social Security disability insurance (SSDI) payments, disability insurers frequently require claimants to apply for such benefits. A recent 1st Circuit opinion, U.S. ex.rel. Loughren v. Unum Group, 2010 U.S.App.LEXIS 15668 (1st Cir. July 29, 2010), dealt with an […]
The issue of which insurer is responsible for paying a claimant’s disability benefits was the subject of Mitchell v. CB Richard Ellis Long Term Disability Plan, 2010 U.S.App.LEXIS 15252 (9th Cir. July 26, 2010). InMitchell, the plaintiff, Michael Mitchell, worked as a commercial real estate broker for CB Richard Ellis for several years until he […]