Giddens v. Equitable Life Assur. Society of the U.S., 2006 U.S.App.LEXIS 8970 (11th Cir. April 12, 2006). The plaintiff, a dentist, purchased two ”own occupation” disability policies from Equitable. Both policies contained provisions for total disability as well as residual (partial) disability. The issue before the court was whether Allen Giddens was totally or partially […]
In a very significant ruling, the 6th U.S. Circuit Court of Appeals extended several recent precedents to reject an insurer’s reviewing doctor’s findings and uphold a judgment reinstating payment of disability benefits. Evans v. Unum Provident Corp., 2006 U.S.App.LEXIS 1359 (Jan. 20, 2006). The plaintiff, a nursing-home administrator, became disabled due to a seizure disorder […]
The plaintiff, a pharmaceutical sales representative, suffered from degenerative spinal disc disease, which progressively worsened to the point where he could no longer maintain employment.
A federal judge recently looked beyond the claim record and into a reviewer’s wallet in concluding that an insurer improperly terminated disability benefits.
A recent 7th U.S. Circuit Court of Appeals case could aptly be entitled ”Halpin Redux,” since the decision was written by Judge Kenneth F. Ripple, who penned Halpin v. W.W. Grainger Inc., 962 F.2d 685 (7th Cir. 1992), and the case covers the identical ground.
In Schneider v. Sentry Group Long Term Disability Plan, 2005 U.S. App. LEXIS 19273 (7th Cir., Sept. 7), an employee of Sentry Life began receiving disability benefits in 2001 due to major depression.
The disability insurance policy at issue in a federal court decision acknowledged that the insurer was a fiduciary and had discretion to determine eligibility for benefits and construe the policy terms. The policy further stated that ERISA fiduciaries ”have an obligation to administer the plan prudently and to act in the interest of you and other plan participants and beneficiaries.”