A production supervisor for an engineering company sought disability benefits after aggravating a back injury when he fell down a flight of stairs. Plaintiff Alfredo Ruiz applied for benefits from Continental Casualty Co. and submitted certification from his attending physician, who reported that due to physical limitations, Ruiz ”may not work.” Additional records were later […]
In Ariana M v. Humana Health Plan of Texas, Inc., 2018 WL 1096980 (5th Cir. March 1, 2018), a divided Fifth Circuit issued an en banc ruling that fiinally overturned Pierre v. Conn. Gen. Life Ins. Co., 932 F.2d 1552 (5th Cir. 1991) and concurred with every other Circuit that Firestone Tire & Rubber Co. v. […]
A recent decision issued by the U.S. Court of Appeals for the Fifth Circuit illuminates the importance of the standard of judicial review applied to resolution of cases seeking benefits under ERISA. In Ariana M v. Humana Health Plan of Texas, Inc., 2017 WL 1423765 (5th Cir. April 21, 2017), although the court of appeals […]
A recent ruling from the 1st U.S. Circuit Court of Appeals upheld an insurance company’s denial of health-care benefits for psychiatric treatment. Although the underlying facts are compelling, the most interesting aspect of the ruling was the court’s discussion of civil procedure and judicial standards of review under the Employee Retirement Income Security Act. The […]
Because federal courts generally consider the scope of their review of an ERISA benefit denial as being limited to review of a record, what happens if significant material evidence such as a Social Security determination becomes available only after the claim appeals are exhausted. If the standard of judicial review is arbitrary and capricious, it […]
A recent case involving the FedEx disability program, Mason v. Federal Express Corp., 2016 WL 706163 (D. Alaska February 22, 2016), illustrated how exposure of conflicts of interest in a claim determination affects a court’s review of the evidence. The case involved Maurice Mason, a FedEx employee who suffered from an auto-immune disorder known as […]