On December 1, 2014, the U.S. Court of Appeals heard oral argument in the case of Mary C. Fontaine v. Metropolitan Life Insurance Company. The issue before the court was whether an Illinois insurance regulation banning discretionary clauses in health and disability insurance policies survives ERISA preemption claims. The lower court ruled in Fontaine’s favor. […]
In Cerone v. Reliance Standard Life Ins.Co., 2014 U.S.Dist.LEXIS 46529 (S.D.Cal. March 28, 2014), after the plaintiff’s accidental death claim based on the death of her husband was denied and her appeal exhausted, Debra Cerone filed suit against Reliance Standard Life Insurance Company. The issue decided in this opinion was whether the de novo or abuse of discretion standard of review applied.
From time to time we comment on court opinions relevant to disability insurance and ERISA litigation – Gerhardt v. Liberty Life Assur.Co. of Boston, 2013 U.S.App.LEXIS 23912 (8th Cir. November 29, 2013)(Issue: Independent Medical Examinations; Transferable skills analysis). Lisa Gerhardt, a nurse, applied for disability benefits from her employer’s group long-term disability insurance company in […]
An insurer’s choice to rely on file reviews in place of examinations can be critical to the outcome of litigation, a lesson taught by Tolstedt v. Standard Ins. Co., 2013 U.S.Dist.LEXIS 134946 (D.Mont. June 24, 2013). There, the plaintiff, Michael Tolstedt, a trial lawyer from Billings, Mont., began taking prescription medication for depression on Sept. […]
A federal judge in Alabama (Karen Bowdre) recently issued a critical ruling in a disability case involving fibromyalgia. The court made numerous keen observations about the review process and the nature of fibromyalgia, carefully analyzing all of the issues presented. Here is our discussion and analysis of the court’s ruling: Williams v. United of Omaha […]
Disability claims involving chronic fatigue syndrome and fibromyalgia are difficult to assess because the symptoms are self-reported and cannot be objectively verified. However, in Schnoor v. Walgreen Income Protection Plan, 2013 U.S.Dist.LEXIS 114435 (W.D.Mich. Aug. 14, 2013), the court had no difficulty seeing through a deficient claim evaluation, despite the broad deference given to the […]