How to Respond to New Evidence Generated After Submitting an LTD Appeal
Proton beam radiation therapy is used to treat various forms of cancer. Rather than using X-rays, proton therapy directs focused energy from protons at tumors. […]
Articles
Updates on the latest in benefits news and practical pointers for your benefits-related issues.
6th Circ. Judge Correctly ID’d ERISA Civil Procedure Conflict
A recently issued ruling from the U.S. Court of Appeals for the Sixth Circuit, Tranbarger v. Lincoln Life & Annuity Co., addresses the fundamental issue of how courts should be adjudicating Employee Retirement Income Security Act cases.[…]
ERISA Ruling Shows Why Insurers Must Justify Claim Denials
Employee benefit claimants’ entitlement to a full and fair review of claim denials prior to judicial intervention is embedded in the Employee Retirement Income Security Act.[1] Regulations promulgated by the
U.S. Department of Labor flesh out the specifics as to what constitutes such a review. […]
Updated Standard of Care Cements Ruling in Health Benefits Dispute
Proton beam radiation therapy is used to treat various forms of cancer. Rather than using X-rays, proton therapy directs focused energy from protons at tumors. […]
How to Defeat Ambiguities in Disability Insurance Claim Forms
The start of every disability insurance claim is the completion of forms the claimants is required to submit to receive benefits. While the forms are ostensibly designed to be clear and straightforward, the questions asked on the disability insurance claim forms often confuse claimants, and ambiguities in disability insurance claim forms can lead to misunderstandings and delays in the processing of claims. […]
Digestive Disorders and Disability Insurance: What You Need to Know
Many physical and mental conditions can prevent an individual from working on a regular basis. That is particularly true of a number of digestive disorders. If you suffer from a digestive disorder and plan to file a disability claim, it’s important that you be aware of how insurance carriers address these types of claims. […]
Disability Insurer Loses Bid to Limit Benefits Physician Sought
Both federal and state laws mandate parity in health insurance policies between physical and behavioral health conditions. However, mental health parity is not required in disability insurance policies by any state other than Vermont. […]
The Role of the Treating Doctor in a Disability Insurance Claim
Every claim for disability insurance benefits requires the completion of three forms – the claimant’s statement, the employer’s statement, and the attending physician’s statement certifying the claimant’s disability. The claimant’s statement notifies the insurance company about what the claim is about and why the claimant is asserting an inability to work. […]
What Steps Can I take if My Claim for Long-Term Care Insurance Benefits Is Denied?
Long-term care (LTC) insurance is very complex. The requirements for receiving coverage are far more demanding than what is needed to qualify for long-term disability insurance – the insured needs to be unable to perform or needs substantial assistance to perform at least two basic activities of daily living such as feeding oneself, dressing, showering or bathing, toileting, or transferring from a seated to standing position or vice versa. Alternatively, a substantial cognitive impairment would qualify someone to receive long term care insurance benefits. […]
Severance Pact Forecloses Right To Pursue Disability Claim Later
Lawyers who represent employees in severance negotiations should be aware and take heed of the recent New York federal court ruling in Schuyler v. Sun Life Assurance Co., 2023 WL 2388757 (S.D. N.Y., March 7, 2023). That case illustrated a dangerous pitfall that may unwittingly result in unintended unfortunate consequences based on the court’s finding that an employee’s release of her employer also waived the employee’s right to sue her disability insurer. […]
Denied Sight-Unseen: Why Are Non-Examining Doctors So Prevalent in the Disability Insurance Industry?
Accessing mental health treatment can be difficult, even with health insurance. Critical laws are in place to expand access to mental health treatment by requiring equal coverage of mental health and medical/surgical care. […]
The Important Role Of Contra Proferentem In ERISA Cases
The outcome of Employee Retirement Income Security Act cases often turns on how courts interpret the meaning of specific benefit plan terms. The recently decided case of Stein v. Paul Revere Life Insurance Company, issued by the U.S. District Court for the Eastern District of Pennsylvania on March 16, illustrates what happens when plan terms are unclear and can have different meanings. […]