Covid-19 has not just raised a host of medical challenges for the medical profession. In addition to public health questions that have resulted from doctors being faced with a novel virus that has behaved differently from other diseases encountered by medical science, Covid has also raised several questions about various kinds of insurance […]
Unlike most industrialized countries, the U.S. does not provide universal government-sponsored health insurance coverage to all of its citizens and residents. Instead, most Americans receive coverage through their employer, while older Americans and people of lesser means receive either Medicare or Medicaid benefits. […]
Suppose you cannot work due to an illness or injury and are fortunate to have long-term disability coverage through your employer. In that case, you will want to do everything in your power to maximize your chances of getting your LTD application approved and minimize the disruption to your income […]
As 2022 is coming into view and the Covid-19 pandemic is still with us, many employers are establishing workplace policies requiring that all employees be vaccinated. But instituting such policies raise several legal issues that complicate employers’ plans to have a fully vaccinated workforce. We explore both the issues and the solution below.[…]
The Employee Retirement Income Security Act impacts hundreds of millions of Americans who participate in employee benefit plans sponsored by their employers. However, as Graham v. Board of Ed. Of City of Chicago, 2021 WL 3508563 (7th Cir. Aug. 10, 2021), recently pointed out, ERISA doesn’t cover all employer-sponsored plans […]
Being on disability does not require one to be homebound or bedbound twenty-four hours a day. Nor does being on disability require a complete inability to perform activities beyond basic activities of daily living. Both private disability insurance and Social Security disability tolerate some activity, and the test to receive benefits […]
More than 45 years after the Employee Retirement Income Security Act’s passage, the reach of ERISA preemption is still being litigated, as illustrated by a July 28 ruling from the U.S. Court of Appeals for the Seventh Circuit […]
Long-term disability (“LTD”) insurers will sometimes conduct surveillance of benefit recipients and claimants to assess their ongoing entitlement to benefits. Disability insurers will look for video surveillance footage that captures physical activity inconsistent with the claimant’s alleged disability. Naturally, this can be a cause for concern and feel like […]
Courts adjudicating ERISA cases have borrowed a standard of judicial review from administrative law known as the arbitrary and capricious standard. Even though the ERISA law is derived mostly from trust law where a trustee’s actions are reviewed for an abuse of discretion, federal courts have substituted the […]
If your long term disability (LTD) benefits are denied or terminated, the denial letter will include a discussion of your right to bring an appeal or lawsuit. A lawsuit might seem like a better option. After all (you may think), how likely is it that the insurance company will voluntarily overturn its decision to deny your benefits […]
If you have been receiving long-term disability (LTD) benefits for a while, and/or your medical condition is chronic and unlikely to improve, it is not uncommon to receive a letter from your LTD plan offering a lump sum settlement of your disability claim. Sometimes called a “policy buy-out,” these offers represent a calculated […]
A common reason given for denials of health insurance coverage is a “lack of medical necessity.” When an insurance company denies a claim on that basis, that means the insurer disagrees with the patient’s doctor. Medical necessity denials are especially prevalent in claims involving mental health treatment, […]