Articles
Updates on the latest in benefits news and practical pointers for your benefits-related issues.
Appeals Court: Objective Evidence More Than Medical Tests
What is “objective” evidence? A recent ruling from the 6th U.S. Circuit Court of Appeals definitively answered that question.
6th Circ. Ruling Offers Fresh Look at ERISA Exhaustion
Is exhaustion of administrative remedies in challenging Employee Retirement Income Security Act-governed benefit denials required as a precondition to filing a lawsuit? A concurring opinion in Wallace v. Oakwood Healthcare Inc.[1] by U.S. Circuit Judge Amul Thapar of the Sixth Circuit raises provocative questions about the administrative exhaustion doctrine in ERISA cases and suggests that other […]
Practical Considerations for Disability Claimants During the COVID-19 Pandemic
The COVID-19 pandemic has wrought a previously unfathomable level of casualties and economic disruption in the United States and worldwide in just a few short weeks. Since mid-March, 16.9 million Americans have filed jobless claims, and one out of every 10 U.S. workers who had employment prior to the pandemic is now jobless. Many people with […]
Accidental Death Ruling Highlights Flaw in ERISA Deference
Since the publication in 1943 of James M. Cain’s noir classic, “Double Indemnity,” there has been a public fascination with accidental death insurance. Surprisingly, even when a sudden and unexpected death occurs other than as a result of a heart attack or other clear-cut medical condition, the issue of whether the death was accidental or […]
Divided Court Backs Denial of Accidental Death Claim
Causation is always a key issue in accidental death insurance claims as a recent 1st U.S. Circuit Court of Appeals decision teaches.
In Arruda v. Zurich American Insurance Co., 2020 WL 880548 (1st Cir., Feb. 24), the 1st Circuit overturned a judgment in favor of the plaintiff, Denise Arruda, in relation to an accidental death insurance claim relating to the death of her husband, Joseph Arruda. The insurer maintained that Joseph’s death was caused or contributed to by Joseph’s pre-existing health conditions. The 1st Circuit agreed.
Behavioral Health Ruling Supports Benefit Claim Appeals
Litigating health benefit claim denials is extremely challenging for plaintiffs. Especially under the Employee Retirement Income Security Act — where many cases are decided under the arbitrary and capricious standard of review that upholds an insurance claim denial so long as the basis for the claim decision is viewed as reasonable by a court
Plaintiff Loses De Novo Review, Couldn’t Prove Disability Argument
Mark D. DeBofsky is a name partner of DeBofsky Law He handles civil and appellate litigation involving employee benefits, disability insurance and other insurance claims and coverage, and Social Security law. A recent decision issued by the 7th U.S. Circuit Court of Appeals offers valuable insight into the meaning of the de novo standard of […]
Settlement Gives Relief to Aggrieved Long Term Care Policyholders
Purchasers of long term care insurance from MetLife who experienced a hike in premium rates may soon receive relief pursuant to a settlement agreement reached in the case Newman v. Metropolitan Life Ins. Co., No. 1:16-cv-03530 (N.D. Ill). The settlement follows a rare victory in the Seventh Circuit Court of Appeals for aggrieved long-term care […]
Why Do Health Insurers Deny Claims?
When you are ill and a doctor recommends a course of treatment, you naturally assume that your health insurer will reimburse the cost. That is not always the case, though, and it is not uncommon for health insurance benefits to be denied, especially if the costs are high. Examples of types of claims that are […]
Courts Continue to Permit Plaintiffs to Plead Simultaneous Claims for Benefits and Breach of Fiduciary Duty Under ERISA
Ever since the Supreme Court’s ruling in Varity Corp. v. Howe, 516 U.S. 489 (1996), courts have grappled with whether plaintiffs who file suit under the Employee Retirement Security Act of 1974 (“ERISA”) can plead simultaneous claims for benefits under § 502(a)(1)(B) along with claims for equitable relief under § 502(a)(3), and if so, under […]