Defining “Full and Fair” Review of Disability Benefits Claim
In order to ensure justice, the full and fair review process in disability benefits claims must be clearly defined.
Articles
Updates on the latest in benefits news and practical pointers for your benefits-related issues.
Post-Traumatic Stress Disorder and LTD Benefits
In recent years, there has been greater recognition of post-traumatic stress disorder, commonly referred to as PTSD. Many veterans returning from overseas conflicts experience PTSD, but the condition is not limited to former military. PTSD may occur following a significant injury or psychological shock and results in persistent mental or emotional distress. According to the […]
Court Parses Difference Between Residual Disability and Total Disability
A decision by the U.S. District Court for the District of New Jersey highlights the difference between residual and total disability.
Insurers Send Payments Directly to Patients Depriving Providers of Reimbursement for Services
America’s healthcare system is complex. Unlike single-payer systems that exist in virtually all other industrialized countries, the U.S. relies on private health insurers to cover healthcare costs, many of which are for-profit companies. The way health insurance typically works in the U.S. is that when a patient sees a doctor or goes to the hospital […]
Insurer’s Exclusion for Outdoor Mental Health Programs Rejected
One of the hottest current topics in Employee Retirement Income Security Act litigation concerns medical insurance coverage for residential treatment of behavioral health disorders. A recent Utah federal court ruling, Michael D. and Madeline D. v. Anthem Health Plans of Kentucky Inc., 2019 WL 586673 (D. Utah, Feb. 13, 2019), is a prime example. The […]
Disability Insurance Bars Pre-Existing Conditions
Although the Affordable Care Act prohibits health insurance denials on account of pre-existing conditions, the ACA is inapplicable to disability insurance. A recent federal court case from Massachusetts, Holzman v. Hartford Life & Accident Insurance Co., 2019 WL 181527 (D. Mass., Jan. 14, 2019), examined whether a claim for disability benefits fell within a pre-existing condition exclusion and reached a surprising conclusion.
How You Talk to Your Doctor Matters
After you experience an injury or sickness that affects your ability to work, obtaining disability benefits can be as difficult as trying to recover physically. Even if you have purchased disability insurance or have long-term disability insurance (LTD) coverage through your employer, you may not fully understand how to tap into those benefits when the […]
Court OKs Disability Claim by Attorney With Chronic Pain
A decision by the U.S. District Court for the Southern District of Ohio upholds an attorney’s claim for disability benefits based on chronic pain.
Insurer’s Bid to Use Videotape to Halt Disability Benefits Finds No Takers
Surveillance may sometimes be a useful tool in detecting potential insurance fraud. In a recent California case, however, video surveillance obtained by a disability insurer was insufficient to convince a judge that it correctly decided to terminate an insured’s benefit payments. The case of Fleming v. Unum Life Insurance Company of America, 2018 WL 6133859 […]
What Are Pre-Existing Conditions?
In a recent Ohio federal court ruling, Linda Hines successfully challenged Unum’s invocation of its pre-existing condition exclusion when she became disabled due to anisometropia, a neurologic condition where the brain is unable to coordinate the separate images generated by each eye. Unum maintained that the cataract surgery Hines underwent during the 3-month lookback period prior […]