Multiple Sclerosis is a serious neurological disorder that is often disabling. The Multiple Sclerosis Foundation estimates that more than 400,000 people in the United States suffer some level of symptoms from the condition. Not all cases lead to disability. However, the condition can progress to the point that continuing to work is no longer an option for […]
A recent ruling from the 6th U.S. Circuit Court of Appeals emphasized the importance of in-person examinations in relation to disability benefits. In Guest-Marcotte v. Life Insurance Company of North America, 2018 WL 1578090 (6th Cir. March 30, 2018)(Unpublished), the plaintiff, Kimberly Guest-Marcotte, filed a claim for disability benefits due to Ehlers-Danlos syndrome Type III, […]
The outcome of Simmons v. Paul Revere Life Insurance Co., 2018 WL 558960 (W.D. Wash., Jan. 25, 2018), discussed in Part 1 of this column on Monday is not as clear-cut as the court found. Since Dr. William Simmons, a dentist, was no longer able to perform a number of material job duties that were a major part of his practice prior to his car accident, his claim raised serious issues about the protection his disability policy provided.
Anecdotally, the most litigated accidental death insurance claims involve drunk driving. The next most prevalent type of litigated accidental death claim are cases involving autoerotic asphyxiation. The recent ruling in Tran v. Minnesota Life Ins. Co., 2018 WL 1156326 (N.D. Ill. March 5, 2018) was one such case. The plaintiff was the widow of an […]
In Ariana M v. Humana Health Plan of Texas, Inc., 2018 WL 1096980 (5th Cir. March 1, 2018), a divided Fifth Circuit issued an en banc ruling that finally overturned Pierre v. Conn. Gen. Life Ins. Co., 932 F.2d 1552 (5th Cir. 1991) and concurred with every other Circuit that Firestone Tire & Rubber Co. v. […]
A Montana federal court began a recent ruling by asking: “Who is the beneficiary of a lawsuit stemming from an ERISA employee’s misfortune? Is it the ERISA plan or is it the unfortunate employee?” The case, Rustad-Link v. Providence Health and Services and Unum Group Corp., 2018 WL 627560 (D. Mont., Jan. 30, 2018), involved […]
A recent article published by Bloomberg Law offers a stark warning to disability insurance claimants who use social media. The article by Jacklyn Wille entitled “Facebook Has a New Friend: Disability Insurers” (https://www.bna.com/facebook-new-friend-n73014475033/) discusses insurers’ use of social media to investigate disability insurance claimants.
Qualifying for disability benefits often requires claimants to face many hurdles. An initial claim denial is not the end of the road, though. If you have group coverage, it is likely governed by ERISA, the Employee Retirement Income Security Act. One of the benefits of ERISA is that if a claim is denied, the claimant […]
Is the ability to work only on a part-time basis enough to deny disability benefits? The answer is no, according to the 10th U.S. Circuit Court of Appeals. The case of Van Steen v. Life Insurance Company of North America, 2018 WL 256806 (10th Cir., Jan. 2, 2018), involved Carl Van Steen, who worked as […]
The ERISA 1 law was enacted in 1974 by Congress to protect . . . participants in employee benefit plans and their beneficiaries, by requiring the disclosure and reporting to participants and beneficiaries of financial and other information with respect thereto, by establishing standards of conduct, responsibility, and obligation for fiduciaries of employee benefit plans, and by […]
Introduction The starting point to keep in mind when analyzing disability insurance claims handling is that both the insurer and the insured share a desire for accurate claims processing so that meritorious claims receive payment. The recent Supreme Court ruling in Metro.Life Ins.Co. v. Glenn 1 reinforced the need for accurate claims processing, 2 and no one who works in […]
Introduction Chairman Baucus; Ranking Member Grassley; Members of the Senate Finance Committee. Thank you for giving me the opportunity to testify at today’s hearing. When ERISA (Employee Retirement Income Security Act) was passed in 1974, one of the law’s major sponsors, Senator Jacob Javits, hailed it as “the greatest development in the life of the […]