Perhaps the most difficult task in evaluating disability benefit claims is assessing the weight to be given to subjective symptoms. In Cline v. Aetna Life Insurance Co., 2017 WL 5490853 (W.D. N.C., Nov. 15, 2017), the court addressed that issue head-on. The plaintiff, Larry Cline, a commercial pilot for Netjets, suffered from lumbar stenosis and […]
DeBofsky, Sherman & Casciari attorney William Reynolds recently won a significant victory on behalf of one of the firm’s clients. In Watson v. Reliance Standard Life Ins. Co., 2017 WL 5418768 (N.D. Ill. November 14, 2017), the court overturned a disability insurer’s finding that Cheryl Watson suffered from a psychiatric impairment; thus, her benefits were limited […]
Given the high cost of nursing home care, assisted living, or home health care, many people have purchased long-term care insurance with the expectation that it will cover the costs of their care should they ever need such services. Unfortunately, those expectations have not always been met because insurance companies have challenged claims and shown reluctance to pay benefits under long-term care policies.
What does the term “own occupation” mean in disability insurance coverage? The answer to that question was recently provided by a federal court in New Jersey. The case of Patterson v. Aetna Life Insurance Co., 2017 WL 4786562 (D. N.J., Oct. 23, 2017), involved Christopher Patterson, who became disabled in 2007 following spine surgery and […]
Nearly all group long-term disability insurance policies limit the duration of benefit payments for psychiatric conditions to 24 months, while disabilities due to physical impairments are generally payable to age 65 or until the claimant reaches Social Security normal retirement age. In a recent ruling from a federal court in Montana, Sand-Smith v. Liberty Life […]
A recently issued appellate court decision illustrates the complexity of ERISA preemption. Williby v. Aetna Life Ins. Co, 2017 WL 3482390 (9th Cir. August 15, 2017) involves the interplay between ERISA’s preemption provision and the savings and deemer clauses found in 29 U.S.C. § 1144.The underlying matter concerned a claim for short-term disability benefits under […]
Although the Affordable Care Act, also known as Obamacare, has eliminated health insurers’ exclusion of insureds who have pre-existing conditions, such exclusions remain enforceable in disability insurance policies. However, a recent non-precedential ruling issued by the 11th U.S. Circuit Court of Appeals, Bradshaw v. Reliance Standard Life Insurance Co., 2017 WL 3774536 (11th Cir., Aug. […]
A recent ruling issued by the 7th U.S. Circuit Court of Appeals resolved a controversial issue in Employee Retirement Income Security Act litigation: Does ERISA’s venue provision, 29 U.S.C. Section 1132(e)(2), preclude enforcement of a forum-selection clause in an employee benefits plan? The petitioner, George Mathias, the plan beneficiary, the secretary of labor, as amicus […]
That question was answered in a recently reported federal court ruling from Michigan, Sun v. United of Omaha Life Ins. Co., 2017 WL 3050477 (E.D. Mich. July 19, 2017). The case involved Julia Sun, who worked as a registered nurse caring for quadriplegic patients. After she injured her foot in 2010, and because she also […]
All group disability insurance policies coordinate benefits with other sources of disability income to preclude potential double recoveries. Social Security disability benefits and workers’ compensation benefits are universally identified as offsets against long-term disability insurance payments. A more controversial offset, though, are payments that result from personal-injury claims which compensate claimants for categories of damages […]
Individuals who suffer from eating disorders often run into difficulties securing coverage from their health insurers for treatment, especially for residential care. Last year, ERISA lawyer Mark DeBofsky of DeBofsky Law contacted Illinois State Representative Laura Fine and Illinois State Senator Julie Morrison with an idea to amend the Illinois Insurance Code to provide health […]
The Employee Retirement Income Security Act (ERISA) is extremely broad in its scope. It affects both retirement benefits and other employee benefits such as health insurance in the majority of workplaces in the United States. However, there are exceptions – government employees are exempted from ERISA, meaning that benefits involving federal, state and municipal employees […]