Articles

New wine in an old bottle: the Department of Labor’s revised regulations applicable to disability benefit claims

by Mark Debofsky | Mar 3, 2017 | Disability Benefits

Shortly before the new year began, the Employee Benefits Security Administration of the U.S. Department of Labor (DOL) published final regulations on December 19, 2016, relating to disability benefit claims governed by ERISA: “Claims Procedure for Plans Providing Disability Benefits.” The regulations are effective January 18, 2017, and generally applicable to claims for disability benefits […]

Can a disability insurer rely on a treating doctor’s outlier opinion?

by Mark Debofsky | Feb 25, 2017 | Disability Benefits, ERISA

The recent ruling in Broderick v. Hartford Life and Acc. Ins. Co., 2017 WL 652451 (D. Minn. February 16, 2017) presents an interesting challenge – if a doctor gives an opinion that his patient can work which contradicts the doctor’s treatment notes and other contemporaneous statements, would that be a sufficient basis to deny benefits?

Court Throws Back Red Herring in Fibromyalgia Disability Case

by Mark Debofsky | Feb 16, 2017 | Disability Benefits, Pain and Disability

A federal court in Michigan recently issued a ruling accusing an insurance company of committing a logical fallacy in adjudicating a disability benefit claim involving fibromyalgia.

Life insurance incontestability – What is it and how do you deal with it?

by Mark Debofsky | Feb 10, 2017 | Life Insurance

After the death of a spouse or loved one who is providing you financial support, one of the first questions that arises is whether the decedent had life insurance. But even if there is a policy in effect, the insurance company may be telling you that payment is being delayed or possibly even denied because […]

Good Intentions Lead to Less Than Positive Outcome for Plaintiff

by Mark Debofsky | Jan 11, 2017 | Disability Benefits, Long Term Disability

A cynical observer once commented that “no good deed goes unpunished.” Unfortunately for the plaintiff in Boyles v. American Heritage Life Insurance Co., 2016 WL 7489048 (W.D. Pa. Dec. 28, 2016), that expression dictated the outcome in this case. The plaintiff, Robert P. Boyles Jr., worked as a commercial insurance producer for an agency that had […]

The problem with file reviews in disability benefit cases

by Mark Debofsky | Jan 8, 2017 | Disability Benefits, ERISA

The practice by insurance companies of hiring doctors to review disability benefit claim files has been coming under increasing fire.Doctors are hired to assess  a claimant’s disability based on a review of records rather than examining the claimant or even speaking with the claimant or the treating doctors.A recent ruling from Tennessee, Carty v. Metro. […]

New ERISA disability rules look to level playing field for all

by Mark Debofsky | Jan 4, 2017 | Disability Benefits

Claims for employee benefits governed by the Employee Retirement Income Security Act are extremely complex. Congress directed the U.S. Labor Department to issue regulations to streamline the claim process and the department has striven to fulfill that mandate to make the process “full and fair” as required by statute (29 U.S.C. Section 1133). The regulations […]

“Claims procedure for plans providing disability benefits,” 81 FR 92316

by Mark Debofsky | Dec 18, 2016 | Disability Benefits, ERISA

The Employee Benefits Security Administration of the U.S. Department of Labor has issued final regulations published in the Federal Register on December 19, 2016 (81 Fed. Reg. 92316) relating to disability benefit claims governed by ERISA.Proposed regulations were initially published for comment on November 18, 2015 at 80 Fed.Reg. 72014; and after considering over 100 […]

Medical complications and accidental death insurance

by Mark Debofsky | Dec 17, 2016 | Accidental Death

DeBofsky Law recently won an important accidental death insurance case in the U.S. Court of Appeals – Prather v. Sun Life and Health Insurance Company, 2016 WL 7232144 (7th Cir. December 13, 2016) – /Cases/Prather-v-Sun-Life.pdf.   The case was brought on behalf of Lee Ann Prather, the widow of Jeremy Prather, who died at age 31 […]

Inconclusive medical tests should not undermine benefits claim, court rules

by Mark Debofsky | Dec 14, 2016 | Disability Benefits, Pain and Disability

If a disability benefit claim is submitted without a specific diagnosis, does that prevent the claimant from qualifying for benefits? That was the question answered by Graham v. Life Insurance Company of North America, 2016 WL 6958151 (N.D. Ga., Nov. 28, 2016), which ruled the absence of a definitive diagnosis does not necessarily pose an […]

Appeals court takes stand on sitting, opts for Labor Department ruling

by Mark Debofsky | Dec 7, 2016 | Disability Benefits, Long Term Disability

The determination of a claimant’s physical exertional capability is critical in cases involving occupational assessment. The U.S. Department of Labor has created specific categories, “sedentary,” “light,” “medium” and “heavy,” to define the physical requirements of various jobs; and the Social Security Administration utilizes the same terminology in its disability insurance program.

What is the Employee Benefits Security Administration?

by Mark Debofsky | Nov 17, 2016 | ERISA, Pension Plans

You have likely heard of the Employee Retirement Income Security Act (ERISA) that establishes minimum standards for pension plans in private industry. But, do you know anything about the agency that manages it? To best understand ERISA, it is important to know the history and structure of the agency that manages it. Pensions have a […]