DeBofsky Law successfully challenges forum selection clause
DeBofsky & Associates successfully challenged a forum selection clause in a recent ERISA case.
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Updates on the latest in benefits news and practical pointers for your benefits-related issues.
New survey shows insurance company bad faith in cancer claims
Those diagnosed with cancer are fighting many battles. They not only have to deal with their health, but they also have to deal with paying for healthcare. Cancer patents rely on their health insurance to provide coverage for effective healthcare. Unfortunately, some insurance carriers sidestep their responsibilities when it comes to patient care for those […]
Can a Discounted Premium Bill Create an ERISA plan?
The recent case of Gooden v. Unum Life Ins. Co. of Am., 2016 WL 3059752 (E.D. Tenn. March 30, 2016) involved a familiar scenario – whether a “list bill” arrangement constitutes an ERISA plan.
Disability insurer taken to task for delayed action on disability claim
Claims for employee benefits brought under the Employee Retirement Income Security Act are subject to very strict rules regarding time limits for deciding claims. However, neither the ERISA statute, nor the claim regulations found at 29 C.F.R. Section 2560.503-1 prescribe specific penalties for violating the rules.
Insurers must evaluate cognitive/mental demands of an occupation
DeBofsky, Sherman & Casciari attorneys Mark DeBofsky and Martina Sherman recently won the case of Wonsowski v. United of Omaha Life Ins. Co., 2016 WL 3088141 (N.D. Ill. June 2, 2016) following a bench trial before Magistrate Judge Geraldine Soat Brown in the federal court in Chicago. The case involved Shellie Wonsowski, who had worked […]
How to interpret the “each and every duty” requirement in a disability insurance policy
Many disability insurance policies require a showing of an inability to perform each and every regular job duty. Does that mean you can’t be considered disabled if you are unable to perform some but not all of the required job duties? In most jurisdictions, the answer is yes – you need not prove an inability […]
One disability claim case brings several common themes together
In reviewing disability determinations, a number of problematic issues appear with relative frequency. The recently issued ruling in Groth v. Centurylink Disability Plan, 2016 WL 1621724 (S.D. Ohio, April 25, 2016), contains a potpourri of such issues. Plaintiff Stacie Groth claimed she was disabled due to lumbar degenerative disk disease, fibromyalgia, depression and anxiety. Despite […]
What did you really buy with your long-term care policy?
When you purchase a long-term care insurance policy, you are buying peace of mind. You know that the cost of various assisted-care living options range from expensive to astronomical. Even if you have a reasonably large portfolio of assets, and potentially could afford to the monthly costs of an assisted living or nursing home, you […]
Does Your Insurance Plan Cover the Latest Hepatitis C treatments?
A recent report by the Centers for Disease Control found that Hepatitis C-related deaths are at an all-time high in the United States. As reported by the Washington Post, the report found that more Americans die from the disease than from 60 other infectious diseases combined. Approximately 3.5 million Americans are thought to have the disease, although many may be unaware due to the initial slow and silent damage it inflicts upon the liver.
When can a Social Security determination be admitted into evidence in an ERISA long-term disability benefit case?
Because federal courts generally consider the scope of their review of an ERISA benefit denial as being limited to review of a record, what happens if significant material evidence such as a Social Security determination becomes available only after the claim appeals are exhausted. If the standard of judicial review is arbitrary and capricious, it […]
Health insurer’s three-word denial brings cold shoulder from 2nd Circuit
In Halo v. Yale Health Plan, 2016 WL 1426291 (2nd Cir., April 12, 2016), the 2nd U.S. Circuit Court of Appeals recently addressed whether an Employee Retirement Income Security Act-governed health insurance plan’s failure to issue a benefit determination compliant with federal claims-processing regulations should be penalized and, if so, how. The U.S. District Court […]
Man Finds His Claim Narrow Enough to Avoid ERISA Pre-Emption Provisions
The scope of pre-emption of state laws under the Employee Retirement Income Security Act (ERISA) is so broad that it generally precludes recovery of any damages or remedies beyond the limited remedies enumerated in 29 U.S.C. Section 1132(a). Thus, the availability of any recompense in a denial of benefits case beyond the benefits claimed, plus […]