Reimbursement claims that health insurance plans assert against personal-injury recoveries frustrate the plaintiffs’ bar and tie up the courts. A recent ruling from a federal court in Pennsylvania resolving the issues remaining following a Supreme Court remand is instructive in the manner it addressed some of the thorniest issues presented in such claims. In U.S. […]
Most disability benefit claim decisions focus on medical issues and often overlook the equally critical need to perform an accurate vocational evaluation. The recent case of Mackey v. Liberty Life Assurance Company of Boston, 2016 WL 915271 (W.D. Ark., March 7), is a singular exception. This case involved Brenda Mackey, a former registered nurse who […]
Since the Supreme Court’s ruling in Heimeshoff v. Hartford Life & Acc.Insur.Co., 134 S.Ct. 604 (December 16, 2013), which held that contractual limitations periods established by ERISA-governed employee benefit plans are enforceable, there has been much confusion about when such limitations periods commence and when they end. A recent ruling from the U.S. Court of Appeals […]
In Stapleton v. Advocate Health Care Network, 2016 WL 1055784 (7th Cir. March 17, 2016), the U.S. Court of Appeals for the Seventh Circuit joined the Third Circuit (Kaplan v. St. Peter’s Healthcare Sys., 810 F .3d 175 (3d Cir.2015)) in holding that a benefit plan established by a church-affiliated organization such as a hospital is not exempt from ERISA.
The American Benefits Council reports that 93 million Americans get their insurance from self-funded plans. These plans serve as an alternative to employers contracting with insurance companies that assume the risk. On March 1, the U.S. Supreme Court ruled that Vermont data collection law violates the U.S. Employee Retirement Security Act (ERISA). In a 6-2 […]
A recent case involving the FedEx disability program, Mason v. Federal Express Corp., 2016 WL 706163 (D. Alaska February 22, 2016), illustrated how exposure of conflicts of interest in a claim determination affects a court’s review of the evidence. The case involved Maurice Mason, a FedEx employee who suffered from an auto-immune disorder known as […]
A recent ruling from a federal court in Kentucky raised serious concerns about the validity of vocational assessments performed by disability insurance companies.
In Bishop v. Aetna Life Insurance Co., 2016 WL 591765 (E.D. Ky., Feb. 12, 2016), the court overturned a denial of disability benefits after finding that Aetna improperly disregarded a Social Security determination and that its vocational assessment was markedly flawed and biased.
In a case factually reminiscent of Booton v. Lockheed Medical Benefits Plan, 110 F.3d 1461, 1463 (9th Cir. 1997), as both cases involved claims for extensive dental reconstruction following accidents, a federal court in California found an abuse of discretion in a benefit plan’s denial of dental benefits.
The Supreme Court has once again waded into the Serbonian Bog of what is meant by the term “appropriate equitable relief” contained in 29 U.S.C. Section 1132(a)(3) (ERISA Section 502(a)(3)), which authorizes a civil action to be brought “by a participant, beneficiary or fiduciary (A) to enjoin any act or practice which violates any provision […]
The ERISA statute contains a provision that permits a large universe of potential claimants to seek “appropriate equitable relief.” 29 U.S.C. Sec. 1132(a)(3). Over a series of rulings the Supreme Court has wrestled with the meaning of that term. Historically, courts of equity were limited in the remedies they could provide litigants who came before […]
Two lessons taught by a recently decided case from Indiana are that insurers need to fairly and independently assess disability claims and must consider the co-morbidity of multiple physical and psychological impairments.
Aetna Life Insurance Company has attracted significant judicial scorn of late in the manner in which it adjudicates disability benefits.Two recent decisions are illustrative – Jalowiec v. Aetna Life Ins. Co., 2015 WL 9294269 (D. Minn. December 21, 2015) and Granville v. Aetna Life Ins. Co., 2015 WL 9026025 (M.D. Pa. December 15, 2015). In […]