Articles

Updates on the latest in benefits news and practical pointers for your benefits-related issues.

Does ERISA Allow Depositions of Claim Adjusters in Disability Insurance Claims?

by Mark Debofsky | Dec 4, 2013 | Civil Procedure, Disability Benefits, ERISA

Despite the fact that the Federal Rules of Civil Procedure are intended to apply to all civil actions adjudicated in federal court, ERISA cases receive different treatment, especially cases that involve disability insurance benefits. In Charles v. UPS National Long Term Disability Plan, 2013 U.S.Dist.LEXIS 164218 (E.D.Pa. November 19, 2013), the court was called upon to decide whether to allow a deposition of the claim adjuster who denied benefits.

Two points of view on offset for veteran and disability benefits

by Mark Debofsky | Dec 2, 2013 | Offsets to Disability Benefits

After more than 10 years of war in Iraq and Afghanistan, many veterans are returning home with disabilities, some of which are latent and do not manifest themselves until years later. If a veteran who later qualifies for veteran benefits also receives disability benefits under their private-sector employer’s group long-term disability insurance plans, the question […]

Court recognizes fiduciary breach claim when health insurer gives erroneous information

by Mark Debofsky | Nov 11, 2013 | ERISA, Fiduciary Duties, Health Benefits

A new court ruling is the first to recognize a fiduciary breach claim against a health insurer when misinformation given by its representative cost an employee his benefits.

Court finds for insured in absence of examination

by Mark Debofsky | Oct 13, 2013 | ERISA Standard of Review, Mental vs. Physical Disabilities

An insurer’s choice to rely on file reviews in place of examinations can be critical to the outcome of litigation, a lesson taught by Tolstedt v. Standard Ins. Co., 2013 U.S.Dist.LEXIS 134946 (D.Mont. June 24, 2013). There, the plaintiff, Michael Tolstedt, a trial lawyer from Billings, Mont., began taking prescription medication for depression on Sept. […]

Remands as final judgments? Court dismisses ERISA case

by Mark Debofsky | Oct 10, 2013 | Accidental Death, Civil Procedure, ERISA

Federal courts of appeals have limited jurisdiction and may only hear appeals from final judgments. Recently, the 3rd U.S. Circuit Court of Appeals was called upon to decide whether it had jurisdiction to hear an appeal of a benefit case decided under the Employee Retirement Income Security Act (ERISA). Instead of entering judgment outright, the […]

A federal judge in Alabama

by Mark Debofsky | Oct 8, 2013 | ERISA Standard of Review, Pain and Disability

A federal judge in Alabama (Karen Bowdre) recently issued a critical ruling in a disability case involving fibromyalgia. The court made numerous keen observations about the review process and the nature of fibromyalgia, carefully analyzing all of the issues presented. Here is our discussion and analysis of the court’s ruling: Williams v. United of Omaha […]

Court report looks at issue of filing suits under pseudonyms

by Mark Debofsky | Oct 3, 2013 | Civil Procedure

Litigation often involves sensitive personal issues that parties are reluctant to publicly disclose. Often in such cases, the parties resort to filing suit under a pseudonym to protect the identity of one or both of the parties. Cases involving disability benefits inherently relate to personal and confidential medical issues, yet courts rarely permit pseudonymous filings […]

Papotto v. Hartford Life & Acc.Ins.Co., 2013 U.S.App.LEXIS 19660

by Mark Debofsky | Oct 2, 2013 | Accidental Death, Civil Procedure

Papotto v. Hartford Life & Acc.Ins.Co., 2013 U.S.App.LEXIS 19660 (3d Cir. September 26, 2013) is a significant recently issued case involving ERISA civil procedure. The underlying issue in this case dealt with an accidental death and dismemberment insurance policy. The policy excluded losses “sustained while Intoxicated.” Because the decedent had consumed alcohol prior to his […]

More on the CIGNA Regulatory Settlement Agreement

by Mark Debofsky | Sep 29, 2013 | ERISA

Nearly all 50 state insurance commissioners, including Andrew Boron, the Illinois Insurance Director, have now signed on to the Regulatory Settlement Agreement that requires CIGNA disability insurance companies such as the Life Insurance Company of North America to reconsider denied claims under revised guidelines for: Consideration of Social Security disability awards Evaluation of medical evidence […]

Is there a duty to investigate?

by Mark Debofsky | Sep 23, 2013 | Disability Benefits, ERISA

The question of whether an insurer has a duty to investigate the legitimacy of evidence submitted by a spurned intimate acquaintance was presented in the recently decided case of Truitt v. Unum Life Ins. Co. of Amer., 2013 U.S.App.LEXIS 18639 (5th Cir. Sept. 6, 2013). The plaintiff, Terri Truitt, had worked as an attorney in […]

More on Freeland v. Unum, a case litigated by DeBofsky Law

by Mark Debofsky | Sep 16, 2013 | Mental vs. Physical Disabilities

Freeland v. Unum Life Ins.Co. of America, 2013 U.S.Dist.LEXIS 116931 (W.D.Wisc. August 19, 2013)(Issue: Risk of Disability)(opinion_and_order.pdf). A key focus of the court’s ruling was on the Unum Regulatory Settlement Agreement of 2004, which required Unum to consider the co-morbidity of multiple impairments and give significant weight to Social Security determinations. Based on those guidelines, […]

Federal court explains why ERISA governs insurance benefit disputes

by Mark Debofsky | Aug 28, 2013 | ERISA, Long Term Disability

The question of why group long-term disability insurance policies are governed by the Employee Retirement Income Security Act (ERISA) was recently answered in Gross v. Sun Life Assur. Co. of Canada, 2013 U.S.App.LEXIS 17059 (1st Cir. Aug. 16, 2013). That case involved Diahann Gross, an optician who became disabled in 2006 due to complex regional […]

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