A recent decision by the 6th U.S. Circuit Court of Appeals presented a checklist of issues that were found to have demonstrated arbitrary and capricious conduct in the denial of disability benefits. The case of Shaw v. AT&T Umbrella Plan No. 1, 2015 WL 4548232 (6th Cir. July 29), involved Raymond Shaw, a 39-year-old customer […]
A recent case out of New York’s District Court illustrates when ERISA governs owner benefit plans. The Employee Retirement Income Security Act of 1974 sets minimum standards for private retirement, pension and health plans. Yet ERISA is a complex law and it is not always clear whether ERISA applies to a particular benefit plan. ERISA exemption […]
To qualify for Social Security disability benefits, a claimant must prove an inability to engage in “any” meaningful work, a standard considered extremely difficult to meet. However, as a recent case shows, the FedEx disability benefit plan imposes qualification standards that are even harder than Social Security’s. In Oliver v. Aetna Life Insurance Co., 2015 […]
One of the most important aspects of the Affordable Care Act, or Obamacare as it is commonly known, is the right to seek independent review of a health benefit denial. The notion of an independent review of an insurance company’s decision may seem to be a fair and objective way to resolve a dispute over […]
Most working people buy life insurance for their family’s financial protection in the event of untimely death. And many employee benefit plans that offer life insurance also provide death and dismemberment (AD&D) insurance, which provides added protection in the event death or loss of limb occurs in an “accident,” which the seminal appellate ruling in […]
Many disability insurance plans require objective proof of disability as a condition of receiving benefits. But what happens when a claimant suffers from a condition that cannot be diagnosed by objective testing. Migraine headaches constitute such a condition. More than 10 percent of the world’s adult population are afflicted by migraine headaches annually, according to […]
Qualifying for disability benefits based on headaches or other disorders that are so painful that narcotic medications are prescribed can be a major challenge. Since there is no objective way to measure pain and because most migraine and cluster headaches are impossible to diagnose with objective testing such as MRI studies, disability insurers often resist […]
A decision by the U.S. District Court for the Northern District of Illinois takes into account the role of weekends in extending ERISA deadlines.
A recent federal court ruling, Songer v. Reliance Std. Life Ins. Co., 2015 WL 2098126 (W.D. Pa. May 5, 2015), examined offsets of “other income benefits” such as Social Security disability payments. Since the insured’s income exceeded the maximum insured amount, his benefit was capped at an amount substantially less than the typical insured benefit […]
Paying restitution to victims is an important aspect of the criminal justice system.
In evaluating a disability insurance claim from the perspective of whether the claimant can perform his or her own occupation, what must an insurer consider? That question was recently answered by the 1st U.S. Circuit Court of Appeals. In McDonough v. Aetna Life Insurance Co., 2015 WL 1684079 (1st Cir., April 15), plaintiff Joseph McDonough […]
Two recent cases looked at monies paid to disability insurance claimants after the onset of disability and analyzed the question of whether the monies constituted income or profit distributions. Although the claimants lost in both Fine v. Sun Life Assur. Co. of Canada, 2015 WL 1534513 (E.D. Va. April 6, 2015) and in Bencivenga v. […]