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. […]
Although health plan exclusions for pre-existing conditions are no longer permissible under the Affordable Care Act, disability insurers may still lawfully invoke such exclusions in their policies. But the exclusions must be applied narrowly. This was illustrated in Meyer v. Unum Life Insurance Company of America, 2015 U.S. Dist. LEXIS 42092 (D.Kan., March 31). John […]
A recent ruling received by DeBofsky, Sherman & Casciari examined the issue of how to determine pre-disability earnings. In Cheney v. Standard Ins. Co., 2015 WL 2015 U.S.Dist.LEXIS 30918 (N.D.Ill. March 13, 2015)(Issue: Pre-Disability Earnings). In an earlier ruling (Cheney v. Standard Ins. Co., No. 13 C 4269, 2014 WL 4259861 (N.D. Ill. Aug. 28, […]
In 2013, the 6th U.S. Circuit Court of Appeals electrified the ERISA world when it ruled that in addition to paying benefits due after a wrongful rejection of a disability insurance claim, the Life Insurance Company of North America (LINA), a Cigna Corp. subsidiary, would also have to disgorge the profits it earned on the […]
A man with cerebral palsy and other disabilities recently won an appeal against a disability benefits denial. The panel reviewing his case reminded the SSA to review the specifics of each case and avoid broad generalizations. A recent case serves as a reminder that a claimant’s real world employability must be taken into consideration as opposed to making a disability determination based on broad generalizations that could lead to a denial of benefits.
Signing a severance agreement or settlement agreement with an employer that contains a general release may unintentionally bar a claimant from pursuing a disability benefit claim under ERISA. That was the lesson learned by Dr. Thomas Gonda, Jr., who worked as a thoracic surgeon at Kaiser Permanente until he became disabled due to cognitive impairments […]
Although lawsuits challenging employee benefit denials under the Employee Retirement Income Security Act (ERISA) are brought as “civil actions” in accordance with the United States Code, the manner in which such cases are adjudicated deviates from the norm according to a recent article authored by Mark DeBofsky, “A Critical Appraisal of the Current State of […]