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 […]
A recent ruling from a federal court in Alabama – Rosen v. Provident Life and Accident Insur. Co., 2015 WL 260839 (N.D.Ala. January 21, 2015) addressed a controversial issue involving ERISA preemption. Typically, ERISA is implicated only where an employer sponsors a retirement plan or offers group coverage to its employees for disability, life, or […]
DeBofsky, Sherman & Casciari recently won the case of Warner v. Unum Life Ins. Co., No. 12 C 02782, 2014 U.S. Dist. LEXIS 178765 (N.D. Ill. Dec. 31, 2014), where the district court granted summary judgment for the plaintiff, ruling that Unum Life Insurance Company (“Unum”) acted arbitrarily and capriciously by disregarding the results of […]
Setting aside money for retirement is just one step towards future financial security. In addition to funding retirement savings, a long-term care insurance policy may provide additional protection in the event of debilitating illness. This form of insurance is designed to afford protection against the expenses of long-term care in the home or in a […]
On December 1, 2014, the U.S. Court of Appeals heard oral argument in the case of Mary C. Fontaine v. Metropolitan Life Insurance Company. The issue before the court was whether an Illinois insurance regulation banning discretionary clauses in health and disability insurance policies survives ERISA preemption claims. The lower court ruled in Fontaine’s favor. […]
In evaluating occupational disability claims, insurers distinguish between the insured’s job and their occupation. If an employee cannot perform their job, they may still be denied disability insurance benefits if they remain capable of performing their occupation as it is generally performed in the national economy. Polnicky v. Liberty Life Assur.Co. of Boston, 2014 WL […]
A recent ruling from a federal court in Ohio discusses the interplay between the “deemed exhausted” provision of the ERISA claim regulations – 29 C.F.R. Sec. 2560.503-1(l) – and claim administrators’ requests to “toll” the clock on when claim appeals have to be decided. In Gay v. National Rural Electric Cooperative Association Group Benefits Program, 2014 […]