If a health insurer mistakenly advises a patient that a surgical procedure is covered by its policy – and in reliance on that advice, the patient proceeds with the surgery, can the patient recoup the expenses incurred in undergoing the procedure from the insurance company if the insurer maintains that its prior advice was mistaken?
The Seventh Circuit Court of Appeals recently ruled that vitamin supplements do not qualify as medical treatment for purposes of a disability claim.
The main lesson taught by a recent federal court ruling issued in Florida, Wilson v. Walgreen Income Protection Plan, 2013 U.S.Dist.LEXIS 62021 (M.D.Fla. April 29, 2013), is that the Employee Retirement Income Security Act (ERISA) imposes duties of good faith and fair dealing that preclude deceptive and unreasonable claim handling tactics. The plaintiff, Deborah Wilson, […]
The U.S. Supreme Court recently issued a significant ruling on the rights of health benefit plans to recoup payments out of personal-injury settlements. U.S. Airways Inc. v. McCutchen, 2013 U.S.LEXIS 3156 (April 16, 2013) involved James McCutchen, an employee of US Airways and a participant in that organization’s health benefits plan, who was severely injured […]
Woody Allen is quoted as saying that 80 percent of life is just showing up. That was the lesson taught by Neaton v. Hartford Life and Acc.Ins.Co., 2013 U.S.App.LEXIS 5814 (6th Cir. March 21, 2013)(non-precedential) which focused on James Neaton’s absences from work while recovering from multiple surgeries. Neaton, who worked as a debt collector, […]
The phrase “total and permanent disability” can be subject to multiple meanings, as a recent ruling from the 7th U.S. Circuit Court of Appeals pointed out. In Tompkins v. Central Laborers’ Pension Fund, 2013 U.S.App.LEXIS 5161 (7th Cir. March 13, 2013), the appellate court determined that, even in the face of ambiguity, a pension plan administrator offered an interpretation of that phrase which was reasonable and within the scope of his/her discretionary authority when interpreting the plan.
Lump-sum pension distributions are frequently the subject of litigation and the 7th U.S. Circuit Court of Appeals addressed such a case in Dennison v. MONY Life Retirement Income Security Plan for Employees, 2013 U.S.App.LEXIS 4651 (7th Cir. March 6, 2013). The named plaintiff in a class action, John Dennison, was employed by MONY (Mutual of […]
The scope of remedies available under Employee Retirement Income Security Act due to an employer or plan administrator’s breach of fiduciary duty is undergoing a dramatic transformation in the wake of a recent Supreme Court ruling. The most recent example is Gearlds v. Entergy Services Inc., 2013 U.S.App.LEXIS 3831 (5th Cir. Feb. 19, 2013). That […]
The enforceability of a forum selection clause was the subject of a recent ruling issued by U.S District Judge Milton I. Shadur in Coleman v. Supervalu, Inc. Short Term Disability Program, 2013 U.S.Dist.LEXIS 13372 (N.D.Ill. Jan. 31, 2013). The case involved Eboni Coleman, a retail pharmacist who worked at a Jewel-Osco store in Illinois. Litigation arose after Jewel-Osco’s parent corporation denied Coleman’s short-term disability benefit claim.
In Employee Retirement Income Security Act benefits litigation, the selection of the judicial standard of review often dictates the outcome of the case.
Is a significant risk of relapse, if a disability benefit claimant were to return to work, a current disability? That was the question answered in Colby v. Union Security Ins. Co., 2013 U.S.App.LEXIS 1149 (1st Cir. Jan. 17, 2013). Although the court acknowledged that another court of appeals had decided the issue differently, in this […]
All disability insurance policies contain provisions requiring that insureds receive regular care from a physician. However, such clauses are usually liberally interpreted. For example in Heller v. Equitable Life Ins. Soc’y, 833 F.2d 1253, 1257 (7th Cir. 1987), the court ruled that such a clause could not be read to require an insured to undergo […]