Articles

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

Deferential Review Process Needs Fair Standards

by Mark Debofsky | Jan 18, 2012 | ERISA Standard of Review

Should courts be giving deference to benefit decisions made by insurance companies? Although the U.S. Supreme Court ruled in Firestone Tire v. Bruch, 489 U.S. 101 (1989), that deference was permissible in Employee Retirement Income Security Act (ERISA) benefit claims disputes, the court pointed out that the default standard of adjudication should be de novo, which means a court weighs the evidence afresh and gives equal consideration to both plaintiff and defendant.

Court Reconsiders Remanded Benefit Case

by Mark Debofsky | Jan 4, 2012 | ERISA

The Seventh Circuit Court of Appeals recently granted disability benefits to a former employee of Wal-Mart Stores Inc. who had been turned down for coverage twice.

Approach Clarifies Benefit Claim Determinations

by Mark Debofsky | Dec 21, 2011 | Disability Benefits

A recent opinion issued by the 1st U.S. Circuit Court of Appeals suggests a new approach for assessing the reasonableness of benefit claim determinations under the Employee Retirement Income Security Act (ERISA) abuse of discretion standard of review.

Court Looks at Critical Issues Involving Syndrome

by Mark Debofsky | Dec 7, 2011 | Long Term Disability

A ruling issued by a federal court in California illustrates a number of critical issues involving a claim for disability benefits due to chronic fatigue syndrome.

McCutchen may influence other court decisions

by Mark Debofsky | Nov 25, 2011 | ERISA, Health Benefits

The recent 3rd U.S. Circuit Court of Appeals ruling in U.S. Airways, Inc. v. McCutchen, 2011 U.S.App.LEXIS 22883 (3d Cir. Nov. 16, 2011) dealt with the question of whether the equitable doctrine of unjust enrichment could be used to mitigate an ERISA benefit plan’s claim for reimbursement. McCutchen involved a claim brought by a medical […]

Return to work can create benefits controversy

by Mark Debofsky | Nov 2, 2011 | Disability Benefits

A controversial issue in disability benefit evaluations is whether benefits are due to someone whose medical condition, while presently in remission, would be aggravated to such an extent by a return to work that the claimant’s life or health would be jeopardized. The issue is commonly referred to as “risk of disability” or “common care […]

Does Insurer Get Offset From VA Disability Benefits?

by Mark Debofsky | Oct 19, 2011 | Offsets to Disability Benefits

In 2010, I authored a column titled, “The standard of review can affect application of offsets,” Chicago Daily Law Bulletin, July 12, 2010. That column discussed two recently issued U.S. District Court rulings on the subject of benefit offsets and pointed out the standard of Employee Retirement Income Security Act (ERISA) review could determine whether a plan administrator had the power to interpret an ambiguous plan provision in a self-serving manner.

Ruling addresses policy limitations

by Mark Debofsky | Oct 6, 2011 | Disability Benefits, Long Term Disability, Offsets to Disability Benefits, Pain and Disability

Despite significant medical advances in recent years, many debilitating impairments remain impossible to diagnose through imaging such as x-ray or MRI, electrodiagostic testing, or blood tests. Consequently, due to potential uncertainty as to the legitimacy of such conditions, disability insurers have adopted policy provisions that purport to limit payments for conditions such as fibromyalgia, chronic […]

A Crucial Distinction Exists in the Types of Plans

by Mark Debofsky | Sep 21, 2011 | ERISA

An issue that never seems to go away is where courts should draw the line between an employee benefit plan and insurance coverage purchased by an individual through an arrangement made available by an employer.

Determining When a Cause of Action Accrues

by Mark Debofsky | Sep 7, 2011 | Disability Benefits, ERISA

One of the most confusing aspects of ERISA litigation is the determination of when a cause of action accrues. As the defendant learned to its detriment in’ Withrow v. Bache Halsey Stuart Shield Inc. Salary Protection Plan, 2011 U.S.App.LEXIS 17526 (9th Cir. August 23, 2011), the failure to effectively trigger an accrual of a cause of action prevented a statute of limitations from running for about 25 years. The case involved a stockbroker, Valerie Withrow, who became employed by Bache (now Prudential Securities) in 1979

Court takes controversial position in Pettaway

by Mark Debofsky | Aug 24, 2011 | Long Term Disability, Residual/Partial vs. Total Disability

A decision by the 7th Circuit Court of Appeals has taken a controversial position in the ongoing case of Pettaway v. Board of Trustees of Western Conference of Teamsters Pension Plan.

How do courts weigh conflicts of interest?

by Mark Debofsky | Aug 10, 2011 | Disability Benefits

The U.S. Supreme Court admonished the lower courts in Metropolitan Life Insurance Company v. Glenn, 554 U.S. 101 (2008), that in adjudicating Employee Retirement Income Security Act (ERISA) benefit cases, courts must take into consideration the conflict of interest inherent in circumstances where the same party, such as an insurance company, both administers benefits and […]

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