After more than 10 years of war in Iraq and Afghanistan, many veterans are returning home with disabilities, some of which are latent and do not manifest themselves until years later. If a veteran who later qualifies for veteran benefits also receives disability benefits under their private-sector employer’s group long-term disability insurance plans, the question […]
A new court ruling is the first to recognize a fiduciary breach claim against a health insurer when misinformation given by its representative cost an employee his benefits.
An insurer’s choice to rely on file reviews in place of examinations can be critical to the outcome of litigation, a lesson taught by Tolstedt v. Standard Ins. Co., 2013 U.S.Dist.LEXIS 134946 (D.Mont. June 24, 2013). There, the plaintiff, Michael Tolstedt, a trial lawyer from Billings, Mont., began taking prescription medication for depression on Sept. […]
Federal courts of appeals have limited jurisdiction and may only hear appeals from final judgments. Recently, the 3rd U.S. Circuit Court of Appeals was called upon to decide whether it had jurisdiction to hear an appeal of a benefit case decided under the Employee Retirement Income Security Act (ERISA). Instead of entering judgment outright, the […]
A federal judge in Alabama (Karen Bowdre) recently issued a critical ruling in a disability case involving fibromyalgia. The court made numerous keen observations about the review process and the nature of fibromyalgia, carefully analyzing all of the issues presented. Here is our discussion and analysis of the court’s ruling: Williams v. United of Omaha […]
Litigation often involves sensitive personal issues that parties are reluctant to publicly disclose. Often in such cases, the parties resort to filing suit under a pseudonym to protect the identity of one or both of the parties. Cases involving disability benefits inherently relate to personal and confidential medical issues, yet courts rarely permit pseudonymous filings […]
Papotto v. Hartford Life & Acc.Ins.Co., 2013 U.S.App.LEXIS 19660 (3d Cir. September 26, 2013) is a significant recently issued case involving ERISA civil procedure. The underlying issue in this case dealt with an accidental death and dismemberment insurance policy. The policy excluded losses “sustained while Intoxicated.” Because the decedent had consumed alcohol prior to his […]
Nearly all 50 state insurance commissioners, including Andrew Boron, the Illinois Insurance Director, have now signed on to the Regulatory Settlement Agreement that requires CIGNA disability insurance companies such as the Life Insurance Company of North America to reconsider denied claims under revised guidelines for: Consideration of Social Security disability awards Evaluation of medical evidence […]
The question of whether an insurer has a duty to investigate the legitimacy of evidence submitted by a spurned intimate acquaintance was presented in the recently decided case of Truitt v. Unum Life Ins. Co. of Amer., 2013 U.S.App.LEXIS 18639 (5th Cir. Sept. 6, 2013). The plaintiff, Terri Truitt, had worked as an attorney in […]
Freeland v. Unum Life Ins.Co. of America, 2013 U.S.Dist.LEXIS 116931 (W.D.Wisc. August 19, 2013)(Issue: Risk of Disability)(opinion_and_order.pdf). A key focus of the court’s ruling was on the Unum Regulatory Settlement Agreement of 2004, which required Unum to consider the co-morbidity of multiple impairments and give significant weight to Social Security determinations. Based on those guidelines, […]
The question of why group long-term disability insurance policies are governed by the Employee Retirement Income Security Act (ERISA) was recently answered in Gross v. Sun Life Assur. Co. of Canada, 2013 U.S.App.LEXIS 17059 (1st Cir. Aug. 16, 2013). That case involved Diahann Gross, an optician who became disabled in 2006 due to complex regional […]
Disability claims involving chronic fatigue syndrome and fibromyalgia are difficult to assess because the symptoms are self-reported and cannot be objectively verified. However, in Schnoor v. Walgreen Income Protection Plan, 2013 U.S.Dist.LEXIS 114435 (W.D.Mich. Aug. 14, 2013), the court had no difficulty seeing through a deficient claim evaluation, despite the broad deference given to the […]