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5 Factors Give Courts Help in Reviewing ERISA Cases

A recent ruling from the 9th U.S. Circuit Court of Appeals illustrates the difficulty courts have in assessing claims involving medical conditions such as chronic fatigue syndrome. Salomaa v. Honda Long Term Disability Plan, 2011 U.S.App.LEXIS 4386 (9th Cir. March 7, 2011) involved a longtime employee of Honda, Samuel Salomaa, who was described by his […]

Who decides whether treatment is appropriate?

Can a disability insurer force its insured to undergo surgery? That was the issue raised in the recent ruling in Paul Revere Life Ins.Co. v. DiBari, 2010 U.S.Dist.LEXIS 122906 (D.Conn. Nov. 19, 2010); and while the answer to the question is no, the court ruled in DiBari that the insurance company did have the right […]

ERISA “full and fair” review of voluntary appeals

One of the key requirements under ERISA is that litigation of denied benefit claims is generally deemed premature unless the claimant has exhausted pre-suit appeal rights and been given a “full and fair review.” The basis of that requirement is found in 29 U.S.C. § 1133, which mandates that denied claims receive a full and […]

The duty to notify of post-employment rights

The continuation of life insurance coverage after employment ends is fraught with issues that frequently lead to litigation. Normally, group coverage ends on the last day of employment; however, most group life insurance policies have features that allow coverage to be converted to individual coverage, placing the onus on the employer to give notice of […]

Using SSDI applications to screen disability claims

Because group disability insurance policies coordinate the benefits payable with benefits paid by other sources such as Social Security disability insurance (SSDI) payments, disability insurers frequently require claimants to apply for such benefits. A recent 1st Circuit opinion, U.S. ex.rel. Loughren v. Unum Group, 2010 U.S.App.LEXIS 15668 (1st Cir. July 29, 2010), dealt with an […]

A Court Wades Through How a Disability is Defined

The issue of which insurer is responsible for paying a claimant’s disability benefits was the subject of Mitchell v. CB Richard Ellis Long Term Disability Plan, 2010 U.S.App.LEXIS 15252 (9th Cir. July 26, 2010). InMitchell, the plaintiff, Michael Mitchell, worked as a commercial real estate broker for CB Richard Ellis for several years until he […]

A ruling that could protect thousands of claimants

The 2nd U.S. Circuit Court of Appeals recently issued a significant ruling involving disability benefits. In Durakovic v. Building Service 32BJ Pension Fund, 2010 U.S.App.LEXIS 12937 (2nd Cir. June 24, 2010), Bejaze Durakovic, a Yugoslavian emigrant with a grade school education, worked as an office cleaner in New York City until she stopped working in […]

The standard of review can affect application of offsets

Two recent district court rulings ,Day v. AT&T Disability Income Plan, 2010 U.S.Dist.LEXIS 61477 (N.D.Cal. June 8, 2010) and Riley v. Sun Life and Health Assur.Co., 2010 U.S.Dist.LEXIS 61881 (D.Neb. June 18, 2010), starkly illustrate how the standard of review in ERISA cases can dramatically impact the application of offsets against benefits payable. In both […]

Accidental death benefits to survivors of drunken drivers

The issue of whether accidental death benefits are payable to the survivors of drunken drivers has been the subject of numerous reported decisions over the past 20 years. Surprisingly, despite insurers’ efforts to exclude coverage under accidental death insurance policies under such circumstances, policies still exist that lack an explicit exclusion for deaths occurring where […]

Considering a ‘prevailing party’ requirement

The Employee Retirement Income Security Act of 1974 (ERISA) provides: “In any action under this title (other than an action described in paragraph 2) by a participant, beneficiary, or fiduciary, the court in its discretion may allow a reasonable attorney’s fee and costs of action to either party.” 29 U.S.C. § 1132(g)(1). In Hardt v. […]

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