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 […]
Although the Supreme Court’s ruling in United States v. Windsor, 133 S.Ct. 2675 (2013), invalidated Section 3 of the federal Defense of Marriage Act (DOMA) that stipulated a marriage may only be between one man and one woman, the ruling left unresolved a number of critical issues.
Although the Employee Retirement Income Security Act (ERISA) clearly delineates the parties who have standing to sue to redress a claimed wrongful benefit denial (employee benefit plan participants and beneficiaries – 29 U.S.C. Section 1132(a)(1)(B)), the statute is silent as to whether insurers that both underwrite and fund employer-sponsored benefits such as disability or health […]
Click Here Despite the applicability of the arbitrary and capricious standard of review, the court granted in substantial part the plaintiff’s motion to compel discovery. Although the court acknowledged that in the Seventh Circuit, the scope of a court’s review of an ERISA benefit denial under a deferential standard of review is limited to the “administrative” […]
Following market conduct investigations performed by the insurance departments of the States of California, Maine, and several other jurisdictions, in May 2013, the CIGNA companies that administer long-term disability insurance benefits (Life Insurance Company of North America, Connecticut General Life Insurance Company, CIGNA Life and Health Insurance Company, and other affiliated companies) entered into a […]
On July 26, 2013, the U.S. Court of Appeals for the Seventh Circuit issued a ruling in Larson v. United Healthcare Insur.Co., No. 12-1256 click here permitting ERISA plaintiffs to sue insurance companies that underwrite and are responsible for paying benefits when claims are asserted that benefits have been wrongfully denied. This ruling marks a […]
A decision by a federal court has expanded the scope of discovery available in ERISA cases. In Williams v. FedEx Corp. Servs., Inc., No. 19 C 5706, 2021 WL 2854244 (N.D. Ill. July 8, 2021), the plaintiff sought to depose a plan administrator, but the defendant argued that the administrator was not a proper deponent because he was not involved in the initial denial of the claim. The court ultimately allowed the deposition, ruling that the administrator had information relevant to the plaintiff’s claim.