Articles

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

Courts Deal With Issue of ERISA Attorney Fees

by Mark Debofsky | Jan 18, 2010 | Attorneys' Fees

The saga of Fitts v. Unum Life Ins.Co. of America, 2010 U.S.Dist.LEXIS 2529 (D.D.C. Jan. 13, 2010), which has spanned more than 10 years, has finally come to an end. The case went to the Court of Appeals twice on the issue of whether Unum’s limitation on the duration of benefits for mental and nervous disorders applied to bipolar disorder suffered by Jane Fitts. After the most recent appellate ruling, which I wrote about in an earlier article (“Struggle over ‘mental illness’ exclusions,” Chicago Daily Law Bulletin, March 31, 2008), the parties finally reached a settlement.

ERISA: A Frankenstein Made Up of Different Laws

by Mark Debofsky | Jan 4, 2010 | Long Term Disability

Conflict of interest in the administration of benefit claims is a topic that has long concerned Judge William Acker Jr. of the Northern District of Alabama. Blankenship v. Metropolitan Life Insurance Co., Civ. No. 08-AR-0639-S (N.D. Ala., Dec. 30) is merely the latest in a series of rulings critical of the manner in which courts have treated ERISA cases.

Applying deferential standard of review in evaluating claims

by Mark Debofsky | Dec 21, 2009 | ERISA Standard of Review

In McGahey v. Harvard University Flexible Benefits Plan, 2009 U.S.Dist. LEXIS 115364 (D.Mass. Dec. 11, 2009), the court wrestled with how to apply a deferential standard of review in evaluating a claim for disability benefits. The plaintiff, Rosemary McGahey, who had worked as the director of residential dining at Harvard University, injured her right knee when she slipped on ice while at work in February 2004.

Get to the truth on the matter

by Mark Debofsky | Nov 30, 2009 | Accidental Death

An interesting case involving accidental death and dismemberment benefits was recently issued by the 10th Circuit. In Rasenack v. AIG Life Ins. Co., 2009 U.S.App.LEXIS 24027 (10th Circuit. Nov. 2, 2009), the court discussed a number of issues affecting claims arising under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq. […]

Court revisits difficult issue of ‘total disability’

by Mark Debofsky | Nov 16, 2009 | Residual/Partial vs. Total Disability

In a decision, the Seventh Circuit Court of Appeals revisited the difficult issue of total disability in a case involving a disability claim under an ERISA plan.

Battle over standard of review likely to continue

by Mark Debofsky | Nov 2, 2009 | ERISA Standard of Review

Earlier this year, I wrote about a significant ruling issued by the 6th U.S. Circuit Court of Appeals, American Council of Life Insurers v. Ross, 558 F.3d 600 (March 18) (“Discretionary clauses under heavy fire, Chicago Daily Law Bulletin April 6). Ross upheld the authority of states to ban clauses in insurance policies that give insurers discretion to decide health and disability claims and thus trigger a deferential standard of court review over such claims.

When a literal reading can be overridden

by Mark Debofsky | Oct 19, 2009 | ERISA Standard of Review, Long Term Disability

The arbitrary and capricious standard of review gives employers such broad discretion to interpret benefit plan provisions that a literal reading of the plan can be overridden according to Wallace v. Johnson & Johnson, 2009 U.S.App.LEXIS 22529 (1st U.S. Circuit Court of Appeals, Oct. 14). Wallace, who spent 14 years as a manager with Johnson […]

9th Circuit Ruling Provides Greater Protection of Benefits

by Mark Debofsky | Oct 5, 2009 | Disability Benefits, ERISA Standard of Review

In Montour v. Hartford Life & Accid.Ins.Co., 2009 U.S.App.LEXIS 20378 (Sep. 14), the 9th U.S. Circuit Court of Appeals has taken an approach to Glenn v. Metro.Life Ins.Co., 128 S.Ct. 2343 (2008), that requires a court reviewing a benefit decision governed by the Employee Retirement Income Security Act, 29 U.S.C. §1001 et seq., to apply […]

Clarity Needed on Contractual Periods of Limitation

by Mark Debofsky | Sep 21, 2009 | ERISA

The application of contractual periods of limitation that shorten the statutory limitation period during which suit can be brought continues to be a hot topic of litigation in ERISA claims. Scharff v. Raytheon Company Short Term Disability Plan, 2009 U.S.App.LEXIS 20130 (Sept. 9), is the most recent example, and offers a cautionary lesson to benefit claimants.

Ruling clarifies contractual limitations periods

by Mark Debofsky | Aug 31, 2009 | Disability Benefits, ERISA

A recent ruling from the 6th U.S. Circuit Court of Appeals, Rice v. Jefferson Pilot Financial Ins. Co., 2009 U.S.App.LEXIS 18962 (Aug. 24), explains the operation of contractual limitations periods in disability policies in a way that offers instruction and certainty to litigants facing similar issues. The plaintiff, Jerry Rice, alleged he became disabled in […]

Payment delays merely encourage denials

by Mark Debofsky | Aug 3, 2009 | Civil Procedure, Disability Benefits, ERISA

After a district court overturned Liberty’s termination of disability payments in Gerhardt v. Liberty Life Assur.Co. of Boston,2009 U.S.App.LEXIS 16170 (8th Cir. July 23), it remanded the claim to Liberty for further proceedings. Instead of proceeding with the remand, Liberty sought to appeal the ruling. However, the 8th U.S. Circuit Court of Appeals concluded the […]

Claims require an ‘independent decision,’ not a ‘review’

by Mark Debofsky | Jul 6, 2009 | ERISA Standard of Review

The 7th U.S. Circuit Court of Appeals recent ruling in Krolnik v. Prudential Ins.Co., 2009 U.S.App.LEXIS 13916 (June 29), constitutes the definitive statement as to the scope of ERISA claims adjudication under the de novo standard. Krolnik involved a relatively typical disability insurance benefit claim under a group policy issued by Prudential Insurance Company. The […]

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