The threshold issue in every Employee Retirement Income Security Act (ERISA)-governed benefit dispute is the standard of review utilized by the court in adjudicating the claim. Following the Supreme Court’s ruling in Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), a veritable land rush ensued as insurers and plan administrators sought to […]
When an intoxicated driver dies in a collision, can his survivors collect under an accidental death insurance policy? Most courts deem such an occurrence an accident; however, in Whinery v. Life Ins.Co. of North America, 2012 U.S.Dist.LEXIS 160667 (C.D.Cal. Nov. 7, 2012), the court upheld an insurer’s benefit denial under a deferential standard of review. […]
As the recent case of White v. Prudential Ins.Co., 2012 U.S.Dist.LEXIS 160773 (E.D.Pa. Nov. 9, 2012) illustrates, whether a disabling condition is psychiatric or physical is not easily determined. The plaintiff in this case, James White, worked as the chief operating officer, chief financial officer and director of risk management at Holt Oversight & Logistical Technologies. In 2007, White was seriously injured in a rollover car accident that occurred when his vehicle was struck by another car.
A federal court has allowed an insurance company to argue a previously waived defense in a disability benefits case, deviating from typical procedural rules. In Safer v. Reliance Standard Life Insurance Co., 2021 WL 2370381 (E.D. La. June 9, 2021), the plaintiff filed a lawsuit after the insurer denied his claim for long-term disability benefits.
Abuse of prescription narcotic pain medications has drawn increasing media scrutiny now that drug overdose deaths have surpassed automobile accidents as the leading cause of accidental death in the United States (See, “Prescription for Addition,” Wall Street Journal, Oct. 6, 2012). In a recent decision from Oregon, the court was called upon to decide whether […]
A federal court has ruled that an insurance company’s use of surveillance in denying a claim for disability benefits was an abuse of discretion. In Spooner v. Reliance Standard Life Insurance Co., 2021 WL 2720302 (E.D.N.Y. July 1, 2021), the plaintiff was a former account executive with a media company who stopped working due to chronic pain from fibromyalgia, a sleep disorder and a psychiatric condition.
During the U.S. Supreme Court’s upcoming term, the court is scheduled to hear the case of U.S. Airways v. McCutchen, 663 F.3d 671 (3d Cir. 2011), which was the subject of an earlier article of mine (“McCutchen may influence other court decisions,” Nov. 25, 2011). McCutchen will address the complex question of whether equitable principles […]
Table of ContentsExecutive Summary:Introduction1. Who Gets the Last Word in the Claim Review Process2. Confusion Regarding Statutes of Limitations3. Treating Doctor Opinions4. Deferential Court Review/Administrative Law Paradigm/Remands of Claims6. DamagesConclusion Executive Summary: I am an experienced practitioner in the field of representing claimants in disability benefit disputes. In my practice, I have encountered a number […]
One of the most vexing issues in employee benefits law relates to the apparent absence of remedies when harm results from misrepresentations made to employees since Employee Retirement Income Security Act (ERISA) only permits “appropriate equitable relief” (29 U.S.C. § 1132(a)(3)) and bars claims seeking legal remedies such as monetary damages. A leading example of […]
A recent ruling from the 9th U.S. Circuit Court of Appeals illustrates just how critical the Employee Retirement Income Security Act (ERISA) standard of review is to the outcome of a case. In Day v. AT&T Disability Income Plan, 2012 U.S.App.LEXIS 13558 (9th Cir. July 3, 2012), the court addressed whether it would be permissible […]
In order to prevent a double-recovery of benefits when claimants qualify to receive both Social Security and disability insurance payments, most group insurers include provisions in their policies that reduce the insurance payment by the amount of Social Security benefits received by the claimant. In addition, since Social Security adjudications often follow the disability insurance […]
In civil actions brought under statutes that permit the winning party to recover attorney fees, fee litigation can take on a life of its own as illustrated by a recent ruling issued by a U.S. District Court in Connecticut. In an earlier opinion, the court entered judgment in favor of the plaintiff, Paige Fairbaugh, who […]