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 […]
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 of problems with ERISA claims and litigation that need to be examined by the Department of Labor: ERISA claimants are denied the last word in claim appeals, which permits insurers […]
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 […]
A recent ruling from the 3rd U.S. Circuit Court of Appeals is a wake-up call to professionals who are paying both for disability insurance coverage at their place of work and also maintaining supplemental disability coverage purchased through a professional association. Fleisher v. Standard Ins.Co., 2012 U.S.App.LEXIS 9907 (3d Cir. May 17, 2012) ruled that […]
In addition to disability insurance claims, accidental death claims are the frequent subject of Employee Retirement Income Security Act (ERISA) litigation. One recent ruling was cited by the website, Above the Law, as “A Self-Abuse of Discretion? (Or: The most interesting ERISA opinion ever.)” abovethelaw.com/?s=self-abuse. In Martin v. Hartford Life and Acc.Ins.Co., 2012 U.S.App.LEXIS 7879 […]
Patent law is not ordinarily the place an ERISA practitioner would look to gain insight concerning ERISA civil procedure. However, in a recent patent ruling issued by the Supreme Court, Kappos v. Hyatt, 132 S. Ct. 1690 (April 18, 2012), the Court presented fodder for rethinking the manner in which ERISA cases are adjudicated. Kappos […]
A recent U.S. Supreme Court ruling involving patent law may revive procedural challenges to the means by which Employee Retirement Income Security Act (ERISA) cases are adjudicated. In Kappos v. Hyatt, 2012 U.S.LEXIS 3107 (U.S.S.Ct. April 18, 2012), the Supreme Court examined a provision of the Patent Act of 1952 enabling a patent applicant whose […]
Due to the quasi-administrative law paradigm the courts apply in Employee Retirement Income Security Act (ERISA) cases, no issue has confounded the courts more than the scope of permitted discovery. In Wise v. Life Ins.Co. of North America, 2012 U.S.Dist.LEXIS 50231 (C.D.Ill. April 10, 2012), the plaintiff, Linda Wise, sought accidental death benefits under an ERISA plan sponsored by her late husband’s employer, Honeywell International Inc. The plan was underwritten and insured by the Life Insurance Company of North America (LINA), a CIGNA company.
The most difficult disability claims to adjudicate involve symptoms that cannot be objectively verified. Medical science has yet to develop tests that can verify or quantify pain or fatigue, although many medical conditions are associated with such symptoms. A recent example of such a case is Heim v. Life Ins. Co. of North America. 2012 […]