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 […]
A court recently found that Liberty Life Assurance Company of Boston made a decision “apparently devoid of reasoning” in denying a claim for disability benefits under a long-term disability policy. In Yost v. Liberty Life Assurance Co. of Boston, 6:19-CV-1132, 2021 WL 2263017 (M.D. Fla. June 3, 2021), the plaintiff, a nurse anesthetist, filed a lawsuit after Liberty denied her claim.
There is currently a circuit split as to whether district court rulings remanding Employee Retirement Income Security Act (ERISA) employee benefit claims to plan administrators are appealable. In Young v. Prudential Ins.Co. of America, 2012 U.S.App.LEXIS 3387 (11th Cir. Feb. 21, 2012), the 11th U.S. Circuit Court of Appeals held that a remand order is […]
After overturning a district court denial and winning a victory in the U.S. Court of Appeals finding Unum’s interpretation of the self-reported illness clause in its disability insurance policies was arbitrary and capricious (661 F.3d 323), the plaintiff was denied fees on remand. Weitzenkamp v. Unum Life Ins. Co. 2011 U.S.Dist.LEXIS 11095 (E.D.Wisc. Jan. 31, […]
A recent ruling from the 9th U.S. Circuit Court of Appeals addressed the question of whether an alleged failure to meet a statutory requirement results in the federal court losing subject matter jurisdiction.
Should courts be giving deference to benefit decisions made by insurance companies? Although the U.S. Supreme Court ruled in Firestone Tire v. Bruch, 489 U.S. 101 (1989), that deference was permissible in Employee Retirement Income Security Act (ERISA) benefit claims disputes, the court pointed out that the default standard of adjudication should be de novo, which means a court weighs the evidence afresh and gives equal consideration to both plaintiff and defendant.
The Seventh Circuit Court of Appeals recently granted disability benefits to a former employee of Wal-Mart Stores Inc. who had been turned down for coverage twice.