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.
A recent opinion issued by the 1st U.S. Circuit Court of Appeals suggests a new approach for assessing the reasonableness of benefit claim determinations under the Employee Retirement Income Security Act (ERISA) abuse of discretion standard of review.
A ruling issued by a federal court in California illustrates a number of critical issues involving a claim for disability benefits due to chronic fatigue syndrome.
The recent 3rd U.S. Circuit Court of Appeals ruling in U.S. Airways, Inc. v. McCutchen, 2011 U.S.App.LEXIS 22883 (3d Cir. Nov. 16, 2011) dealt with the question of whether the equitable doctrine of unjust enrichment could be used to mitigate an ERISA benefit plan’s claim for reimbursement. McCutchen involved a claim brought by a medical […]
A controversial issue in disability benefit evaluations is whether benefits are due to someone whose medical condition, while presently in remission, would be aggravated to such an extent by a return to work that the claimant’s life or health would be jeopardized. The issue is commonly referred to as “risk of disability” or “common care […]
In 2010, I authored a column titled, “The standard of review can affect application of offsets,” Chicago Daily Law Bulletin, July 12, 2010. That column discussed two recently issued U.S. District Court rulings on the subject of benefit offsets and pointed out the standard of Employee Retirement Income Security Act (ERISA) review could determine whether a plan administrator had the power to interpret an ambiguous plan provision in a self-serving manner.
Despite significant medical advances in recent years, many debilitating impairments remain impossible to diagnose through imaging such as x-ray or MRI, electrodiagostic testing, or blood tests. Consequently, due to potential uncertainty as to the legitimacy of such conditions, disability insurers have adopted policy provisions that purport to limit payments for conditions such as fibromyalgia, chronic […]
An issue that never seems to go away is where courts should draw the line between an employee benefit plan and insurance coverage purchased by an individual through an arrangement made available by an employer.