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.
One of the most confusing aspects of ERISA litigation is the determination of when a cause of action accrues. As the defendant learned to its detriment in’ Withrow v. Bache Halsey Stuart Shield Inc. Salary Protection Plan, 2011 U.S.App.LEXIS 17526 (9th Cir. August 23, 2011), the failure to effectively trigger an accrual of a cause of action prevented a statute of limitations from running for about 25 years. The case involved a stockbroker, Valerie Withrow, who became employed by Bache (now Prudential Securities) in 1979
A decision by the 7th Circuit Court of Appeals has taken a controversial position in the ongoing case of Pettaway v. Board of Trustees of Western Conference of Teamsters Pension Plan.
The U.S. Supreme Court admonished the lower courts in Metropolitan Life Insurance Company v. Glenn, 554 U.S. 101 (2008), that in adjudicating Employee Retirement Income Security Act (ERISA) benefit cases, courts must take into consideration the conflict of interest inherent in circumstances where the same party, such as an insurance company, both administers benefits and […]
The contingency fee is often described as the “poor man’s key to the courthouse door” and the availability of representation on a contingency fee basis is “rooted in our commitment to equal justice for both those of moderate means and the wealthy.” Leonard C. Arnold Ltd. v. Northern Trust Co., 116 Ill.2d 157, 164 (1987).
A simple issue that has nonetheless confounded the courts in Employee Retirement Income Security Act (ERISA) benefits litigation is the question of who may be sued as a defendant.