Pension plans in the United States have undergone a dramatic transformation over the past 30 years. The traditional defined-benefit plan which offers an annuity for a stated amount based on salary and years of service has been virtually eliminated and replaced by defined-contribution plans, popularly known as the “401(k) plan,” where the employee contributes a […]
In many Employee Retirement Income and Security Act (ERISA) cases, the standard of review applied by a court is often the key factor in determining the outcome of a dispute over disability cases. Such cases often involve conflicting medical opinions and, where the insurer has properly reserved discretionary authority, it almost always wins the battle […]
Calculating disability benefits for owners of businesses can be very complicated, especially in situations where the insured continues working and receives both a salary as well as a share of the profits from the business. How is the insurer to know whether the insured is manipulating business earnings and under-reporting W-2 earnings from the business? […]
Although the Federal Rules of Civil Procedure are all-encompassing when it comes to civil matters adjudicated in federal court, when it comes to employee benefit cases brought under the Employee Retirement Income Security Act (ERISA) statute, 29 U.S.C. § 1132(a), courts often set aside basic federal civil procedure. The recent 2nd U.S. Circuit Court of […]
A recent ruling from the 9th U.S. Circuit Court of Appeals illustrates the difficulty courts have in assessing claims involving medical conditions such as chronic fatigue syndrome. Salomaa v. Honda Long Term Disability Plan, 2011 U.S.App.LEXIS 4386 (9th Cir. March 7, 2011) involved a longtime employee of Honda, Samuel Salomaa, who was described by his […]
Because the Employee Retirement Income Security Act (ERISA) statute lacks a specific limitation provision applicable to benefit claims, but the courts nonetheless enforce contractual limitations periods incorporated in benefit plans, courts frequently struggle with the question of when limitations periods accrue.
A fascinating new ruling from the 7th U.S. Circuit Court of Appeals on the issue of Social Security disability points out many of the difficulties inherent in assessing disability. In Martinez v. Astrue, 2011 U.S.App.LEXIS 960 (7th Cir. 2011), the court issued an opinion incorporating its ruling on three cases all argued on the same […]
Can a disability insurer force its insured to undergo surgery? That was the issue raised in the recent ruling in Paul Revere Life Ins.Co. v. DiBari, 2010 U.S.Dist.LEXIS 122906 (D.Conn. Nov. 19, 2010); and while the answer to the question is no, the court ruled in DiBari that the insurance company did have the right […]
One of the key requirements under ERISA is that litigation of denied benefit claims is generally deemed premature unless the claimant has exhausted pre-suit appeal rights and been given a “full and fair review.” The basis of that requirement is found in 29 U.S.C. § 1133, which mandates that denied claims receive a full and […]
The continuation of life insurance coverage after employment ends is fraught with issues that frequently lead to litigation. Normally, group coverage ends on the last day of employment; however, most group life insurance policies have features that allow coverage to be converted to individual coverage, placing the onus on the employer to give notice of […]
Because group disability insurance policies coordinate the benefits payable with benefits paid by other sources such as Social Security disability insurance (SSDI) payments, disability insurers frequently require claimants to apply for such benefits. A recent 1st Circuit opinion, U.S. ex.rel. Loughren v. Unum Group, 2010 U.S.App.LEXIS 15668 (1st Cir. July 29, 2010), dealt with an […]
The issue of which insurer is responsible for paying a claimant’s disability benefits was the subject of Mitchell v. CB Richard Ellis Long Term Disability Plan, 2010 U.S.App.LEXIS 15252 (9th Cir. July 26, 2010). InMitchell, the plaintiff, Michael Mitchell, worked as a commercial real estate broker for CB Richard Ellis for several years until he […]