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 […]
The 2nd U.S. Circuit Court of Appeals recently issued a significant ruling involving disability benefits. In Durakovic v. Building Service 32BJ Pension Fund, 2010 U.S.App.LEXIS 12937 (2nd Cir. June 24, 2010), Bejaze Durakovic, a Yugoslavian emigrant with a grade school education, worked as an office cleaner in New York City until she stopped working in […]
Two recent district court rulings ,Day v. AT&T Disability Income Plan, 2010 U.S.Dist.LEXIS 61477 (N.D.Cal. June 8, 2010) and Riley v. Sun Life and Health Assur.Co., 2010 U.S.Dist.LEXIS 61881 (D.Neb. June 18, 2010), starkly illustrate how the standard of review in ERISA cases can dramatically impact the application of offsets against benefits payable. In both […]
The issue of whether accidental death benefits are payable to the survivors of drunken drivers has been the subject of numerous reported decisions over the past 20 years. Surprisingly, despite insurers’ efforts to exclude coverage under accidental death insurance policies under such circumstances, policies still exist that lack an explicit exclusion for deaths occurring where […]
The Employee Retirement Income Security Act of 1974 (ERISA) provides: “In any action under this title (other than an action described in paragraph 2) by a participant, beneficiary, or fiduciary, the court in its discretion may allow a reasonable attorney’s fee and costs of action to either party.” 29 U.S.C. § 1132(g)(1). In Hardt v. […]
A recent ruling from a federal court in Texas illustrates the difference between an ERISA welfare benefit and a payroll practice. While the former is subject to federal law, disputes arising in relation to payroll practices belong in state court. In Monkhouse v. Stanley Associates, Inc. Short Term Disability Income Plan, 2010 U.S.Dist.LEXIS 40555 (S.D.Tex. […]
Court decisions have grappled with the challenges of the ERISA limitations period.