Court looks at deficiencies in determining disability
A decision from the U.S. District Court for the District of Columbia reviews the deficiencies of a disability determination.
Articles
Updates on the latest in benefits news and practical pointers for your benefits-related issues.
How CIGNA handles or mishandles disability claims
The case of Cox v. CIGNA Group Insurance, 2010 U.S.Dist.LEXIS 17164 (E.D. Ky., Feb. 24), is illustrative of a pattern suggestive of possible systematic maladministration of disability claims, a finding also made by the California Department of Insurance. California conducted a market conduct study of CIGNA’s disability claim handling and found numerous examples of unfair […]
Who gets the last word in an ERISA claim appeal?
A recent 6th U.S. Circuit Court of Appeals ruling raises the question of who gets the last word in an ERISA claim appeal. In Balmert v. Reliance Standard Life Ins.Co., 2010 U.S.App.LEXIS 2439 (6th Cir. Feb. 5, 2010), the plaintiff, Maribea Balmert, worked as an accountant-tax manager for Big Lots Inc. beginning in 2001. She […]
A split in the circuits exists for ERISA benefit disputes
A recent ruling from the 1st Circuit illustrates a marked disparity between how different federal circuits adjudicate ERISA claims. In Richards v. Hewlett-Packard Corp., 2010 U.S.App.LEXIS 1010 (1st Cir., Jan. 19), the plaintiff, Edward Richards, who worked for Digital Equipment Corporation from 1984 to 1991 as a software engineer, became disabled at age 39 due […]
Courts Deal With Issue of ERISA Attorney Fees
The saga of Fitts v. Unum Life Ins.Co. of America, 2010 U.S.Dist.LEXIS 2529 (D.D.C. Jan. 13, 2010), which has spanned more than 10 years, has finally come to an end. The case went to the Court of Appeals twice on the issue of whether Unum’s limitation on the duration of benefits for mental and nervous disorders applied to bipolar disorder suffered by Jane Fitts. After the most recent appellate ruling, which I wrote about in an earlier article (“Struggle over ‘mental illness’ exclusions,” Chicago Daily Law Bulletin, March 31, 2008), the parties finally reached a settlement.
ERISA: A Frankenstein Made Up of Different Laws
Conflict of interest in the administration of benefit claims is a topic that has long concerned Judge William Acker Jr. of the Northern District of Alabama. Blankenship v. Metropolitan Life Insurance Co., Civ. No. 08-AR-0639-S (N.D. Ala., Dec. 30) is merely the latest in a series of rulings critical of the manner in which courts have treated ERISA cases.
Applying deferential standard of review in evaluating claims
In McGahey v. Harvard University Flexible Benefits Plan, 2009 U.S.Dist. LEXIS 115364 (D.Mass. Dec. 11, 2009), the court wrestled with how to apply a deferential standard of review in evaluating a claim for disability benefits. The plaintiff, Rosemary McGahey, who had worked as the director of residential dining at Harvard University, injured her right knee when she slipped on ice while at work in February 2004.
Get to the truth on the matter
An interesting case involving accidental death and dismemberment benefits was recently issued by the 10th Circuit. In Rasenack v. AIG Life Ins. Co., 2009 U.S.App.LEXIS 24027 (10th Circuit. Nov. 2, 2009), the court discussed a number of issues affecting claims arising under the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq. […]
Court revisits difficult issue of ‘total disability’
In a decision, the Seventh Circuit Court of Appeals revisited the difficult issue of total disability in a case involving a disability claim under an ERISA plan.
Battle over standard of review likely to continue
Earlier this year, I wrote about a significant ruling issued by the 6th U.S. Circuit Court of Appeals, American Council of Life Insurers v. Ross, 558 F.3d 600 (March 18) (“Discretionary clauses under heavy fire, Chicago Daily Law Bulletin April 6). Ross upheld the authority of states to ban clauses in insurance policies that give insurers discretion to decide health and disability claims and thus trigger a deferential standard of court review over such claims.
When a literal reading can be overridden
The arbitrary and capricious standard of review gives employers such broad discretion to interpret benefit plan provisions that a literal reading of the plan can be overridden according to Wallace v. Johnson & Johnson, 2009 U.S.App.LEXIS 22529 (1st U.S. Circuit Court of Appeals, Oct. 14). Wallace, who spent 14 years as a manager with Johnson […]
9th Circuit Ruling Provides Greater Protection of Benefits
In Montour v. Hartford Life & Accid.Ins.Co., 2009 U.S.App.LEXIS 20378 (Sep. 14), the 9th U.S. Circuit Court of Appeals has taken an approach to Glenn v. Metro.Life Ins.Co., 128 S.Ct. 2343 (2008), that requires a court reviewing a benefit decision governed by the Employee Retirement Income Security Act, 29 U.S.C. §1001 et seq., to apply […]