Updates on the latest in benefits news and practical pointers for your benefits-related issues.

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Is expediency more important than accuracy?

The saga of this case, which involved a claim of disability due to complications of diabetes, is a long one that began in 2002 when Unum initially denied the claim for benefits and upheld its decision when the plaintiff submitted her pre-suit appeal. The case, Metzger v. Unum Life Ins.Co. of America, 2007 U.S.App.LEXIS 3755, […]

Ruling on scope, standard of review disturbing

The plaintiff, Gary Rittenhouse, won this case in the district court; however, he suffered a crushing defeat in the Court of Appeals. Rittenhouse, an officer of UnitedHealth Group, began experiencing progressive hearing loss beginning in the 1980s. In 2002, Rittenhouse’s hearing loss had advanced from moderate to severe, and further deterioration occurred in 2003 at […]

Right result, but confusing reasoning

The plaintiff in this case initially became disabled in 1985 as the result of a work accident when a hydraulic door fell on him and fractured his C3 vertebra. Rehabilitation efforts were unsuccessful; and Sloan began receiving long-term disability benefits in the late 1980s. After 24 months, the definition of disability changed from one in […]

Insurer can’t ‘cherry pick’ medical report

The plaintiff in this case was involved in a tragic sledding accident in 1997 that resulted in the death of the plaintiff’s grandson and severe injuries to himself. Fulayter v. Prudential Insur. Co. of America, 2007 U.S.Dist.LEXIS 8394 (D.Ariz. Feb. 6). After a significant period of rehabilitation, Fulayter was able to return to work; however, […]

Insurer can’t keep manual from claimant

In a short, but highly instructive ruling, U.S. District Judge Gerard Lynch ordered that CIGNA disclose its disability insurance claim manual without a protective order, overruling an objection that the insurer might suffer ”competitive injury” if such information was disclosed. Levy v. INA Life Insur.Co. of N.Y., 2006 U.S.Dist.LEXIS 83060 (S.D.N.Y. Nov. 14, 2006). Because […]

Work ability more than just physical

The plaintiff, a 55-year-old night cleaner, filed for total and permanent disability benefits due to osteoarthritis of her right knee. The case is Demirovic v. Building Service 32B-J Pension Fund, 2006 U.S.App.LEXIS 25891, from the 2d U.S. Circuit Court of Appeals, Oct. 19, 2006. Accompanying her application was a notice of award from the Social […]

Opinion aberrational on work definition

In deciding whether an insurer properly terminated the plaintiff’s benefits, the 6th U.S. Circuit Court of Appeals in Osborne v. Hartford Life & Accident Insur. Co., 2006 U.S.App.LEXIS 24640 (Oct. 3), first noted the issue turned on the meaning of the insured’s ”own occupation” as used in the policy. The plaintiff was the chairman and […]

Standard of review didn’t prevent reversal

In a recent case, despite the application of an arbitrary and capricious standard of review, the 6th U.S. Circuit Court of Appeals concluded that when MetLife terminated Wanda Glenn’s benefits, its actions were not ”the result of a deliberative process or that it was based on substantial evidence.” Glenn v. MetLife, 2006 U.S.App.LEXIS 22432 (Sept […]

Oversights led to offsets for veteran’s benefits

The issue in the 5th U.S. Circuit Court of Appeals ruling High v. E-Systems Inc Long Term Disability Income and Death Benefit Plan, 2006 U.S.App.LEXIS 19613, (Aug. 3), was whether MetLife had the authority to offset Veterans Administration disability benefits that the plaintiff had been receiving even before he was hired by E-Systems in 1982 […]

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