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

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5th Circuit Stands Alone on Degree of Disability

After winning summary judgment in the trial court, plaintiff Linda Ellis suffered a crushing defeat in the 5th U.S. Circuit Court of Appeals, which rejected her claim for disability coverage.Ellis v. Liberty Life Assurance Company of Boston, 2004 U.S.App.LEXIS 24199 (5th Cir., Nov. 19). Ellis was a loan officer for Chase Manhattan Bank until 1999, […]

Erring on ERISA by looking for common sense

The recent decision in Unum Life Insurance Company of America v. O’Brien, 2004 U.S. Dist. LEXIS 20761 (M.D. Fla., Oct. 4), presents a typical scenario where a disability insurer sues an unrepresented claimant, seeking reimbursement of benefits that had been overpaid due to the receipt of a Social Security award. Such suits are based on […]

Turning up the power of the lens raises the heat

Today’s case demonstrates that the actions of benefits administrators are worth some thought on the part of a plaintiff lawyer looking to heighten the level of scrutiny that is applied by a reviewing court. Kosiba v. Merck & Co., 2004 U.S.App.LEXIS 19164 (3d Cir. 9/14/2004). Anyone who litigates cases brought under the ERISA statute (Employee […]

Ruling undercuts ERISA promise of protection

For the last year, there has been an ongoing debate in the federal court in Philadelphia as to whether the Employee Retirement Income Security Act, 29 U.S.C. sec1001, et seq., preempts claims involving insured benefits such as disability or health insurance disputes brought under Pennsylvania’s bad-faith statute, 42 Pa.C.S. sec8371. On the one side are […]

Preexisting conditions: symptoms vs. diagnosis

The 3d U.S. Circuit Court of Appeals recently confronted the question of whether a “preexisting” condition really was preexisting and thus precluded insurance coverage. McLeod v. Hartford Life and Accident Insurance Co., 2004 U.S.App.LEXIS 12253 (3d Cir., June 22). Plaintiff Shirley McLeod, who had been receiving treatment for a variety of illnesses beginning in 1997, […]

Courts Seek Clarity on Subjective Diseases

Claims involving sicknesses such as fibromyalgia, a condition for which medical science has yet to develop a laboratory test, can be challenging both for claimants and insurers. A recent decision from Minnesota, which followed a ruling from our 7th U.S. Circuit Court of Appeals, is very instructive, though, on the adjudication of such claims.

Ruling warns against failure to communicate

The 8th U.S. Circuit Court of Appeals recently decided a disability benefits case involving a medical condition that is drawing increased attention among neurologists. Abram v. Cargill Inc., 2005 U.S. App. LEXIS 1142 (8th Cir., Jan. 24). Plaintiff Ellen Abram applied for disability benefits in 2000 when she could no longer work due to post-polio […]

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