A recent district court ruling involving a commercial airline pilot discussed a fascinating issue known as “legal” disability. A legal disability, in contrast to a factual disability, occurs on account of a loss of licensure or certification to practice in a profession. The cases discussing legal disabilities involve issues such as loss of a medical […]
A decision from the U.S. District Court for the District of Columbia reviews the deficiencies of a disability determination.
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 […]
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 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 […]
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.
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.
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.
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. […]
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.
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.
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 […]