Two significant rulings issued days apart upheld the authority of state departments of insurance to prohibit life and disability insurers from including discretionary clauses in their policies that would have the effect of triggering an arbitrary and capricious standard of review under the ERISA law. At issue was the adoption by several states of a […]
Welch v. Unum Life Ins. Co. of America, 2007 U.S.Dist.LEXIS 91796 (D.Kansas Dec. 13, 2007), was before the court on remand from the 10th U.S. Circuit Court of Appeals (Welch v. Unum Life Insur. Co. of America , 382 F.3d 1078 (10th Cir. 2004), where the appellate court ruled that consideration had to be given […]
After a district court awarded benefits to the plaintiff, the insurer successfully appealed to the 10th U.S. Circuit Court of Appeals, which issued a ruling narrowly constraining the scope of consideration of ERISA claims under the de novo standard of adjudication. Jewell v. Life Ins.Co. of North America, 2007 U.S.App.LEXIS 27832 (Nov. 30, 2007). The […]
Kaelin v. Tenet Employee Benefit Plan, 2007 U.S.Dist.LEXIS 86063 (E.D.Pa. Nov. 21), has had a long and tortured history. Before this final ruling, the district court had issued two earlier rulings: Kaelin v. Tenet Employee Benefit Plan, 405 F. Supp. 2d 562 (E.D. Pa. 2005), and Kaelin v. Tenet Employee Benefit Plan, 2006 U.S.Dist.LEXIS 14858 […]
In Shane v. Albertson’s Inc., 2007 U.S.App.LEXIS 24092 (9th Cir. Oct. 15), Stacey Shane originally qualified for disability benefits under Albertson’s ERISA-governed disability income plan in 2000 on account of a knee injury; and benefits were paid continuously for two years. However, benefits were terminated in 2003 when the Albertson’s Medical Review Committee determined Shane […]
In Rich v. Principal Life Ins.Co., 2007 Ill.LEXIS 1157 (Ill.S.Ct. Sept. 20), the plaintiff purchased a disability income policy in 1980 that provided benefits in the event of ”total disability,” defined as ”the complete inability of the insured due to Injury or Sickness to perform any and every duty pertaining to an occupation (as defined […]
In Corry v. Liberty Life Assur.Co. of Boston, 2007 U.S.App.LEXIS 20605 (Aug. 28). the 5th U.S. Circuit Court of Appeals overturned a district court finding in favor of a claimant suffering from fibromyalgia, finding no abuse of discretion in the insurer’s determination.
The plaintiff, who had worked as a sales manager for Dell, became disabled in 1995. She applied for disability benefits from Liberty, and her claim was approved. Social Security also granted benefits.
n LaSalle v. Mercantile Bancorporation Inc. Long Term Disability Plan , 2007 U.S.App.LEXIS 19573 (8th Cir. Aug. 17), the plaintiff, who suffered from severe liver disease and had undergone two liver transplants, began receiving benefits in 1998. Benefits were paid on account of LaSalle’s physical limitations until June 2001.
A recent case from the Seventh Circuit Court of Appeals indicates that insurance companies cannot expect the courts to rubber-stamp their denials of benefits.
In Weiss v. Prudential Ins.Co. of America, 2007 U.S.Dist.LEXIS 56357 (D.N.J. Aug. 2), the plaintiff, who worked for a country vocational board of education as a food services instructor for special education students was injured when he slipped and fell in a freezer at work and herniated a disk in his back. Weiss had disability […]
Diaz v. Prudential Ins. Co. of America, 2007 U.S.App.LEXIS 20067 (7th Cir. 8/23/2007). For the second time, the 7th U.S. Circuit Court of Appeals was called upon to untangle summary judgment rulings issued by the district court in this proceeding. In the first appeal (424 F.3d 635 (7th Cir. 2005)), the court of appeals reversed […]
Although unpublished, a recent case from the 6th U.S. Circuit Court of Appeals presents a number of significant issues and should be reissued as a published decision. Houston v. Unum Life Ins.Co. of America, 2007 U.S.App.LEXIS 18553 (July 27). Houston involved a claimant who worked as a housekeeping supervisor for Ritz-Carlton Hotels for more than […]