Another Court Questions Impartiality of Doctor
A federal judge recently looked beyond the claim record and into a reviewer’s wallet in concluding that an insurer improperly terminated disability benefits.
Articles
Updates on the latest in benefits news and practical pointers for your benefits-related issues.
Claimant Denied Fair Chance to Continue Benefits
A recent 7th U.S. Circuit Court of Appeals case could aptly be entitled ”Halpin Redux,” since the decision was written by Judge Kenneth F. Ripple, who penned Halpin v. W.W. Grainger Inc., 962 F.2d 685 (7th Cir. 1992), and the case covers the identical ground.
In Schneider v. Sentry Group Long Term Disability Plan, 2005 U.S. App. LEXIS 19273 (7th Cir., Sept. 7), an employee of Sentry Life began receiving disability benefits in 2001 due to major depression.
Court applies common sense to ERISA
In this short but fascinating ruling, a federal court in Florida analyzed defendant Unum Life Insurance Co.’s motion for a protective order after the plaintiff issued notices to depose Unum claims employees and one of the insurer’s doctors. The claimed basis for the protective order was Unum’s contention that the depositions would not lead to […]
Death Apparently Not Enough to Prove Disability
The disability insurance policy at issue in a federal court decision acknowledged that the insurer was a fiduciary and had discretion to determine eligibility for benefits and construe the policy terms. The policy further stated that ERISA fiduciaries ”have an obligation to administer the plan prudently and to act in the interest of you and other plan participants and beneficiaries.”
Judgment an incentive for careful claims review
The choice of a standard of review can make a big difference in the ultimate disposition of a case, as a recent federal court decision illustrates. In a fascinating opinion in Minix v. Liberty Life Assurance Company of Boston, 2005 U.S. Dist. LEXIS 15309 (N.D. Ind., July 22), plaintiff Guy Minix was awarded judgment upon […]
Law trying to get head around mental illness
The issue in Parker v. SunLife Assurance Co. of Canada, 2005 U.S. Dist. LEXIS 15436 (M.D. Fla., July 29), turned on whether the insurer properly invoked a 24-month limit on payment of benefits for mental and nervous disorders when the claimant was disabled due to a bipolar disorder. The policy defined ”mental illness” as ”mental, […]
Standard of review in ERISA cases too deferential
A former football player for the Minnesota Vikings, Brent Boyd, sought disability benefits under a plan maintained by the National Football League. His claim was denied by the plan based on a finding that Boyd’s disability did not result from football-related injuries, and the district court upheld that determination. On appellate review, the 9th U.S. […]
Testimony presented to the ERISA Advisory Council-Working Group on health and welfare benefit plans’ communications
The current regime of treating claims administered by health and disability insurers in the same manner as pension benefit claims has proven to be a recipe for disaster. First and foremost on the agenda for fixing the current system is the need to improve the communications provided to plan participants and their beneficiaries. Judge Richard […]
Appeals court rejects ruling on tardy review
Deadlines carry little weight if there are no repercussion for missing them. Take the case of Gatti v. Reliance Standard Life Insurance Co., 2005 U.S.App.LEXIS 9895 (9th Cir., May 31), which involved a claimant who received disability benefits for nearly seven years due to complications of Hepatitis B. The insurer cut off benefits in 2000, […]
1st Circuit Overlooks Crucial ERISA Distinction
In a very significant ruling, the 1st U.S. Circuit Court of Appeals offered its view on the scope of a de novo judicial review of a benefits denial claim governed by the ERISA law: ”The claimant was not entitled to trial or to admit desired new evidence outside the administrative record or to discovery.” Plaintiff […]
Changed definition halts disability benefits
A production supervisor for an engineering company sought disability benefits after aggravating a back injury when he fell down a flight of stairs. Plaintiff Alfredo Ruiz applied for benefits from Continental Casualty Co. and submitted certification from his attending physician, who reported that due to physical limitations, Ruiz ”may not work.” Additional records were later […]
Deferential, yes, but certainly not inconsequential
The 6th U.S. Circuit Court of Appeals recently served up a surprise: a comprehensive signed opinion that was issued as unpublished, even though it covers significant ground and makes precedential findings in the course of reversing a denial of disability benefits. Moon v. Unum Provident Corp., 2005 U.S. App. LEXIS 4775 (6th Cir., March 22).