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.”
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 […]
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, […]
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. […]
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 […]
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, […]
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 […]
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 […]
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).
Our law firm recently won a summary judgment ruling in a case that is instructive to litigants having to deal with disability due to severe pain.
Chief U.S. District Judge William Young, the author of the provocative indictment of the claims practices of the Unum Provident Corp. in Radford Trust v. First Unum Life Insurance Company of America, 321 F.Supp.2d 226 (D. Mass. 2004), has written yet another thoughtful opinion. The ruling in Iwata v. Intel Corp., 2004 U.S. Dist. LEXIS […]