In deciding whether an insurer properly terminated the plaintiff’s benefits, the 6th U.S. Circuit Court of Appeals in Osborne v. Hartford Life & Accident Insur. Co., 2006 U.S.App.LEXIS 24640 (Oct. 3), first noted the issue turned on the meaning of the insured’s ”own occupation” as used in the policy. The plaintiff was the chairman and […]
In a recent case, despite the application of an arbitrary and capricious standard of review, the 6th U.S. Circuit Court of Appeals concluded that when MetLife terminated Wanda Glenn’s benefits, its actions were not ”the result of a deliberative process or that it was based on substantial evidence.” Glenn v. MetLife, 2006 U.S.App.LEXIS 22432 (Sept […]
The issue in the 5th U.S. Circuit Court of Appeals ruling High v. E-Systems Inc Long Term Disability Income and Death Benefit Plan, 2006 U.S.App.LEXIS 19613, (Aug. 3), was whether MetLife had the authority to offset Veterans Administration disability benefits that the plaintiff had been receiving even before he was hired by E-Systems in 1982 […]
A decision from the U.S. Court of Appeals for the Seventh Circuit reveals how a court misunderstood key definitions in a disability case.
The 6th U.S. Circuit Court of Appeals’ ruling in Moon v. Unum Provident Corp., 2006 U.S. App. LEXIS 22321 (June 29) (published), has tremendous instructive value with respect to awards of attorneys’ fees following a Court of Appeals reversal of benefit denial.
Today’s column discusses Burroughs v. Bellsouth Telecommunications Inc., 2006 U.S. Dist. LEXIS 52815. (June 14). Burroughs is a tour de force expose of how the ERISA law has been interpreted by the courts in a manner that thoroughly betrays Congress’ intent to protect promised benefits. U.S. District Judge William Acker Jr., a frequent critic of […]
A decision by the U.S. District Court for the Southern District of New York reveals a court’s flawed analysis of disability.
Hopkins v. Prudential Insur.Co. of America, 2006 WL 1343432 (N.D. Ill., May 12). Plaintiff, an employee of Bank One Corporation, challenged his disability insurer’s invocation of a preexisting condition exclusion to deny him long-term disability benefits. Hopkins was first employed by Bank One in 1999, and elected long-term disability insurance coverage when he commenced employment. […]
In 1989, the Supreme Court issued Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101 (1989), which permitted the inclusion of language in employee benefit plans (including insurance policies) that would trigger a deferential standard of court review in ERISA cases.
The plaintiff, a loan originator, originally became disabled in 1993 due to an ankle injury. Although her ankle improved, she was also involved in a serious car accident, and her benefits were continued until 1996 when Hartford cut off the benefit payments even though she continued to suffer from pain, fatigue, problems with memory and […]
Dennis Paese, a long-time employee and director of labor relations for Sequa Corporation, was severely injured in a car accident. Paese v. Hartford Life and Accident Insur. Co., 2006 U.S.App.LEXIS 13007 (2d U.S. Circuit Court of Appeals May 24,2006).
The plaintiff commenced this action seeking injunctive relief under the ERISA statute after Prudential terminated her benefit claim for the third time. Perkins v. Prudential Insur. Co. of America, 417 F.Supp.2d 1149 (C.D.Cal. March 1, 2006). Perkins initially became disabled in 1997; after Prudential denied her claim, litigation resulted in an award of benefits. Another […]