Mealey's Disability Insurance : Mealey's : Legal News & Analysis

Mealey's Disability Insurance

September 02, 2022
Suit Seeking LTD Benefits Barred By Doctrine Of Res Judicata, Judge Says

SANTA ANA, Calif. — A disability claimant’s suit seeking long-term disability (LTD) benefits is barred by the doctrine of res judicata because the same parties and the same claims are at issue in the claimant’s instant suit as were at issue in the claimant’s prior suit, a California federal judge said Aug. 1 in granting the disability insurer’s motion to dismiss.
August 29, 2022
District Court Properly Found No Disability Benefits Owed, Disability Insurer Says

CHICAGO — A district court correctly found that a disability claimant was not entitled to long-term disability (LTD) benefits because the evidence supports a finding that the claimant did not show by a preponderance that he was unable to perform the duties of his own occupation, a disability insurer contends in its Aug. 24 appellee brief filed in the Seventh Circuit U.S. Court of Appeals.
August 29, 2022
Disability Claimant Failed To File Suit Within 3 Years As Required By Policy

ATLANTA — A district court properly dismissed a disability claimant’s suit alleging that her long-term disability benefits were wrongfully terminated because the claimant failed to file her suit within three years as required by the policy’s three-year suit limitations provision and failed to show that she did not have actual notice of the limitations provision, the 11th Circuit U.S. Court of Appeals said Aug. 25.
August 26, 2022
Texas Judge Approves NFL Plan’s Posting Of $3.3M Bond In Disability Suit

DALLAS — A Texas federal judge on Aug. 23 approved the posting of a $3.3 million appeal bond and stayed the execution of judgment in a former National Football League (NFL) player’s suit for disability benefits while the NFL retirement plan appeals the judgment entered in the player’s favor.
August 24, 2022
Administrative Record To Be Sealed In California Disability Benefits Suit

SAN FRANCISCO — A California federal magistrate judge on Aug. 22 granted a disability claimant’s motion to seal the administrative record pertaining to a disability benefits claim after determining that the claimant met the standard of providing compelling reasons to seal the record.
August 23, 2022
Disability Plan’s Termination Of Benefits Was Not Abuse Of Discretion, Judge Says

ALEXANDRIA, Va. — The termination of a claimant’s long-term disability (LTD) benefits based on a finding that the claimant was not disabled from performing the duties of any occupation was not an abuse of discretion because the decision was supported by adequate evidence and the claimant was afforded a full and fair review, a Virginia federal judge said Aug. 18 in granting the plan’s motion for summary judgment on the administrative record.
August 23, 2022
Disability Plan Did Not Abuse Discretion In Calculating Claimant’s LTD Benefits

EUGENE, Ore. — A disability plan’s refusal to pay a claimant 66.6% of his salary in long-term disability (LTD) benefits was not an abuse of discretion because the plan reasonably determined that the claimant’s disability onset date occurred before the effective date of the claimant’s “buy up” election to receive 66.6%, rather than 50%, of his salary in LTD benefits, an Oregon federal judge said Aug. 19 in granting the plan’s motion for summary judgment.
August 22, 2022
Mental Health Diagnoses Do Not Prevent Claimant From Working In Own Occupation

MINNEAPOLIS — A Minnesota federal judge on Aug. 19 granted a disability insurer’s motion for summary judgment and denied a disability claimant’s motion for summary judgment after determining that the insurer’s denial of long-term disability (LTD) benefits was not arbitrary and capricious because a reasonable person could have concluded that the claimant’s mental health diagnoses do not prevent the claimant from performing the duties of her own occupation.
August 22, 2022
Breach Of Contract Claim Can Proceed, Bad Faith Claim Fails In Disability Suit

SAN FRANCISCO — A disability claimant’s breach of contract claim can proceed because a question of fact exists as to whether the claimant can perform the material duties of a general and pediatric anesthesiologist; however, the claimant’s bad faith claim cannot proceed because the claimant failed to show that the disability insurer’s investigation was unreasonable, a California federal judge said Aug. 19.
August 22, 2022
Discovery Permitted In Denial Of Disability Benefits Suit, Magistrate Judge Says

ST. LOUIS — A disability claimant is entitled to conduct limited discovery on claims of breach of fiduciary duty and wrongful denial of disability benefits because the claimant has shown that good cause exists to determine whether the disability insurer operated under a conflict of interest and committed procedural irregularities in the handling of the claim, a Missouri federal magistrate judge said Aug. 15.
August 17, 2022
Panel: Denial Of LTD Benefits For Failure To Provide Medical Records Was Reasonable

RICHMOND, Va. — A disability insurer’s denial of long-term disability (LTD) benefits based on a claimant’s failure to provide requested medical documentation in support of his disability was reasonable because the policy at issue specifically states that failure to provide any requested materials could result in the denial of a claim, the Fourth Circuit U.S. Court of Appeals said Aug. 16 in affirming a district court’s opinion.
August 16, 2022
Disability Claimant’s Suit Dismissed Without Prejudice; No Support For Agent Theory

SAN FRANCISCO — A California federal judge on Aug. 12 granted a disability insurer’s motion to dismiss a breach of contract and bad faith lawsuit after determining that the claimant, who sought disability benefits under a policy issued to a bone marrow donor program, failed to show that that the program was acting as an agent for the disability insurer when his claim for benefits was denied.
August 15, 2022
Prior Plan Exclusion Applies; No LTD Benefits Owed, 11th Circuit Panel Affirms

BIRMINGHAM, Ala. — The 11th Circuit U.S. Court of Appeals on Aug. 10 affirmed a district court’s finding that a disability insurer’s decision to deny a long-term disability (LTD) benefits claim based on the plan’s prior plan exclusion was not wrong because the insurer’s interpretation of the exclusion as a bar to coverage was reasonable.
August 11, 2022
Parties File Stipulation Of Dismissal In Long COVID, Disability Benefits Suit

SAN FRANCISCO — A disability insurer and a disability claimant suffering from symptoms of long COVID following a battle with COVID-19 have settled the claimant’s suit seeking a reinstatement of short-term disability (STD) benefits and a finding that she is entitled to long-term disability (LTD) benefits, according to an Aug. 8 stipulation of dismissal filed by the parties in California federal court.
August 04, 2022
Disability Claimant Achieved Some Success On Merits; Attorney Fee Award Warranted

CONCORD, N.H. — Because a disability claimant achieved some success on the merits when a disability insurer agreed to remand a long-term disability (LTD) benefits claim for reconsideration after the claimant filed suit, the claimant is entitled to attorney fees of $17,312, a New Hampshire federal judge said July 28.
August 04, 2022
LTD Claim Remanded To Plan Administrator For Full, Fair Review

GREEN BAY, Wis. — A Wisconsin federal judge on July 29 remanded a long-term disability (LTD) benefits claim to a plan administrator after determining that the denial of the claim was arbitrary and capricious based on the claims administrator’s finding that the medical evidence did not support the claimant’s disability.
August 04, 2022
Termination Of Benefits Was Not Arbitrary, Capricious, Federal Judge Determines

NEWARK, N.J. — A disability insurer’s decision to terminate a claimant’s long-term disability benefits was not arbitrary and capricious because the claimant was paid the maximum amount of benefits for a mental illness under the plan and failed to show that she was physically disabled from performing the duties of her own occupation, a New Jersey federal judge said July 29 in granting the disability insurer’s motion for summary judgment and in denying the claimant’s motion for summary judgment.
August 02, 2022
Judge Allows Disability Insurer To Stay A Portion Of Judgment Reinstating Benefits

SEATTLE — A Washington federal judge on July 25 granted a disability insurer’s motion to stay a portion of a judgment reinstating a claimant’s past long-term disability (LTD) benefits upon the posting of a bond while the insurer’s appeals the judgment but denied the insurer’s motion to stay the portion of the judgment ordering the insurer to pay ongoing LTD benefits because the portion of the judgment related to the ongoing benefits qualifies as injunctive relief that is not subject to an automatic stay.
August 01, 2022
Court Erred In Not Allowing Disability Claimant To Present Additional Evidence

ATLANTA — The 11th Circuit U.S. Court of Appeals on July 29 reversed and remanded a district court’s ruling that a disability claimant was not permitted to submit additional evidence in support of his claim that a disability insurer wrongfully terminated his claim because 11th Circuit precedent allows evidence outside of the administrative record to be presented when a de novo standard of review applies.
July 29, 2022
No Ambiguity Exists In Disability Policy, 5th Circuit Panel Says In Affirming

NEW ORLEANS — A district court did not err in finding that a disability insurer properly terminated a claimant’s benefits after five years because the policy phrase “any gainful occupation” is not ambiguous, the Fifth Circuit U.S. Court of Appeal said July 27.
July 27, 2022
Disability Insurer Properly Rescinded Policy, Federal Judge Says In Adopting Report

CENTRAL ISLIP, N.Y. — In a July 22 docket order, a New York federal judge adopted a magistrate judge’s recommendation to grant a disability insurer’s motion for summary judgment, agreeing with the magistrate judge’s conclusion that the insurer properly rescinded the disability policy based on fraudulent and material misrepresentations made by the insured regarding a preexisting neck condition and that the insurer did not act in bad faith in handling the insured’s claim.
July 21, 2022
Amount In Controversy Not Met In Disability, Bad Faith Suit, Magistrate Judge Says

AUGUSTA, Ga. — A disability claimant’s breach of contract and bad faith suit should be remanded to Georgia state court because the disability insurer failed to prove by a preponderance of the evidence that the amount in controversy exceeds the federal jurisdictional minimum of $75,000, a Georgia federal magistrate judge recommended June 27.
July 21, 2022
Disability Insurer Did Not Abuse Its Discretion In Terminating LTD Benefits

HOUSTON — A disability insurer did not abuse its discretion in determining that a disability claimant was not disabled from performing the duties of any gainful occupation because the record shows that the insurer conducted multiple peer-to-peer reviews with the claimant’s treating physicians and that the claimant did not suffer from functional limitations as a result of her physical and mental health ailments, a Texas federal judge said July 18.
July 20, 2022
Judge Awards Enhanced Lodestar, Conditional Attorney Fees In NFL Disability Row

DALLAS — Saying “David took on Goliath and prevailed,” a Texas federal judge on July 18 awarded enhanced attorney fees of $1,232,058.75 and conditional appellate attorney fees of $600,000 in a former National Football League player’s suit for disability benefits under the Employee Retirement Income Security Act.
July 19, 2022
Denial Of Benefits Was Not Arbitrary, Capricious, Federal Judge Says

LOUISVILLE, Ky. — A disability insurer’s denial of a long-term disability benefits claim was not arbitrary and capricious because the insurer thoroughly considered the claimant’s restrictions before concluding that the claimant was not disabled from performing the duties of her own occupation, a Kentucky federal judge said July 18.