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Mealey's Disability Insurance

  • February 18, 2026

    Judge: LTD Claimant Met Only Own-Occupation Definition Of Disability

    GRAND RAPIDS, Mich. — On de novo review of a case challenging termination of long-term disability (LTD) benefits for a marketing agency account executive who was diagnosed with “an acute intractable headache,” a Michigan federal judge ruled that the claimant is entitled to benefits under the plan’s initial “regular occupation” definition of disability but not under the subsequent “any gainful occupation” definition.

  • February 18, 2026

    Suit That Former Physician’s Assistant Filed Over LTD Benefits Is Dropped

    LYNCHBURG, Va. — Pursuant to a joint stipulation, dismissal with prejudice has been entered in a suit that a former emergency room physician’s assistant filed against the claims administrator that terminated his long-term disability (LTD) benefits; the plaintiff said he “underwent a PET/CT scan that indicated Alzheimer’s dementia” and argued in part that discovery from other lawsuits has shown that the insurer’s reviewer “denies 85-90% of all disability claims she reviews.”

  • February 17, 2026

    California Federal Judge: Massachusetts Law Applies To Suit Over LTD Benefits

    SANTA ANA, Calif. — A claims administrator’s decision to deny long-term disability (LTD) benefits to a former executive will be reviewed for abuse of discretion rather than de novo after a California federal judge on Feb. 13 ruled that because the policy has a Massachusetts choice of law clause, a California law that invalidates discretionary clauses does not apply.

  • February 13, 2026

    Pa. Federal Judge Partly Grants Motion To Compel In LTD Benefits Case

    WILLIAMSPORT, Pa. — A Pennsylvania federal judge on Feb. 12 declined to compel production of “batting average” information and communications concerning state or federal investigations but ordered the administrator of a group long-term disability (LTD) policy to provide some of the information a claimant seeks regarding incentives for insurance adjusters and reviewing physicians, the administrator’s review policies and procedures and its use of a third-party medical review company.

  • February 13, 2026

    Disability Retirement Denial Is Reversed Due To Inadequate Medical Reviews

    LONDON, Ky. — Concluding that there was not substantial evidence to support an independent medical examination (IME) on which the administrator relied and that the administrative record as a whole shows that the decision to deny disability retirement benefits was arbitrary, a Kentucky federal judge granted judgment in favor of a former ward clerk that he ruled is entitled to the benefits.

  • February 13, 2026

    On De Novo Review, Paramedic With Fibromyalgia Wins Retroactive LTD Benefits

    KALAMAZOO, Mich. — Saying the administrator of a long-term disability (LTD) policy “constructed a bar to Plaintiff’s claim which is neither present in the policy nor reflective of the medical reality that objective testing cannot definitively show the presence of very real conditions such as Plaintiff’s,” a Michigan federal judge ruled that a paramedic who suffers from fibromyalgia and myofascial pain is entitled to retroactive benefits, interest, reasonable attorney fees and costs.

  • February 12, 2026

    Federal Judge: Surveillance Videos Given ‘Undue Weight’ In LTD Benefits Cut

    BOSTON — Denying competing summary judgment motions and saying remand for reprocessing is appropriate when “the plan administrator has failed to comply with” Employee Retirement Income Security Act guidelines, a Massachusetts federal judge ordered the administrator to further review its termination of a school employee’s long-term disability (LTD) benefits.

  • February 10, 2026

    Disability Determination, Other Issues Briefed Before 6th Circuit In Benefits Case

    CINCINNATI — Arguing in part that the claimant’s “proven ability to work coupled with the improvement documented by her own treating providers” was sufficient to show that she was not totally disabled under the terms of the long-term disability (LTD) plan, appellants urged the Sixth Circuit U.S. Court of Appeals to affirm denial of benefits for a project director who stopped working because of symptoms she attributed to long COVID.

  • February 10, 2026

    LTD Insurer Objects To Order Allowing Discovery On Fiduciary Breach Claim

    MINNEAPOLIS — A long-term disability (LTD) insurer that is trying to get a federal magistrate judge’s discovery order reversed argues in a Minnesota federal court filing that the claimant should not have been allowed “to parse out conduct from an ordinary denial of benefits claim and re-brand it as a separate claim for breach of fiduciary duty and thereby obtain discovery in contravention of Eighth Circuit authority prohibiting discovery on” benefits claims asserted under the Employee Retirement Income Security Act.

  • February 09, 2026

    5th Circuit Panel Lets Reversal Of Fee Award To NFL Disability Claimant Stand

    NEW ORLEANS — In a per curiam order denying panel rehearing issued without explanation, the Fifth Circuit U.S. Court of Appeals let stand its reversal of an award of more than $1.25 million in attorney fees to a former National Football League player who sued for a higher level of disability benefits than he was awarded, prevailed after a bench trial and then saw that favorable ruling reversed in a previous appeal.

  • February 04, 2026

    Split Kentucky Panel Orders New Damages Trial In STD Benefits Case

    FRANKFORT, Ky. — In an unpublished opinion, a split Kentucky appeals panel reversed and remanded a ruling against the third-party administrator of a short-term disability (STD) plan in a long-running case where a jury awarded the claimant $7,125,000 in emotional distress and punitive damages

  • January 29, 2026

    Class Certification, Summary Judgment Denied In Suit Over NFL Disability Denials

    BALTIMORE — Finding that “the commonality and typicality prerequisites are not met here,” a Maryland federal judge on Jan. 28 declined to certify “a class spanning over five decades of NFL players” in a suit over NFL disability benefits; in separate rulings the same day, she denied three motions in which the defendants sought summary judgment and denied the plaintiffs’ motion to strike two declarations submitted in support of the summary judgment motions.

  • January 29, 2026

    Judge: Former Surgeon Deserves Total Disability Benefits Due To ‘Injury’

    KALAMAZOO, Mich. — On de novo review, a Michigan federal judge concluded that insurers wrongly denied a total disability claim filed by a surgeon who had long received residual disability benefits because of back pain and that awarding him benefits outright is appropriate because the insurers “are not entitled to a ‘second bite at the apple.’”

  • January 23, 2026

    11th Circuit Affirms Insurer Win In LTD ‘Active Employment’ Case

    ATLANTA — Concluding in an unpublished per curiam opinion that an insurer “had a reasonable basis” for finding that a surgeon dropped below the number of working hours required for “active employment” early in the COVID-19 pandemic, the 11th Circuit U.S. Court of Appeals affirmed summary judgment for the insurer that denied long-term disability (LTD) benefits on the basis that a tremor he consulted a doctor about over that time constituted an excluded preexisting condition.

  • January 21, 2026

    SSA To Court: Former DOGE Team’s Data Use Possibly Noncompliant With TRO

    BALTIMORE — The Social Security Administration (SSA) filed a notice in a federal court in Maryland stating that in December 2025 it made two Hatch Act referrals to the U.S. Office of Special Counsel and notified the U.S. Department of Justice of instances of use of SSA data “by the then-SSA DOGE [Department of Government Efficiency] Team” that were “potentially outside of SSA policy and/or noncompliant” with a temporary restraining order (TRO) entered in March 2025.

  • January 21, 2026

    Judge: Engineer Claiming COVID Vaccine Injury Is Due LTD Benefits

    SAN JOSE, Calif. — On de novo review, a California federal judge concluded that a mechanical engineer who said she was disabled by a COVID vaccine injury due to symptoms including fatigue and brain fog is entitled to retroactive long-term disability (LTD) benefits under the plan’s initial “regular occupation” standard.

  • January 20, 2026

    Judge Finds Factual Dispute On Intent-To-Defraud Question In Disability Case

    BALTIMORE — Partly denying an insurer’s motion for summary judgment in a case over an individual disability insurance (IDI) policy it wants to rescind because the pro se defendant didn’t disclose her full criminal history, a Maryland federal judge applied Maryland law and concluded that there is a material factual dispute regarding whether the insurer showed that the defendant “intended to defraud” it.

  • January 20, 2026

    11th Circuit Won’t Rehear LTD Preexisting Conditions Exclusion Case

    ATLANTA — Without substantive explanation, the 11th Circuit U.S. Court of Appeals denied an unanswered petition for en banc rehearing concerning a split panel’s ruling that it was unreasonable for a long-term disability (LTD) insurer to interpret a preexisting conditions exclusion in a way that the majority said means that “treatment for a headache during the lookback period converts any disease or condition that causes headaches into a preexisting condition.”

  • January 16, 2026

    Pa. Federal Judge Upholds Denial Of LTD Benefits For River Pilot With Long COVID

    PHILADELPHIA — Saying he is “constrained by” the arbitrary and capricious standard of review, a Pennsylvania federal judge on Jan. 15 upheld denial of long-term disability (LTD) benefits for a river pilot who was diagnosed with long COVID.

  • January 16, 2026

    Residual Disability Benefits Case Is Dismissed Under ‘Combined Period’ Provision

    NEW YORK — Dismissing a dentist’s suit alleging breach of contract and breach of the implied covenant of good faith and fair dealing, a New York federal judge agreed with the insurer defendants that the policy terms permitted termination of residual disability benefits at the dentist’s 65th birthday and did not promise lifetime benefits.

  • January 16, 2026

    Judge Applies ‘Regular Care’ Provision In Upholding LTD Benefits Termination

    CHICAGO — Finding on de novo review that a former Whole Foods worker who briefly obtained long-term disability (LTD) benefits because of back pain didn’t show “that he was under the ‘regular care of a physician’ as is required under the Plan,” an Illinois federal judge upheld termination of the benefits.

  • January 15, 2026

    2nd Circuit Affirms Arbitrary And Capricious Standard In LTD Benefits Case

    NEW YORK — Briefly upholding the trial court’s decision to use the arbitrary and capricious review standard in a long-term disability (LTD) benefits case, the Second Circuit U.S. Court of Appeals said in a Jan. 15 nonprecedential summary order that it affirmed the ruling for the reasons given in the lower court’s “detailed opinion and order.”

  • January 15, 2026

    LTD Claimant Takes Pre-Existing Condition Exclusion Fight To 9th Circuit

    SAN FRANCISCO — Arguing that the trial court made errors on de novo review including “expansively applying a pre-existing condition exclusion to bar coverage for a disability caused by post-coverage traumatic injuries” and “disregarding uncontroverted medical evidence,” an appellant claimant filed a Jan. 14 brief urging the Ninth Circuit U.S. Court of Appeals to reverse an order that upheld denial of her claim for long-term disability (LTD) benefits.

  • January 14, 2026

    Washington Federal Judge Trims Attorney Fees In Remanded ERISA Disability Case

    SEATTLE — Addressing an opposed request for attorney fees totaling $239,390 in a long-term disability (LTD) benefits case involving long COVID that was remanded to the administrator for full consideration because of a “substantial” procedural error, a Washington federal judge on Jan. 13 reduced the hours and the blended hourly rate, concluding that the appropriate fee award in the Employee Retirement Income Security Act case is $112,050.

  • January 14, 2026

    Termination Of Investment Portfolio Manager’s LTD Benefits Is Upheld

    ALEXANDRIA, Va. — Upholding termination of long-term disability (LTD) benefits under a regular-occupation standard for an investment portfolio manager whom surveillance showed had played 20 rounds of golf in three months in late 2024 despite allegedly disabling back problems, a Virginia federal judge concluded that despite there being some support for his claim, the termination “was both the product of a deliberate, principled reasoning process, and supported by substantial evidence.”