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Mealey's Disability Insurance

  • March 23, 2026

    LTD Claimant Files 7th Circuit Appeal In ‘Regular Care’ Provision Case

    CHICAGO — A former Whole Foods worker who said he had to stop working because of back pain has gone to the Seventh Circuit U.S. Court of Appeals to challenge a ruling that upheld termination of his long-term disability (LTD) benefits on the grounds that he didn’t show “that he was under the ‘regular care of a physician’ as is required under the Plan.”

  • March 20, 2026

    After Remand For IME, Disability Claimant Gets Benefit Termination Overturned

    CHATTANOOGA, Tenn. — A Tennessee federal judge who previously ordered further factual development in a suit over a long-term disability (LTD) claim that involves a mental illness limitation, pain and the headache condition occipital neuralgia on March 19 granted judgment on the administrative record, ruling on de novo review that the claimant was disabled under the policy’s any gainful occupation definition as of March 2021 and is entitled to continuing benefits.

  • March 20, 2026

    On De Novo Review, Judge Affirms LTD Denial Under Preexisting Exclusion

    MINNEAPOLIS — Using the de novo standard of review because of an Oregon regulation prohibiting discretionary clauses, a Minnesota federal judge affirmed denial of long-term disability (LTD) benefits, explaining that because the claimant’s “disability was based on her low back pain and she was treated for low back pain during the lookback period, the pre-existing condition exclusion squarely applies.”

  • March 19, 2026

    Judge Upholds LTD Insurer’s Decision To End Benefits After Limitation Period

    SANTA ANA, Calif. — Finding on de novo review that a long-term disability (LTD) claimant “has not adequately demonstrated he is disabled under the Policy after the 24-month mental disorder limitation period expired,” a California federal judge upheld termination of the benefits under a usual-occupation standard.

  • March 18, 2026

    LTD Insurer To 9th Circuit: Affirm Preexisting Condition Exclusion Ruling

    SAN FRANCISCO — Describing the ruling at issue as “plausible, logical and supported by the record,” an insurer urged the Ninth Circuit U.S. Court of Appeals to affirm an order that upheld its denial of long-term disability (LTD) benefits under a preexisting condition exclusion.

  • March 18, 2026

    2nd Circuit Finds No Clear Error In LTD Ruling Involving Purported Long COVID

    NEW YORK — Saying in part that it found no error “in the district court’s decision to assign minimal weight to [the claimant]’s self-reported symptoms and to focus, instead, on the paucity of objective record evidence supporting her claimed inability to work,” the Second Circuit U.S. Court of Appeals issued a March 17 summary order affirming judgment for a long-term disability (LTD) plan administrator that denied a claim that was based on a nurse practitioner’s purported symptoms of long COVID.

  • March 17, 2026

    Judge: Nurse Is Physically Disabled Under LTD Plan’s Terms, Deserves Benefits

    PHOENIX — Using “heightened skepticism” because of a structural conflict of interest and “procedural irregularities,” a judge sitting by designation in an Arizona federal court ruled that a registered nurse is due long-term disability (LTD) benefits because the insurer’s failure to view her “conditions and symptoms in the aggregate was a consequential factor that amounted to an abuse of discretion.”

  • March 16, 2026

    Judge: Short-Term Disability Plan Is Payroll Practice Exempt From ERISA

    BOSTON — Concluding that the “payroll practice exception” applies, a Massachusetts federal judge dismissed a suit concerning a self-insured short-term disability plan (STDP) for lack of subject matter jurisdiction on the grounds that the plan is not governed by the Employee Retirement Income Security Act.

  • March 16, 2026

    Former Transactional Attorney Wins LTD Case In Massachusetts Federal Court

    BOSTON — Calling the insurer’s determination “arbitrary and capricious in multiple respects,” a Massachusetts federal judge largely granted summary judgment in favor of a former attorney who challenged termination of her long-term disability (LTD) benefits.

  • March 12, 2026

    Former NFL Player Sues Over Denial Of His Claim For Disability Benefits

    NORFOLK, Va. — Claiming that his application for total and permanent (T&P) disability benefits didn’t get “a full and fair review” and that “the lasting effects of his injuries . . . render him substantially unable to engage in any occupation or employment for remuneration or profit” under the applicable definition, former National Football League player Aaron R. Rouse sued the NFL Player Disability and Survivor Benefit Plan in a Virginia federal court on March 11 for retroactive and continuing benefits.

  • March 12, 2026

    Suit Involving Cousin’s Purported Disability Fraud Is Dismissed As Untimely

    DALLAS — Without substantive explanation, a Texas federal judge overruled objections and accepted a report and recommendation to dismiss as untimely a lawsuit involving fraud and bad faith claims in which the pro se plaintiff challenged a roughly two-decade-old termination of long-term disability (LTD) benefits and alleged that a cousin fraudulently used her identity to file a successful disability claim.

  • March 09, 2026

    Massachusetts Panel Reverses Ruling For Claimant In Disability COLA Dispute

    BOSTON — Disagreeing with a lower court’s conclusion that policy language is ambiguous, a Massachusetts Appeals Court panel reversed judgment on a breach of contract claim for a disability income recipient who challenged the fact that benefits under a cost-of-living adjustment (COLA) rider stopped accruing after her 65th birthday.

  • March 05, 2026

    On De Novo Review, LTD Claimant Is Found To Be Physically Disabled

    MADISON, Wis. — Granting each side a partial victory, a Wisconsin federal judge decided on de novo review that a long-term disability plan (LTD) administrator must pay benefits because physical impairments rendered the claimant disabled under an own-occupation standard, but the administrator is allowed to recover overpayment caused by the claimant’s receipt of Social Security Disability Insurance (SSDI) benefits.

  • March 04, 2026

    4th Circuit Affirms Use Of De Novo Review For Untimely LTD Decision

    RICHMOND, Va. — Affirming a lower court’s use of the de novo standard of review in a long-term disability (LTD) benefits case because the plan administrator failed to meet a regulatory deadline during the administrative appeal of its initial decision, the Fourth Circuit U.S. Court of Appeals on March 3 upheld a ruling that the appellee is owed past-due benefits because long COVID symptoms have disabled her from working as an engineer.

  • March 03, 2026

    Disability Insurer’s Interpretation Of Plan Terms Wins In COLA Benefits Dispute

    SALT LAKE CITY — Distinguishing Colt v. Mass. Mut. Life Ins. Co. because of the concessions the insurer in that case made, a Utah federal judge ruled against a former anesthesiologist who argued that he was entitled to lifetime benefits under cost of living adjustment (COLA) riders per the terms of his disability income coverage.

  • February 23, 2026

    Claimant Who Sought Disability Benefits For Long COVID Loses Case

    BURLINGTON, Vt. — Granting judgment on the administrative record against a claimant who unsuccessfully sought short-term and long-term disability (STD and LTD) benefits due to symptoms he attributed to long COVID despite being awarded disability benefits by the Social Security Administration (SSA), a Vermont federal judge on Feb. 20 said she found “no evidence that Plaintiff was intentionally deceitful” but concluded that he “is not a reliable source of information due to his conflicting statements, self-described poor memory, psychiatric symptoms, and extensive marijuana use.”

  • 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.