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

Mealey's Disability Insurance

June 26, 2025
California Federal Judge Gives Disability Insurers Win In Breach, Bad Faith Row

LOS ANGELES — Granting summary judgment for insurers in an individual disability insurance (IDI) dispute, a California federal judge ruled in part that insurers were prejudiced by late notice of the claim.
June 25, 2025
In ‘Close Call’ Case, Judge Rules For LTD Claimant In Any-Occupation Dispute

SACRAMENTO, Calif. — In a decision he described as “a very close call,” a California federal judge ruled on de novo review that a claimant was disabled from any occupation under the terms of a long-term disability (LTD) plan; among other things, the judge resolved opposed requests for judicial notice and explained his findings that the opinions of several doctors should be given little to no weight but the claimant’s “reports of pain are entitled to some weight.”
June 25, 2025
LTD Insurer Wins Summary Judgment In Dispute Involving Sedentary Work Ability

SYRACUSE, N.Y. — Saying in part that “[s]ubstantial evidence supports the Defendant’s determination that Plaintiff can perform sedentary work,” a New York federal judge upheld termination of long-term disability (LTD) benefits for a nurse practitioner under an “any gainful occupation” definition of disability.
June 16, 2025
4th Circuit Upholds LTD Benefits Ruling Involving ‘Objective Evidence’ Exception

RICHMOND, Va. — Saying in part that “a patient’s self-reported symptoms of pain and fatigue are the exact sort of evidence that the objective-evidence bar is designed to eliminate,” the Fourth Circuit U.S. Court of Appeals issued an unpublished June 13 opinion affirming judgment for a long-term disability (LTD) insurer that terminated benefits under a maximum lifetime limitations provision for neuromuscular, musculoskeletal and soft tissue disorders.
June 16, 2025
4th Circuit Rules 2-1 For LTD Claimant, Avoids Deciding Review Standard Question

RICHMOND, Va. — In an unpublished opinion that drew a one-paragraph dissent, the Fourth Circuit U.S. Court of Appeals on June 13 upheld summary judgment for a long-term disability (LTD) claimant, saying in part that it didn’t need to decide whether the lower court’s use of de novo review was improper because the insurer’s termination of benefits “does not withstand scrutiny even under the less-rigorous abuse of discretion standard.”
June 16, 2025
Putative Class Lawsuit Challenges Revision To American Airlines LTD Plan

FORT WORTH, Texas — In a putative class complaint filed in Texas federal court, a disabled pilot sued American Airlines Inc. (AA) and related defendants under the theory that a May 2024 revision of its long-term disability (LTD) plan improperly excluded “vacation, ratification bonuses, profit sharing, one-time supplemental payment, bereavement, grievance payouts, extended sick bank, and Special Assignment” from average monthly compensation, resulting in underpayment of LTD benefits.
June 13, 2025
7th Circuit Affirms Ruling Against LTD Claimant Who Has Fibromyalgia

CHICAGO — Calling the challenged decision “detailed and diligent,” the Seventh Circuit U.S. Court of Appeals on June 12 ruled that a district court properly found that a former PricewaterhouseCoopers LLP (PwC) director failed to satisfy her burden of proving that she remained disabled from working in a sedentary occupation as a result of symptoms related to fibromyalgia.
June 13, 2025
Claimant With Long COVID To Challenge LTD Benefit Denial In 9th Circuit

SAN DIEGO — A claimant who unsuccessfully sought long-term disability (LTD) benefits due to symptoms he attributed to long COVID and cardiac issues is taking his case to the Ninth Circuit U.S. Court of Appeals after a California federal judge upheld denial of his claim on de novo review.
June 11, 2025
Judge Denies Transfer Bid LTD Insurer Didn’t Make With ‘Reasonable Promptness’

MIAMI — Noting that recently produced medical records are generally not admissible in the original jurisdiction but would be where the defendant sought transfer, a Florida federal judge denied a long-term disability (LTD) insurer’s motion, saying it “plainly did not act with reasonable promptness to request transfer.”
June 10, 2025
Judge Won’t Stay Fees Bid Pending Appeal Of LTD Ruling For Claimant

PITTSBURGH — A motion for more than $126,000 in attorney fees will proceed after a Pennsylvania magistrate judge denied an insurer’s request for a stay pending resolution of its appeal of a summary judgment ruling in favor of a physician who successfully challenged denial of her claim for long-term disability (LTD) benefits.
June 10, 2025
9th Circuit Sets Argument In Oral Surgeon’s Bid To Revive Disability Benefits Case

SAN FRANCISCO — The Ninth Circuit U.S. Court of Appeals has scheduled oral argument for July 7 in an appeal seeking revival of an oral surgeon’s breach of contract and bad faith suit filed after he unsuccessfully sought disability benefits on the grounds that his comorbid conditions and inability to access recommended personal protective equipment (PPE) made it necessary to close his practice early in the COVID-19 pandemic.
June 09, 2025
Split U.S. Supreme Court Resumes DOGE Access To SSA Records

WASHINGTON, D.C. — A U.S. Supreme Court majority on June 6 concluded that the Social Security Administration (SSA) must again provide access to agency records to a Department of Government Efficiency (DOGE) SSA team, staying a preliminary injunction issued in April by a federal judge in Maryland.
June 06, 2025
Claimant Who Sought LTD Benefits After Termination Wins Reversal

RIVERSIDE, Calif. — In minute findings of fact and conclusions of law reversing denial of long-term disability (LTD) benefits for a claimant who has a genetic musculoskeletal disorder, received a kidney transplant and asserted that he “pushed himself to work far beyond his ability to effectively do so,” a California federal judge ruled in part that “[a] plaintiff could be disabled under the Plan without experiencing a loss of earnings and while still working continuously.”
June 05, 2025
Judge Issues Mixed Ruling In LTD Row Involving Wrong Occupation Standard

MINNEAPOLIS — Issuing a mixed ruling in a long-term disability (LTD) benefits dispute filed by a former box-stacker who was incarcerated for part of the period at issue, a Minnesota federal judge ruled that the claimant is due eight months of benefits because the insurer should have used an “own occupation” standard rather than the “any occupation” one but that the any-occupation standard applies from then on and he is not entitled to benefits under it.
May 23, 2025
U.S. Supreme Court Briefs Debate Injunction Stay Request In SSA Records Case

WASHINGTON, D.C. — Discretionary review by the U.S. Supreme Court of an injunction in a case over Department of Government Efficiency (DOGE) access to Social Security Administration (SSA) data is not necessary as the application by the SSA and other federal government agencies and officials fails to “present a question meriting” high court review, a union and two groups argue in their opposition; however, the federal government parties write in their reply that the groups lack standing and their claims will fail on the merits.
May 22, 2025
Judge Dismisses STD Benefits Case As Moot But Lets Claimant Seek Fees

CINCINNATI — Defendants that voluntarily reversed the challenged termination of short-term disability (STD) benefits after they were sued and paid up could still be liable for attorney fees under a brief May 21 dismissal ruling in which an Ohio federal judge fully adopted a report and recommendation, noting that the time for objections had expired without any being filed.
May 20, 2025
Fighting Fees, NFL Plan Urges 5th Circuit To Say Disability Claimant Had No Success

NEW ORLEANS — In its appellant brief urging the Fifth Circuit U.S. Court of Appeals to reverse an award of more than $1.25 million in attorney fees and costs, the Bert Bell/Pete Rozelle NFL Player Retirement Plan called the award “an unprecedented expansion of the availability of attorney’s fees to ERISA litigants who do not succeed on any legal claim and obtain no judicial relief.”
May 16, 2025
6th Circuit Finds No Abuse Of Discretion In Long COVID LTD Benefits Denial

CINCINNATI — Ruling against a claimant who said in her opening brief that “this appears to be the first ‘Long COVID’ disability case to come before the Court,” the Sixth Circuit U.S. Court of Appeals on May 15 affirmed a judgment upholding denial of her claim for long-term disability (LTD) benefits, concluding that the insurer’s “decision was neither procedurally nor substantively unreasonable.”
May 14, 2025
Bad Faith Claims Bifurcated From Breach Of Contract Claim In Disability Suit

LOUISVILLE, Ky. — A Kentucky federal judge granted a disability income insurer’s motion to bifurcate an insured’s breach of contract claim from the insured’s bad faith claims after determining that bifurcation will promote judicial efficiency because the bad faith claims are dependent on the success of the breach of contract claim.
May 14, 2025
Former Physician’s Assistant Whose LTD Benefits Were Nixed Sues For Reinstatement

LYNCHBURG, Va. — Suing the claims administrator that terminated his long-term disability (LTD) benefits, a former emergency room physician’s assistant who says he “underwent a PET/CT scan that indicated Alzheimer’s dementia” argues in part that discovery from other lawsuits has shown that the insurer’s reviewer “denies 85-90% of all disability claims she reviews.”
May 14, 2025
Insurer Gets LTD Benefits Case Transferred To Different California Federal Court

SAN FRANCISCO — An Employee Retirement Income Security Act suit in which a claimant who says she has “disabling symptoms” of long COVID is challenging denial of her claim for long-term disability (LTD) and life insurance waiver of premium (LWOP) benefits will be transferred to a different federal court in California after a judge considered “deference owed to Plaintiff’s choice of forum, convenience, and the local interest in the case.”
May 13, 2025
Judge Upholds LTD Claim Denial Under Policy’s ‘Most Appropriate’ Requirement

TACOMA, Wash. — Ruling in part that a pharmacist who has been diagnosed with functional neurological disorder (FND) and is being treated by naturopaths “has not met her burden of proving that she is under the continuing care of a medical doctor or a medical practitioner with the same authority as a medical doctor, in the most appropriate specialty for her condition,” a Washington federal judge affirmed denial of her claim for long-term disability (LTD) benefits.
May 13, 2025
Deal Reported After Partial Summary Judgment Bids Fail In LTD Row

SANTA ANA, Calif. — Days after a California federal judge denied competing motions for partial summary judgment in a lawsuit asserting bad faith and breach of contract claims over calculation of long-term disability (LTD) benefits, the parties told the court they reached an unspecified settlement.
May 13, 2025
After LTD Case Remand To Plan, Parties Dispute Attorney Fee Request

SAN FRANCISCO — Parties in a long-term disability (LTD) benefits case are disputing a $139,650 attorney fee request, with the claimant contending that “a remand for further administrative proceedings is not a trivial success where it is based on a court determination that ERISA rights were violated,” and the defendant arguing in part that no award is warranted under Hummel v. S.E. Rykoff & Co.
May 09, 2025
On De Novo Review, Judge Rules That LTD Claimant Is Physically Disabled

LOS ANGELES — Taking issue with numerous aspects of an insurer’s decision to terminate long-term disability (LTD) benefits, a California federal judge concluded that “[a] preponderance of the evidence shows [that the claimant’s] medical symptoms related to spondylolisthesis, lumbar region status post lumbar fusion, and chronic pain render him disabled under the terms of the Plan.”