[Official Guidance] Eighth Circuit Addresses Standard of Review in Long-Term Disability Insurance Dispute (PDF)
"Standard's [disability insurance] policy language reserving the power to 'resolve all questions . . . [of] interpretation' indicates the administrator has discretionary power to construe ambiguous terms. Thus, our standard of review is for abuse of discretion.' (Hankins v. Standard Insurance Company, 8th Cir., May 14, 2012). (Justia.com)
Managing Disability Risks in an Environment of Individual Responsibility (PDF)
"As employer-sponsored retirement benefit programs have shifted from DB plans to [DC Plans], and as people have become more responsible for their own retirement planning, the responsibility to secure disability benefits has also shifted to employees/retirees. In the employment relationship context, the shift away from providing disability benefits through DB plans to providing the disability benefit through the use of employer-offered insurance has produced differences with respect to coverage, waiting periods, and gaps in coverage." (2012 ERISA Advisory Council)
ERISA Advisory Council to Examine Disability Coverage, Retirement Income and Beneficiary Designations (PDF)
"[The Advisory Council on Employee Welfare and Pension Benefit Plans (also known as the ERISA Advisory Council) [meeting] will be held on June 12-14, 2012 [in] Washington, DC].... The Advisory Council will study the following issues: (1) Managing Disability Risks in an Environment of Individual Responsibility; (2) Current Issues Regarding Income Replacement During Retirement Years; and (3) Current Challenges and Best Practices Concerning Beneficiary Designations in Retirement and Life Insurance Plans." (Employee Benefits Security Administration)
Employee Knowledge and Attitudes about Employer-Provided Disability Insurance
"The survey revealed that most employees underestimate the amount of time individuals will be away from work due to illness and injury. On average, the surveyed employees thought that 25 percent of those who become disabled and are unable to work for at least three months remain disabled for at least two years. But in actuality, it's twice that. Half of the disabled workers who are out of work for three months remain disabled for more than two years." (Consumer Federation of America and Unum)
Disability Income Protection Needs and Opportunities for Employees and Their Families
"In the CFA-Unum survey, only 13 percent of all employees say they know 'a lot' about this insurance, and less than half of those who say they have coverage know how much it costs (41%) or what its benefits are (47%). When given information about disability insurance, a very large majority (90%) say they want this coverage, and nearly as many (86%) say that, if required, they would pay half of a $30 monthly premium, with more than half (56%) saying they would pay all of this premium, to gain income protection." (Consumer Federation of America)
Official Report on Social Security: Text of the 2012 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds (PDF)
"In 2011, Social Security's cost continued to exceed both the program's tax income and its non-interest income, a trend that the Trustees project to continue throughout the short-range period and beyond. The 2011 deficit of tax income relative to cost was $148 billion, and the projected 2012 deficit is $165 billion. The sizes of these deficits are largely due to a temporary reduction in the Social Security payroll tax for 2011 and 2012." (Social Security Administration)
[Guidance Overview] Fourth Circuit Determines Appeal Not Available from District Court Remand to Plan Administrator
In a case of first impression, the Fourth Circuit followed the majority of other Circuits in determining that "a district court order remanding [a claim denial] to an ERISA claims administrator for reconsideration does not constitute a final decision" and held that the Court therefore had no jurisdiction to rule on Aetna's appeal of that remand. Dickens v. Aetna Life Ins. Co. (Justia.com)
[Guidance Overview] Another Question is Answered in the Who's the Employer Q&A Column
Can the spouse of a limited partner in a limited partnership be treated as an employee? (BenefitsLink.com)
Work-Focused Psychotherapy Helps Employees Return Sooner
"Employees who received this therapy and returned to work sooner did not suffer adverse effects and showed significant improvement in mental health over the course of one year, according to the article, 'Work-Focused Treatment of Common Mental Disorders and Return to Work,' published online by the APA's Journal of Occupational Health Psychology." (Society for Human Resource Management)
What Constitutes an Appeal? Not a Mere Request for Records.
"[According to a Federal District Court,] claimant's letter to Plan with the following language did not constitute an appeal: 'We will be reviewing the records and obtaining additional medical information for my client's appeal of the decision to terminate her Long Term Disability.' (Reindl v. Hartford Life and Accident Insurance Co.)" (Lane Powell PC )
House Ways and Means Committee Third Hearing in Series on Securing the Future of the Social Security Disability Insurance Program
The hearing focused on how disability insurance eligibility decisions are made, including the definition of disability and the Federal-State relationship. Links to testimony are on the target page. (Ways and Means Committee)
[Guidance Overview] Worker Entitled to Temporary Disability Benefits Despite Firing over Misconduct
"'The misconduct and insubordination presented in this case are just that, misconduct and insubordination, and nothing more,' the state's Supreme Court stated in its opinion. 'After committing the misconduct and suffering the suspension, [the employee] returned to work. It was then (employer's) option to terminate his employment or allow him to continue working light duty.'" (Business Insurance)
Will Health Care Reform Impact Applications for Disability Benefits?
"The cost of maintaining health insurance coverage during a period lasting at least 24 months (the SSDI 5-month waiting period plus the 19-month Medicare waiting period) creates a disincentive to apply for SSDI benefits, generating 'job lock' -- the inability of a worker to freely leave an employer because doing so would result in loss of employer-provided benefits, like health insurance." (RAND)
Pathways from Disability Onset to Retirement: The Roles of Employer Accommodation and Health Insurance
"How workers and their employers adapt to the onset of a disability is important. A policy that requires employers to provide private disability insurance benefits in the first two years after disability onset may be one way to encourage firms to take greater steps to rehabilitate and accommodate disabled workers. A similar policy implemented in The Netherlands resulted in a 25 percent reduction in the number of disabled beneficiaries per worker." (RAND)
Employee Who Exhausts Leave Has No Claims under the ADA or FMLA, Appeals Court Says
"The court found neither law applied because the employee had exhausted his 12-week annual leave entitlement under the FMLA and could not perform his job's essential functions even with a reasonable accommodation, as required by the ADA." (Mercer)
Update on the Group Long-Term Disability Table to the NAIC Health Actuarial Task Force (PDF)
"The Academy's Group Long-Term Disability Work Group provided an update to the NAIC's Health Actuarial Task Force on the progress of the valuation table as well as seeking the task force's input on how to move forward to finish the table." (American Academy of Actuaries)
Revised EEOC Guidance Clarifies Interplay Between ADA and USERRA for Employers, Explains Rights to Veterans with Service-Related Disabilities
"The Commission's revised Guide for Employers explains how the ADA applies to recruiting, hiring and accommodating veterans with disabilities. It also explains how protections for veterans with service-connected disabilities differ under the ADA and the Uniformed Services Employment and Reemployment Rights Act, as well as laws and regulations that may be helpful to employers that want to make hiring veterans with disabilities a priority." (Wolters Kluwer Law & Business / CCH)
Health Insurance, Health Care and Labor Supply by Older Adults
"This paper examines the effect of elective surgery receipt on Social Security Disability Insurance application and receipt amongst older adults with common chronic conditions." (University of Michigan Retirement Research Center)
Health Insurance, Health care and Labor Supply by Older Adults (PDF)
"Early workforce exits are publicly costly due to foregone payroll taxes and disability benefit payments, but also costly to workers, whose SSDI benefits are typically lower than their earnings, and who lose the additional contributions to retirement benefits and Social Security earnings credits associated with paid work. Despite a large literature that has shown the importance of health status and disability on work and retirement decisions of older workers, relatively little is known about the role of health care utilization in preventing or delaying workforce exit." (University of Michigan Retirement Research Center)
[Guidance Overview] Must a Disability Benefit Denial Letter Inform Claimant of Time Period to File Legal Action?
"Here's a great new case on the topic: Heimeshoff v. Hartford Life & Accident Ins. Co. and Wal-Mart . . . . [Benefit denial letter not required to specify time limitations for suit because the ERISA regulation language 'suggests that the DOL did not intend to require such a time limit notification in the benefit determination.']." (JD SUPRA)
[Guidance Overview] Estoppel in ERISA: Simple Mistakes Can Lead to Costly Litigation
"Even if the participant ultimately fails in proving the elements of estoppel, defending against such claims is costly and time-consuming. Accordingly, employers and plan administrators should take the following steps to protect themselves from these types of claims: . . . ." (Employee Benefits Law Report)
Use of TPAs to Outsource Benefit Plan Administation Increased Substantially During Past Four Years (PDF)
"[R]oughly two in five plan sponsors (37%) say they are increasing the use of third party administrators (outsourcing benefits administration) to some extent in order to manage costs. Among those using this strategy, 65% indicate it has been successful in achieving desired cost savings." (Prudential)
[Guidance Overview] No Extended COBRA Coverage for Disabled Employee Terminated after Reduction of Hours
"As for the employee's argument that a disability extension could be based on an insurer's determination, other courts have held that a plain reading of the statute requires the determination to be made by the SSA. The statutory language requiring a qualified beneficiary to be determined to be disabled 'under title II or XVI of the Social Security Act' seems less than clear on that point, but DOL regulations specifically require a qualified beneficiary to notify the plan administrator that he or she has been determined by the SSA to be disabled." (Thomson Reuters/EBIA)
[Guidance Overview] ERISA 'Participant' Status Is Not a Jurisdictional Issue
"Whether a plaintiff is a 'participant' has posed one of the great metaphysical questions in ERISA benefits litigation. It is usually clear that the person was once a participant ? but following separation from employment, are they still? The question can present itself in the form of another ERISA imponderable ? that of standing . . . ." (Roy Harmon III, Health Plan Law)
The Shortcomings of Group LTD Plans
"Employers willingly providing any type of income protection plan to employees is of course worthy of applause. However, it's reasonable, make that imperative, that both employers and employees are informed of any shortcomings of their GLTD plan." (BenefitsPro)
[Guidance Overview] Court Sides with NFL Pension Board for Denial of Disability Benefits
"[The judge] noted the terms of the Bert Bell/Pete Rozelle NFL Player Retirement Plan say if the voting members of the board are deadlocked on whether a player meets the requirements for disability benefits, the plan provides that it may submit that medical questions to a medical advisory physician (MAP) for a final and binding determination." (PLANSPONSOR.COM)
How to Avoid Leave-Related Lawsuits
"Employers that grant generous leaves for disability or maternity can run afoul of insurance contracts for medical, disability or life coverage. Here are two tips for employers to avoid leave-related lawsuits . . . ." (Employee Benefit News)
[Guidance Overview] ERISA Regs, Conflict of Interest, and Assessing Mental Disabilities and Capabilities
"A New Jersey telecommunications worker became depressed and anxious and went out on medical leave late in 2004. His employer provided 26 weeks' short-term disability, and he then applied for long-term disability benefits. He received them for a year, but the plan then required reapplication, and he and the plan administrator have been wrangling ever since." (Business & Legal Reports, Inc.)
How to Avoid Leave-Related Lawsuits
"1. With self-funded health plans, make sure eligibility policies that are more generous than FMLA or other federal laws are approved by the reinsurance carrier. . . . 2. Clearly communicate conversion rights and termination of coverage to employees on leave." (Employee Benefit News)
[Guidance Overview] Failure to Disclose Time Limit for Filing Suit Resulted in Extended Deadline
"This case reinforces the importance of thorough disclosure and adherence to ERISA's claims procedure requirements. In particular, if a plan imposes a time limit for filing suit under ERISA, this limit should be set forth in the benefit denial notice, as well as in SPDs and other communications, if the plan hopes to enforce it." (Thomson Reuters/EBIA)
Legislation Introduced to Stem Abuse of Public Employee Disability Pensions in New Jersey
"The changes in the bill include: an increase from 4 to 10 years the service credit required before a member of state pension systems becomes available for an ordinary disability pension, and a restriction of disability awards to members who sustained injuries during regular and assigned duties. Disability awards for willful negligence would be eliminated." (newjerseynewsroom.com)
[Guidance Overview] Sedgwick's Denial Letter Complies with ERISA
"The plaintiff's primary argument is that Sedgwick's denial letter did not adequately advise her of what she needed to do to 'perfect' her claim and, therefore, that it was not in compliance with 29 C.F.R. ? 2560.503-1. The Second Circuit disagrees and affirms the District Court in ruling for the plan." (Jelsoft Enterprises Ltd.)
A Review of Employee Benefits Trends and Results Among 'The Principal 10 Best' Companies
"During the recent economic challenges, [companies named by The Principal Financial Group to a list of 'The Principal 10 Best Companies'] maintained robust benefits packages, with more of them increasing rather than decreasing retirement contributions during the past 10 years. Some shifted health insurance expenses onto employees, but a majority absorbed the cost themselves. Investing in wellness programs is a significant trend, driven by concern about the steadily rising cost of health care and hence the cost of health insurance. Another concern was how the changing health policy landscape will affect what benefits they can offer and what those benefits will cost." (Harvard Business Review)
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