Headlines about "Disability plans"
Gathered from the web by the editors at BenefitsLink.com.
Retirees May Be Abusing Disability Insurance, Long Island Rail Road Says
Excerpt: "On Tuesday the railroad gave the state attorney general, Andrew M. Cuomo, and the inspector general of the Metropolitan Transportation Authority evidence raising the possibility that hundreds of its employees were buying private disability insurance policies knowing that the federal railroad board would declare them disabled." (The New York Times; free registration required)
[Guidance Overview] Conflicts of Interest Under ERISA -- A Review of the Recent U.S. Supreme Court Decision
Excerpt: "In Metropolitan Life v. Glenn, 554 U.S. ___ (2008), a divided Court decided that a plan administrator has a conflict of interest when it decides whether to grant or deny claims that the plan will be required to pay. The Court found the conflict to be clear since '[t]he employer's fiduciary interest may counsel in favor of granting a borderline claim while its immediate financial interest counsels to the contrary.'" (Anderson Kill & Olick, P.C. via Mondaq; free registration required)
[Guidance Overview] Three Federal Circuit Courts Consider the Impact of Supreme Court's Glenn Decision on Standard of Review Analysis
Excerpt: "Here is a summary of three post-Glenn circuit court decisions, each of which involved a denial of long-term disability benefits." (Employee Benefits Institute of America)
[Guidance Overview] Reinstatements Revisited: Tate v. Long Term Disability Plan for Salaried Employees,
Excerpt: "After just reviewing the 7th Circuit decision in Hackett v. Xerox Corp. Long-Term Disability Income Plan, 315 F.3d 771 (7th Cir. 2003), so influential in Pannebecker v. Liberty Life Assur. Co., 2008 U.S. App. LEXIS 19753 (9th Cir. Ariz. Sept. 18, 2008), I find this recent decision from the 7th Circuit curious. This appears to be a case where the plan decision should fall in Category #2, as benefits were previously approved, but later terminated without a principled decision. Therefore, under Hackett,benefits should be reinstated." (Health Plan Law blog by Attorney Roy F. Harmon III)
New York Governor Wants Congress to Investigate Long Island Rail Road Disability Plan
Excerpt: "Gov. David A. Paterson Tuesday asked Congress to launch an investigation into possible abuses of a federal disability compensation plan by employees of the Long Island Rail Road. Paterson's call came on the same day that a member of the obscure federal agency that has been recently criticized for rubberstamping LIRR disability claims spoke out against 'an outdated ... system that desperately needs fixing.'" (Newsday)
[Guidance Overview] The Conundrum of ERISA Remands & Reinstatements
Excerpt: "Pannebecker provides helpful analysis on the point of what should follow should the circumstances of a benefit denial necessitate 'remand' to the plan administrator. In Pannebecker, the Ninth Circuit agreed with the district court that the plan administrator was justified in denying disability benefits on the view that the claimant could perform sedentary job duties. In other words, the plan administrator 'won'." (Health Plan Law blog by Attorney Roy F. Harmon III)
New York's Governor Seeks Study of Benefits at Long Island Rail Road
Excerpt: "Gov. David A. Paterson said on Sunday that he would give Andrew M. Cuomo, the state's attorney general, broad powers to investigate the Long Island Rail Road as part of a wide-ranging review his administration would seek of how disability and pension benefits were potentially manipulated by L.I.R.R. supervisors, workers and retirees." (The New York Times; free registration required)
[Guidance Overview] Ninth Circuit Opinion Holds Structural Conflict Exists Where Employer Pays Benefits Out of a Trust
Excerpt: "The Ninth Circuit, in the case of Burke v. Pitney Bowes Inc. Long-Term Disability Plan, weighed in on the interpretation of MetLife v. Glenn in another disability case, appearing to disagree (but not citing) one of the holdings in the recent Eleventh Circuit opinion of Frankie White v. Coca-Cola Bottling Co. . . . (Rather, the court stated it disagreed with the pre-MetLife decision of Gilley v. Monsanto Co., Inc., 490 F.3d 848, 856 (11th Cir. 2007) relied upon by the Eleventh Circuit in the White case.)" (Attorney B. Janell Grenier via Benefitsblog.com)
Another Reason Not to Use Your Pension before Retirement: ERISA Offset
Excerpt: "Every year thousands of people are wrongfully denied long-term disability benefits from their insurance company. Often, these individuals will take early withdrawal from their retirement plan in order to meet basic living expenses while appealing the denial of benefits. As a result, they are left with nothing to fund their retirement and because of the disability, no means of ever earning that income again. To add insult to injury, once the disability carrier decides that they were wrong and should not have denied benefits, they also take credit for the income received from the individual's pension, IRA or other retirement plan." (Florida Disability & LTD Weblog)
Reduction of LTD Benefits Based on Receipt of Social Security Benefits Is Reasonable
Excerpt: "The appellate court also agreed with a lower court ruling that Coca-Cola was right in trying to recoup overpayments of benefits. The court said the Coca-Cola's interpretation of both a provision in the Coca-Cola Long Term Disability Income Plan that permits an offset for the receipt of other disability benefits and one that allows the plan to recoup overpayments of benefits was correct." (PLANSPONSOR.com; free registration required)
[Guidance Overview] In Important 11th Circuit Case After the Glenn Decision, Heightened Arbitrary and Capricious Review Is Questioned
Excerpt: "This recent unpublished 11th Circuit opinion presents interesting comment, post-Glenn, on the appropriate standard of review in a benefits denial case. At issue was the plan administrator's reduction of benefits under a long-term-disability plan based on a participant's receipt of Social Security disability benefits." (Attorney Roy F Harmon III in the Health Plan Law blog)
Workers' Compensation: Benefits, Coverage, and Costs, 2006
Excerpt: "[This 88-page report provides] the only comprehensive national data on this largely state-run program. The study provides estimates of workers' compensation payments -- cash and medical -- for all 50 states, the District of Columbia, and federal program providing workers' compensation." (National Academy of Social Insurance)
Annual Statistical Report on the Social Security Disability Insurance Program, 2007
Excerpt: "Size and Scope of the Social Security Disability Program: Disability benefits were paid to more than 8.1 million people. Awards to disabled workers (804,787) accounted for about 90 percent of awards to all disabled beneficiaries (901,114). In December, payments to disabled beneficiaries totaled almost $7.8 billion. Benefits were terminated for 522,349 disabled workers. Supplemental Security Income payments were another source of income for about 1 out of 6 disabled beneficiaries." (U.S. Social Security Administration)
[Guidance Overview] 'Metlife v. Glenn': The Court Addresses a Conflict Over Conflicts in ERISA Benefit Administration (PDF)
11 pages. Excerpt: "A case concerning disability benefits could have important ramifications for how health benefits are administered as well. . . . This paper analyzes the history of the conflict in the courts over this issue; the Supreme Court's resolution of it in MetLife; and the implications of this decision for plans, beneficiaries, and health policy." (Health Affairs)
[Guidance Overview] The Supreme Court Strikes Twice (but Misses the Mark) (PDF)
4 pages. Excerpt: "In its recently completed term, the Supreme Court issued two ERISA-related opinions that address questions left unanswered by earlier Supreme Court decisions and that are of critical importance for plan administration (and litigation that may result from fiduciary missteps). . . . If the Court's intention was to entertain us with a series of interesting (but not that interesting) and thought-provoking essays . . ., then it hit the target both times. If, on the other hand, the Court's goal was to supply clear and sensible guidance in an area that is generating more (not less) litigation, its aim was not true." (Adams and Reese LLP)
[Opinion] On Estoppel and Equitable Remedies Under ERISA: It Should Be a Two-Way Street
Excerpt: "I've complained at times in the past that too many federal Circuit and District courts view ERISA's equitable remedies as a one way street. Plan fiduciaries chasing subrogation or overpayment claims have free rein to recover money from plan participants under the guise of 'appropriate equitable relief.' Yet those some courts often deny the participants any monetary recovery for violations of ERISA because recovery of money supposedly falls outside the scope of 'appropriate equitable relief.'" (Brian S. King's ERISA Law Blog)
[Guidance Overview] Employee Benefits Developments, August 2008 Issue
Includes ESOP Dividends -- New Tax Reporting Rules; Mere Posting of SPD on Intranet Does Not Ensure Actual Receipt; Trilogy of IRS Guidance Regarding Health Savings Accounts; Service by Director as Interim CEO Results in Loss of Tax Deduction for Corporation; IRS Proposes Regulations Regarding 'Greater of' DB Plan Formulas; and No FICA Tax Refund On Nonqualified Deferred Comp Plan Benefits Never Received; Kentucky Retirement System Does Not Violate the ADEA. (Hodgson Russ)
Total Incapacitation Not Only Proof of Disability in Wyoming
Excerpt: "The Wyoming State Supreme Court has decided that an employee's education and training level, and not just total incapacitation, can cause the worker to be eligible for permanent and total disability." (PLANSPONSOR.com; free registration required)
Beach Erosion on the ERISA Waterfront
Excerpt: "These are interesting times for those who contend for clients along the Maginot Line of ERISA's preemption provisions. Never a particularly easy line to follow, the perimeter has become increasingly uneven on several fronts. [These include provider reimbursement cases, equitable or promissory estoppel, state prohibitions on discretionary clauses, and state law actions against service providers.]" (Health Plan Law blog by Attorney Roy F. Harmon III)
Employer Was Not Off Base in Disability Cutoff
Excerpt: "A federal appellate court has cleared an employer of wrongdoing in the firing of an employee who returned to work while receiving disability benefits. The 1st U.S. Circuit Court of Appeals upheld a lower court decision that found Parametric Technology Corp. (PTC) did not run afoul of the Employee Retirement Income Security Act (ERISA) by carrying out the termination while Alexei Kouvchinov was receiving short-term disability benefits. Circuit Judge Bruce M. Seyla found there was no evidence of discriminatory intent by PTC." (PLANSPONSOR.com; free registration required)
[Guidance Overview] Seventh Circuit Holds for Insurance Carrier Denying Claims Under 'Arbitrary and Capricious' Standard
Excerpt: "Fibromyalgia claims face long odds in federal court, and this Seventh Circuit decision fits the typical pattern. As a post MetLife v. Glenn decision, the case does nonetheless present some surprise in that it does not address the standard of review in more than a passing manner." (Health Plan Law blog by Attorney Roy F. Harmon III)
Getting Social Security Disability Payments Can Be a Fight to The Death
Excerpt: "The crest of baby boomers has reached prime age for disabilities and now slams Social Security offices." (AARP)
Worker's Positive Drug Test While on FMLA Leave not Grounds for Benefits Denial
Excerpt: "A state of Ohio appellate court has thrown out a decision by the Industrial Commission of Ohio denying an employee who tested positive for cocaine temporary total disability compensation." (PLANSPONSOR.com; free registration required)
[Guidance Overview] MetLife v. Glenn Decision Wedges Open Discovery on Use of Outside Consultants
Excerpt: "It was just a matter of time before we saw a case where the district court judge took a fresh view of discovery limitations in view of the Supreme Court's decision in MetLife v. Glenn. In Hogan-Cross, Judge Kaplan rejected MetLife's position that discovery should be limited to the 'administrative' record simply because the policy language contained a discretionary clause. The opinion will likely receive ample use in ERISA discovery disputes on a wide range of issues." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] Harsh Consequences of Shoddy Claim Denials and Explanations of Benefits
Excerpt: "Two recent district court decisions highlight the fact that administrators issuing unclear or incomplete claim denial letters do so at their own peril. In both Tinker v. Versata, Inc. Group Disability Income Insurance Plan, No. 2:06-CV-02906 (E.D. Cal. July 13, 2008) and O'Connell v. Northland Lutheran Retirement Community Employee Benefit Plan, No. 07-C-637 (E.D. Wis. July 15, 2008), judges imposed significant penalties on plans for failing to live up to ERISA's standards in their explanations of claim denials." (McGuireWoods LLP)
[Guidance Overview] U.S. Supreme Court Rules on How ERISA Benefit-Claim Fiduciaries Should Handle Conflicts of Interest
Excerpt: "The United States Supreme Court recently decided Metropolitan Life Insurance Co. v. Glenn ('MetLife'), giving critical guidance to ERISA fiduciaries who consider and decide benefit claims. The Court held that a conflict of interest inherently exists when a fiduciary both makes benefit eligibility decisions under a plan and funds those benefits (referred to by the Court as the 'evaluator/payor conflict'); that courts should consider this conflict as a factor when determining whether the fiduciary abused its discretion in denying benefits; and that the significance of the factor will depend upon the circumstances of the particular case." (Blank Rome LLP)
[Guidance Overview] Benefit Claims Procedures Should Be Reviewed to Address Potential Conflict of Interest Issues Raised in Supreme Court Glenn Decision
Excerpt: "If an employer has any benefit plans where the persons responsible for deciding claims for benefits are also responsible for paying for those benefits, consideration should be given to revising those plans to eliminate those potential conflicts of interest. Steps that employers can take now to address these potential conflicts of interest include the following . . . ." (Bond, Schoeneck & King, PLLC)
[Guidance Overview] COBRA Was Required for Former Employee Receiving Social Security Disability Benefits
Excerpt: "Medicare entitlement can affect an individual's COBRA rights in several different ways, and keeping all the rules straight is not an easy task. This case illustrates that one source of confusion can be the various benefit programs that the SSA operates. As this court explains, receipt of Social Security disability benefits does not justify a failure to provide COBRA." (Employee Benefits Institute of America)
[Guidance Overview] Audio of Webinar: Recent ERISA Litigation - What's the Verdict?
Excerpt: "On July 23, David Levin with Gallagher Benefit Services hosting presented a webinar on recent ERISA litigation and the various issues for sponsors of ERISA plans. This webinar provided an overview of these recent cases and their impact on ERISA plans . . . ." (Drinker Biddle & Reath LLP)
[Guidance Overview] Ninth Circuit Sees Broader Discovery Rights for ERISA Claimants in Conflict of Interest Cases
Excerpt: "The open-ended nature of the inquiry into the existence and effect of structural conflicts of interest in MetLife v. Glenn suggests the possibility, if not the probability, that judges disinclined to give existing precedent hostile to broad discovery ample room to fall back upon the status quo." (Health Plan Law blog by Attorney Roy F. Harmon III)
More Players Call Foul on National Football League's Pension System
Excerpt: "The National Football League's pension system continues to pay players less than they are entitled to for disabilities caused by on-field injuries, a lawsuit filed in U.S. District Court in Baltimore claims. The pension suit against the league is the third one filed by attorney Cyril V. Smith, who won a verdict of more than $1.5 million for the family of the late 'Iron Mike' Webster in 2005. The decision was affirmed by the 4th U.S. Circuit Court of Appeals." (The Daily Record)
[Guidance Overview] Court Rebuffs Fiduciary Breach Claim As Redundant in Claim for Benefits Case
Excerpt: "The Crider opinion offers several interesting insights. First, the case addresses an attempt to incorporate state law into an ERISA long term disability policy. Second, the case raises the nettlesome issue of when a fiduciary breach claim can be heard along side a claim for benefits." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] Plan Without 'Discretion' Language Loses Appeal in Benefits Case
Excerpt: "Two recent federal appeals court cases demonstrate that having the right language in the plan document often determines whether the plan wins or loses a benefits-denial case. In each case, the plan administrator denied a claim for disability benefits, the trial court upheld the plan's decision, and the participant appealed. In the Fourth Circuit case (Woods) the plan lost the appeal, while in the Seventh Circuit case (Gutta) the plan won." (Employee Benefits Institute of America)
[Guidance Overview] What Effect Does MetLife v. Glenn Have on Discovery in Denial of Benefit Claims?
Excerpt: "Apparently none, at least according to the first ruling on this question I have seen out of a court in the First Circuit. In a ruling by a magistrate judge, the United States District Court for the District of Maine has concluded that MetLife v. Glenn does not change the rules in the First Circuit governing the extent to which - if at all - a party is allowed to conduct discovery beyond the administrative record itself in a denied benefits case governed by the arbitrary and capricious standard of review." (Stephen Rosenberg of The McCormack Firm, LLC)
[Guidance Overview] District Court Clarifies Standard for Providing Notice of Plan Limitations Provisions
Excerpt: "A recent decision from the U.S. District Court for the District of Arizona raises important drafting and administrative issues for employers to consider when adding a plan-based statute of limitations provision to their benefit plans. In Solien v. Raytheon Long Term Disability Plan #590, the court refused to uphold a plan-based one-year limitations period for challenging benefit claims in court because the limitation period was not adequately disclosed in the summary plan description (SPD) and was not communicated to the participant as part of the plan's claim denial determination." (McDermott Will & Emery)
[Guidance Overview] 10 Things the Supreme Court Did Not Do in Metlife v. Glenn
Excerpt: "As we look at the disputes presented in the arena of benefit claims and denials through the murky lens held up in Breyer's MetLife opinion, we have reason to ask if legal pragmatism really is as workable as its adherents claim." (Health Plan Law blog by Attorney Roy F. Harmon III)
Listing of Post-MetLife v. Glenn Decisions
Excerpt: "The initial reception by the judiciary is the best indicator of what a Supreme Court decision really 'means'. To that end, here's what I have for decisions citing the case thus far . . . ." (Health Plan Law blog by Attorney Roy F. Harmon III)
Human Resource Professionals Should Review Who Makes Health and Disability Benefit Determinations for Their Companies
Excerpt: "In the employee-benefits case, MetLife vs. Glenn, the Court ruled that companies have a potential conflict of interest when they administer health and disability benefit plans, and decide claims filed under the plans. The justices ruled that courts should consider whether a conflict exists when employees challenge decisions by plan administrators." (Human Resource Executive Online)
[Guidance Overview] Supreme Court Provides Further Guidance on Judicial Review of Benefit Claim Denials
Excerpt: "Last month, in a case closely watched by those who sponsor and administer ERISA plans, the Supreme Court provided additional guidance regarding what constitutes a conflict of interest and how courts should weigh such conflicts. The Supreme Court 's decision potentially affects benefit claims under all types of retirement and welfare plans subject to ERISA." (Faegre & Benson LLP)
A Concise ERISA Counterclaim Review Checklist
Excerpt: "From a survey of the post-Sereboff counterclaim cases, here's a list of key recurring issues . . . ." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] Supreme Court Issues Two Significant Employee Benefits Decisions, But Uncertainty Remains (PDF)
4 pages. Excerpt: "In its recent decisions in Kentucky Retirement Systems v. E.E.O.C. and Metropolitan Life Insurance Company v. Glenn, the United States Supreme Court addressed several important issues regarding the design of employee benefit plans and related litigation. Both decisions, however, have unfortunately left a number of significant issues undecided and may lead to confusion and uncertainty for litigants and courts alike." (Dechert LLP)
[Guidance Overview] Conflict of Interest in Claims Decisions – A Critical Analysis of MetLife v. Glenn
Excerpt: "As a result of the heightened scrutiny that conflicts of interest will be subject to, it is important to take notice of the Supreme Court's position that steps can be taken to minimize the potential adverse effect of financial conflicts of interest. Although these steps are not required, it is likely that employers or insurers who fail to take these steps will be at a distinct disadvantage when a claim denial is challenged in court." (Kilpatrick Stockton LLP)
[Guidance Overview] District Court Opinion Provides Additional Analysis of Post-Sereboff Counterclaims
Excerpt: "I recently noted what appears to be a tendency in disability cases to permit counterclaims against benefit claimants to proceed without significant analysis of the counterclaims' theoretical basis. (See, :: Seventh Circuit Holds That Sereboff Supports Disability Carrier's Counterclaim) In the recent decision in Raybourne v. Cigna, however, the court gives the issue more detailed analysis and is therefore worthy of note." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] Insurer Not Liable for Participant's Claims-Related Copy Costs or for Penalties for Failure to Provide Claims Documents
Excerpt: "Most of the court's conclusions seem unremarkable to us, but this case is noteworthy because the Ninth Circuit seems to be establishing a rule that participants may sue a plan administrator (usually the employer) for penalties under ERISA Section 502(c)(1) for failure to provide relevant documents under the claims regulations. Not all courts would agree with this approach." (Employee Benefits Institute of America)
[Guidance Overview] State Law Placing Limits on Discretionary Language in Insurance Policies Found to Be Preempted by ERISA
Excerpt: "The issue in this case has practical significance because, if ERISA preemption makes this kind of state law unenforceable, affected insurers will be free to include discretionary language that would otherwise be precluded. As a result, benefit denials will, in general, be subject to a more favorable standard of judicial review when challenged in court, making them more likely to be upheld." (Employee Benefits Institute of America)
[Guidance Overview] Conflicted Plan Administrators Face Slightly More Rigorous Judicial Review of Benefit Determinations
Excerpt: "ERISA authorizes companies to fulfill both fiduciary and nonfiduciary functions as long as they do not in actuality commingle those functions. See 29 U.S.C. § 1108(c)(3). ERISA permits dual roles because ERISA's protections in combination with judicial scrutiny, provide adequate structural safeguards to ensure the just administration of employee benefit plans." (Palmer Kazanjian Wohl Perkins, LLP)
[Guidance Overview] Eighth Circuit Relies Upon Pre-Glenn Precedent in Evaluating Disability Claim
Excerpt: "The Eighth Circuit approach to addressing conflicts of interest was set forth in Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir. 1998). In the a post-Glenn claim for disability benefits decision, the Eighth Circuit determined that the approach taken in Woo still works acceptably in light of the Glenn opinion." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] Fourth Circuit Addresses Plan Language Necessary to Secure Deferential Standard of Review
Excerpt: "Language in a long term disability plan that merely designated who must make benefits determinations and the timing of those determinations was not sufficient to trigger a deferential standard of judicial review of the plan administrator's denial of LTD benefits. This was the ruling of the Fourth Circuit U.S. Court of Appeals in Woods v. Prudential Insurance Company of America (No. 07-1580)." (Wolters Kluwer)
[Guidance Overview] Ninth Circuit Shoots Down Claim for Copying Charges in Disability Case
Excerpt: "Mitchell Sgro applied for disability benefits from MetLife, which decided benefit claims for his employer's ERISA plan. Sgro asserted that MetLife refused to evaluate his claim because he did not send copies of medical records. Sgro eventually paid $412 for the copies. MetLife denied his claim after receiving them." (ERISA on the Web)
[Guidance Overview] Court Holds Contractual Language Does Not Bar Plaintiff's Disability Claims
Excerpt: "ERISA does not contain a specific statute of limitations for benefits claims. (This is rather odd given the frequent conception of the statute by the federal judiciary as a 'comprehensive and reticulated' regulatory scheme.) In any event, when Congress omits a statute of limitations for a federal cause of action, courts 'borrow' the local time limitation most analogous to the case at hand." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] Supreme Court Finding of Conflict of Interest Adds New Wrinkle to Benefit Claims Review (PDF)
3 pages. Excerpt: "Taking a cue from Justice Breyer, employers may want to review how their benefits claims decision-making is currently structured and take active steps, such as using third-party administrators ('TPA') that are not the payor to decide claims and evaluating the TPA's performance based on reversals of denials by courts. Insurance companies may want to build firewalls between those who pay the claims and those who decide whether a benefit is valid under the terms of the insurance policy in order to minimize (perhaps to the vanishing point) the structural conflict of interest." (Thompson Hine LLP)
[Guidance Overview] Supreme Court Presumes Conflict of Interest in 'Dual Role' Benefits Denial Cases (PDF)
Excerpt: "On June 19, 2008, the Supreme Court upheld the application of the deferential abuse of discretion standard of review for benefit decisions under ERISA-governed plans even in instances when the decision-maker on the claim also is responsible for paying benefits or is affiliated with the payer." (Seyfarth Shaw LLP)
[Guidance Overview] Counterclaim for Disability Benefits Properly Framed in Terms of Sereboff Prerequisites
Excerpt: "Professor Roger Baron calls our attention to another recent counterclaim case in which the district court got the analysis right. The case is Killian v. Johnson & Johnson, 2008 U.S. Dist. LEXIS 49580 (D.N.J. June 23, 2008). In that case the defendant in a claim for benefits case filed a counterclaim, asserting that social security benefits received by the plaintiff should have been offset from disability benefits paid to her - resulting in her actually owing the plan, on the defendant's theory, some $45,000." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] District Court Finds Abatie Standard Consistent With MetLife v. Glenn Requirements
Excerpt: "A California district court has essentially found the approach taken in Abatie v. Alta Health & Life Ins. Co., 458 F.3d 955 (9th Cir. 2006), consistent with that recently articulated by the U.S. Supreme Court in MetLife v. Glenn." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] Sixth Circuit Says Independent Medical Examination Results Doom Plaintiff's Disability Claim
Excerpt: "The bottom line is that the use of examining physicians can seriously affect the outcome of an ERISA claim. Indeed, in Lupo v. Daimlerchrysler Corp., 2008 U.S. App. LEXIS 13658 (5th Cir. Jun. 24, 2008), the use of an examining physician became entirely conclusive." (The Wood Law Firm)
[Opinion] Some Additional Reflections on the MetLife Decision
Excerpt: "Look first at the majority opinion. Here is the two sentence version of the majority opinion: in deciding whether a conflicted plan decision-maker's rejection of a benefit claim is an abuse of discretion, a district judge should consider and weigh all factors, of which a conflict is one factor. The conflict is not too important, though, if the plan has structural safeguards against decision-maker bias, such as erecting a wall between the 'claims administrators and those interested in firm finances.' Here are three problems with the majority opinion." (Pension & Benefits Blog)
[Guidance Overview] Seventh Circuit Holds That Sereboff Supports Disability Carrier's Counterclaim
Excerpt: "This recent Seventh Circuit opinion in an ERISA disability case addresses the language needed to avoid de novo review, conflicting evidence of disability and an interesting counterclaim argument based upon Sereboff principles." (Health Plan Law blog by Attorney Roy F. Harmon III)
[Guidance Overview] In Metropolitan Life v. Glenn: The Supreme Court Weighs in on Weight to Be Given to Benefit Decisions
Excerpt: "Because this case may well result in more lawsuits filed over denied benefit appeals, plan sponsors and administrators must become more attuned to the necessity of fully documenting their claims review processes, ensuring that all relevant materials (particularly those submitted by the claimant) are addressed in the denial letter, and avoiding inconsistent or irreverent comments in e-mails and other correspondence relating to benefit claims." (Littler Mendelson P.C.)
[Guidance Overview] U.S. Supreme Court Rules on Plan Conflict of Interest and the Standard of Review in ERISA Benefits Litigation
Excerpt: "This Capital Checkup provides background for the decision and an overview of the facts in the case. The decision should not have any immediate impact on plan operations." (The Segal Group, Inc.)
[Guidance Overview] U.S. Supreme Court's Rulings on Employee Benefits, Employment Practices (PDF)
2 pages. (Milliman)
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