Headlines about "Disability plans"
Gathered from the web by the editors at BenefitsLink.com.
[Guidance Overview] Insurer Properly Denied Claim for LTD Benefits Where Beneficiary Was Not 'Disabled' Under the Plan
Excerpt: "An insurance company did not abuse its discretion when it denied a claim for long term disability benefits filed by a beneficiary who did not meet the LTD plan's definition of 'disabled.' This was the ruling of the Third Circuit U.S. Court of Appeals in Taylor v. Union Security Insurance Company and Titus & McConomy Long Term Disability Benefits Plan (No. 08-3692)." (Wolters Kluwer)
[Guidance Overview] Discretionary Clauses in Disability Insurance Policies in California and Their Impact on ERISA Plans (PDF)
At pages 3-6 of 9-page newsletter. Excerpt: "Since February 2004, the California Department of Insurance ('DOI') has prohibited insurance companies from including in their insurance policies 'discretionary clauses' reserving discretionary authority to the insurer as the benefits claims decision-maker. . . . This article provides an update on the effect of the DOI's prohibition of discretionary clauses on the standard of review for ERISA benefit claims litigation. . . . [T]he state's policy against discretionary clauses is currently limited to disability insurance policies." (Trucker Huss)
[Guidance Overview] First Circuit Refines Its Standard of Review Analysis Based on Supreme Court's Glenn Decision
Excerpt: "EBIA Comment: While the court's modest refinements of the First Circuit's standard of review analysis are significant, this case is also interesting for its suggestion that, under Glenn, courts must inquire into the steps a decisionmaker has taken to mitigate the effects of a structural conflict. If plan decisionmakers understand that the courts will be looking for that information, they may be more likely to regularly document the steps they have taken to prevent or mitigate conflicts. And if conflicts are not fully revealed by the administrative record, participants may be more likely to seek discovery about them, although the permissible scope of such discovery remains unsettled." (Employee Benefits Institute of America)
[Guidance Overview] 1st Circuit Refines Benefits Denial Case Law
Excerpt: "After tweaking their standard for how federal judges should handle employee benefits denial cases involving a conflicted plan administrator, federal appellate judges have ordered more hearings in just such a case. The 1st U.S. Circuit Court of Appeals sent back to a lower court Denmark v. Liberty Life Assurance Co. of Boston with instructions to gather more evidence on the issue of why disability benefits were denied in a case that has made several trips through the federal judicial system. In Denmark the lower court found the denial of long-term disability was supported by substantial evidence and within the plan administrator's discretion, and ruled for the insurance company." (PLANSPONSOR.com; free registration required)
[Guidance Overview] ERISA Applies to Tribal Disability Plan Covering Casino Employees
Excerpt: "EBIA Comment: We found this case interesting because there has been little comment from the courts on the difference between 'essential government functions' and 'commercial activities.' We also note that the court rejected the employee's argument that because the plan failed to file annual Form 5500s, it was not subject to ERISA." (Employee Benefits Institute of America)
Seventh Circuit Discusses 'Independent Medical Examinations' in a Footnote to Ruling
Excerpt: "The Seventh Circuit did not feel that the new Glenn standard made a difference in the outcome of this long-term disability case--Jenkins v. Price Waterhouse Long Term Disability Plan. However, the court did, in a footnote, issue a warning about 'independent medical examinations' . . . ." (Attorney B. Janell Grenier via Benefitsblog.com)
[Guidance Overview] The Effect of the Americans with Disabilities Act on Health and Disability Plans (PDF)
Excerpt: "As a general rule, neither ADA nor ERISA requires an employer to provide specific benefits. However, the broad language of ADA does prohibit 'disability-based' discrimination in employee benefits. A distinction based on disability is prohibited, but a distinction that applies equally to all employees is not. Questions about the 'disability-based distinction' often arise for both health plans and disability plans. The issue created by ADAAA is whether an employer that provides health or disability benefits has discriminated against an employee if it does not provide benefits, and therefore denies a claim, for a condition that now qualifies as a disability under ADA." (Miller Chevalier)
[Guidance Overview] The Impact of Disability on Non-Qualified Deferred Compensation Under Code Section 409A
Excerpt: "This article examines the interrelationship between disability and the rules of Section 409A and discusses potential pitfalls that may be avoided with proper examination and drafting of a plan's disability definitions and procedures. Internal Revenue Code Section 409A allows 'disability' to be a payment trigger for deferred compensation, with disability defined under stringent standards set forth in the final regulations under Section 409A. Even if disability is not a payment trigger as such, the occurrence of a disability may impact the timing of payments made under a separation from service trigger. Additionally, a disability may affect vesting or other aspects of the operation of a deferred compensation arrangement, which may have implications under Section 409A. [Originally published March 23, 2009.]" (Faegre & Benson)
[Guidance Overview] No Voluntary Plan Exemption Where Employer Determined Eligibility and Assumed Administrative Role
Excerpt: "EBIA Comment: This employer's involvement with the short-term disability plan -- which included assisting in drafting plan eligibility requirements and helping employees with claims -- is a virtual 'what not to do' list for satisfying the voluntary plan safe harbor's no-endorsement rule (also referred to as 'employer neutrality'). We suspect that this employer intended for the plan to be subject to ERISA, thereby allowing it to use ERISA preemption as a shield to protect it from state-law claims, such as those alleged by the employee." (Employee Benefits Institute of America)
[Guidance Overview] Two More Circuits Change Their Standard of Review Analysis Based on Supreme Court's Glenn Decision
Excerpt: "EBIA Comment: The circuit courts continue to adjust their standard of review analysis in response to the Glenn decision. It may be difficult to predict whether the Glenn analysis would change the outcome in a particular case, but it clearly seems to have that potential." (Employee Benefits Institute of America)
[Guidance Overview] EEOC Warns Employers about ADA Impact of Health Assessments
Excerpt: "The Equal Employment Opportunity Commission (EEOC) has indicated that requiring workers to undergo a health risk assessment that includes disability questions likely violates the Americans with Disabilities Act (ADA). Peggy R. Mastroianni, EEOC associate legal counsel, asserted in an 'informal discussion letter' that the scenario of undergoing such an assessment as a prerequisite for coverage 'does not appear to be job-related and consistent with business necessity, and therefore would violate the ADA.'" (PLANSPONSOR.com; free registration required)
Executive Summaries of Market Surveys on the U.S. Group Disability Market, U.S. Group Life Market, and Absence Management
Excerpt from the group disability survey: 'JHA is pleased to present the 2008 U.S. Group Disability Market Survey. Conducted on an annual basis, this benchmark industry survey covers Group LTD and STD inforce and sales premium results for 2008. Further analysis and data on lapse rates, renewal activity, and ASO are included for those companies that provided this data. Thirty insurance carriers participated in the 2008 Market Survey, representing close to 95% of the group disability insurance marketplace." (JHA, a subsidiary of General Re Life Corporation)
[Guidance Overview] Discovery Under MetLife v. Glenn: First Circuit Decides Important Disability Case
Excerpt: "[On May 6, 2009] the U.S. Court of Appeals for the First Circuit issued its long awaited decision in Denmark v. Liberty Life Ass. Co. The case involves Diane Denmark's assertion that Liberty Life wrongly denied her disability claim. The procedural history is long and torturous. The First Circuit ended up delaying a ruling in the case until MetLife v. Glenn, 128 S.Ct. 2343 (2008), was decided to get the Supreme Court's guidance on how an insurer's conflict of interest affects the standard of review a trial court should utilize in ERISA benefit denial cases." (Brian S. King)
[Guidance Overview] Glenn Is Turning Point in Decade-Long Battle Over Disability Benefits
Excerpt: "The Eighth Circuit applied the Supreme Court's MetLife v. Glenn conflicts analysis and turned the tables for a disabled participant's decade-long quest for disability benefits in the case of Chronister v. Unum Life Insurance Company of America (posted at Plan Sponsor), holding that the insurer had abused its discretion in terminating the participant's disability benefits. While the Eighth Circuit noted the insurer's 'history of biased claims administration' as one factor that the court must consider in determining whether there was an abuse of discretion, the court considered the insurer's 'failure to follow its own claims-handling procedures' with respect to how it dealt with the Social Security's determination that the participant was disabled to be 'most egregious.'" (Attorney B. Janell Grenier via Benefitsblog.com)
[Guidance Overview] Court Uses High Court Decision to Resolve Disability Dispute
Excerpt: "Insurer Unum has lost a decade-long disability benefits dispute after the 8th U.S. Circuit Court of Appeals decided a U.S. Supreme Court decision redefined the abuse of discretion standard of review. The appellate court agreed with Sandra J. Chronister that the high court's decision in Metropolitan Life Insurance Company v. Glenn on how much the conflict of a dual role of a plan administrator that is also a payer of benefits should be considered when reviewing the administrator's denial of benefits . . . meant that Unum must be held to a less-deferential standard of review." (PLANSPONSOR.com; free registration required)
[Guidance Overview] Court of Appeals Finds Sun Life Acted Arbitrarily and Capriciously in Disability Case
Excerpt: "After reviewing the quality and quantity of the medical evidence, the court found that 'the entirety of the medical evidence available to Sun Life was not reviewed in a 'deliberate' or 'principled' fashion, which is a factor suggesting that Sun Life's ultimate determination was arbitary.' The fact that DeLisle worked for two weeks after leaving her employer and listed 'lack of work' as her reason for leaving her employer did not amount to persuasive evidence that she was able to complete the duties of her job on April 17, 2002. For these and other reasons, the Sixth Circuit agreed with the district court and concluded that Sun Life had acted arbitrarily and capriciously." (The Wood Law Firm, PLLC)
[Guidance Overview] Citing ERISA Preemption, Sixth Circuit Dismisses State-Law Claims
Excerpt: "The Sixth Circuit rejected Lerner's [the plaintiff] arguments that his state-law claims against EDS were based not on Continental's denial of long-term disability benefits, but on EDS's alleged failure to make sure that his SDRC benefits were not diminished in the corporate transition. The Court pointed out that Lerner had specifically pled in his state-law claims that his damages included 'the loss of disability insurance benefits (monthly benefit payments, return to work benefits, and rehabilitation benefits.)' In the view of the Court, 'Lerner has thus chosen to seek payment of the disability insurance benefits themselves, not merely damages in an amount equal to those benefits.' Therefore, the Court said, 'the state-law claims against EDS for breach of contract, fraudulent misrepresentation, and innocent misrepresentation 'relate to' an ERISA benefit plan and are preempted by that federal statute.'" (The Wood Law Firm, PLLC)
[Guidance Overview] Eighth Circuit Reverses District Court on Vesting Issue
Excerpt: "The recent Eighth Circuit case of Halbach v. Great-West Life & Annuity Insurance Company involves another controversy over the issue of vesting in regards to medical benefits. The Eighth Circuit overturned the district court on two issues: (1) Whether there was a valid plan amendment eliminating medical benefits for long-term disability recipients; and (2) Whether the disability recipients were vested in their medical benefits prior to the plan amendment." (Attorney B. Janell Grenier via Benefitsblog.com)
[Guidance Overview] Great-West Health Coverage Suit Sent Back for More Hearings
Excerpt: "A federal appellate court has sent back for more hearings a suit filed by disabled employees of Great-West Life & Annuity Co., charging the firm with wrongdoing in connection with cutting off medical coverage for employees on disability leave. The 8th U.S. Court of Appeals said a lower court was wrong in ruling that Great-West intended for employees to have vested health insurance coverage as long as they remained disabled or until age 65. The three-judge appellate panel said they found ambiguous a plan provision allowing the employer to amend the plan and that the lower court judge needed to gather more evidence before resolving the ambiguity." (PLANSPONSOR.com; free registration required)
[Guidance Overview] Recent Long-Term Disability Litigation Decisions
Excerpt: "Judge Gertner of the federal district court in Massachusetts issued a pair of bookend decisions in long term disability cases a few days back that present an interesting contrast with regard to an issue that troubles many critics of the arbitrary and capricious standard, namely the extent to which an administrator deciding a claim for benefits can favor the opinions of its own reviewing physicians over the opinions of the participant/claimant's treating physicians." (Stephen Rosenberg of The McCormack Firm, LLC)
[Guidance Overview] Court Orders CIGNA to Pay Six-Figure Attorney's Fees in ERISA Case
Excerpt: "Steven Alfano won his ERISA claim for long-term disability benefits against CIGNA. The district court had previously ruled that there was 'no sound basis in the record to support CIGNA's finding that plaintiff's back condition ? had in fact improved.' Alfano sought attorney's fees from CIGNA under 29 U.S.C. ? 1132(g)(1). In its analysis, the court considered the following factors under Second Circuit jurisprudence: (1) defendant's culpability or bad faith, (2) defendant's ability to withstand payment, (3) the extent to which an award would deter others from similar conduct, (4) the relative merits of the parties' positions, and (5) whether the action confers a common benefit on a class." (The Wood Law Firm, PLLC)
[Guidance Overview] ERISA Insurer Entitled to Offset Settlement on 2nd Medical Condition
Excerpt: "The 4th Circuit reasoned that the insurer was the fiduciary, as defined by ERISA, and had discretionary authority to interpret the plan and its terms. The court found the insurer acted reasonably in the interpretation of the plan's language. The court noted that the insurer's interpretation was consistent with the plan's design, which was to assure 'an income stream for the disabled employee during the period of disability rather than an independent benefit quantified by a specific disability.'" (Risk & Insurance)
[Guidance Overview] Judicial Development - Gertjejansen v. Kemper Ins. Co.
Excerpt: " A ruling by the 9th U.S. Circuit Court of Appeals emphasizes the importance of complying with the U.S. Department of Labor's regulations on delivering plan documents electronically." (The Precept Employee Benefits Blog)
[Guidance Overview] Eleventh Circuit Holds That ERISA Does Not Authorize Fee Award for 'Pre-Litigation Administrative Proceedings'
Excerpt: "In this case the Eleventh Circuit rejected a claim for attorney's fees for time expended in a 'claims reassessment' process offered by UNUM to claimants whose claims had been denied. After suit was filed following a denial of benefits, the disability claimant received a letter from UNUM offering a claims reassessment as a part of a program instituted by the company in cooperation with states' attorney general offices." (Roy Harmon III via Health Plan Law)
Trends in Short-Term Disability Plan Design (PDF)
4 pages. Excerpt: "[This paper] examines the design and prevalence of short-term disability (STD) programs among Towers Perrin's Benefits Data Bank? (BDB) participants." (Towers Perrin)
[Guidance Overview] Eighth Circuit Requires Evaluation of Conflict Factor As a Tiebreaker
Excerpt: "This opinion from the Eighth Circuit shows a noticeably different tone than the previous regime imposed under the pre-Glenn Eighth Circuit case, Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th Cir. 1998). The facts presented are not remarkable. One could easily envision the Court simply concluding that the omission of a Glenn conflict evaluation would have made little difference in the outcome. The Court's decision to remand the case for evaluation of the conflict as a 'tiebreaker' factor suggests that the Eighth Circuit may see a broader role for Glenn than has been the case in the Forth Circuit thus far." (Roy Harmon III via Health Plan Law)
[Guidance Overview] After the Finding of Conflict: How Should Conflicts of Interest Affect ERISA Judicial Review?
Excerpt: "In a recent law review article, I predicted that the level of review of the administrative record after Glenn will vary based upon judicial temperament. 'The Debate Over Deference In The ERISA Setting - Judicial Review Of Decisions By Conflicted Fiduciaries', 54 South Dakota Law Review 1 (2009). The Sixth and Fourth Circuit Courts of Appeals offer interesting comparisions illustrating differing perspectives on judicial review of benefit denials." (Roy Harmon III via Health Plan Law)
[Guidance Overview] The Seventh Circuit Puts a Spin on Discretionary Review
Excerpt: "There is an interesting twist to a recent Seventh Circuit decision, Leger v. Tribune Company Long Term Disability Plan. The decision starts out as an attempt by the participant to resuscitate her benefits claim by invoking Glenn v. MetLife and asserting that a structural conflict of interest existed warranting an alteration to the standard of review. The Seventh Circuit, though, quickly rejected that position, finding that there wasn't even a conflict of a level that warranted being considered as a factor in conducting an arbitrary and capricious standard of review." (Stephen Rosenberg of The McCormack Firm, LLC)
[Guidance Overview] Arbitration Agreement Upheld Despite Binding Arbitration and Cost-Sharing Provisions
Excerpt: "EBIA Comment: For group health and disability claims, the DOL claims procedure regulations permit mandatory arbitration to be used for one of the required two levels of claims appeals, provided such arbitration is not binding. Group health and disability plans that wish to use binding arbitration may do so only by offering it to claimants as a voluntary method of appeal. Also, the DOL takes the position that the regulations' general prohibition on hampering or hindering claims (which prohibits any practice that requires payment of a fee or costs as a condition to making a claim or an appeal) precludes any requirement for cost-sharing in the arbitration of an appeal." (Employee Benefits Institute of America)
[Guidance Overview] Sixth Circuit Applies Met Life v. Glenn Factors to Overturn Diability Benefit Denial
Excerpt: "The Sixth Circuit continues to develop an impressive body of law favorable to disability claims as Delisle v. Sun Life aptly demonstrates. This case offered the Court an opportunity to refine two independent trends, both advantageous to ERISA claimants. First, the Court revisited its recently vindicated analysis of conflicts of interest. Second, it added to the growing body of post-Nord caselaw which weighs the 'quantity and quality' of medical opinions and finds the treating physician opinions more reliable." (Health Plan Law)
[Guidance Overview] Glenn Ruling Has Far-Reaching Effects on How Courts Treat Plaintiffs' Denied Requests for LTD Benefits
Excerpt: "Between the district and appellate courts' reviews [of this case], the U.S. Supreme Court issued a significant ruling about LTD plans that are covered by ERISA. That decision, in Metropolitan Life Insurance v. Glenn (2008), said that any conflict of interest -- such as that of First Unum in this case -- must automatically be weighed as a factor in whether the insurer's decision was reasonable. First Unum had lied to McCabe, first in telling him a physician had reviewed all his records during the appeal and then in concealing the fact that the nurse had rejected the memo because McCabe's doctor didn't sign it." (Business & Legal Reports, Inc.)
[Guidance Overview] The Stimulus Bill and Other Congressional Action Create New Obligations for Benefit Plan Sponsors
Excerpt: "The President's signing of the American Recovery and Reinvestment Act of 2009 (the 'Stimulus Bill') on February 17, 2009 is just one in a string of recent events which impose new obligations on sponsors of employee benefit plans. This client alert is intended to summarize the employee benefit developments raised by the Stimulus Bill, as well as some other issues now facing employers sponsoring health and retirement plans." (Michael Best & Friedrich LLP)
[Guidance Overview] District Court Holds That Procedural Conflict Results in Expanded Discovery Rights
Excerpt: "In this dispute over long term disability benefits, the district court addressed the scope permissible discovery and the proper standard of review. Given the procedural irregularities found in the record, the court permitted rather extensive discovery beyond the administrative record. In addition, the recent Supreme Court decision in MetLife v. Glenn forced the district court to consider that decision's effect of Third Circuit's use of a 'sliding scale' of heightened scrutiny where the plan fiduciary operated under a conflict of interest." (Health Plan Law)
[Guidance Overview] Ninth Circuit Requires Application of Normal Summary Judgment Rules in Benefits Denial Review
Excerpt: "Discovery issues present one of the most interest post-Glenn arenas for disputes between disability carriers and ERISA plan participants. In this case, the insured obtained long-term disability benefits from Metropolitan Life Insurance Company (MetLife). The Ninth Circuit found fault with the district court's breezy evaluation of the facts in granting summary judgment to the disability carrier." (Health Plan Law)
[Guidance Overview] Neglect of Treating Physicians' Opinions Leads to Decision for Plaintiff
Excerpt: "In rejecting a per se 'treating physician rule', the Supreme Court's opinion in Black & Decker Disability Plan v. Nord did not hold that treating physician opinions can be neglected. This recent Eighth Circuit opinion demonstrates an application of an important caveat in Nord - that the administrator must take into account treating physicians' opinions in reaching its conclusions. The case involved a claim to long term disability benefits. The initial claim was denied and a claim for benefits filed in the district court." (Health Plan Law)
[Guidance Overview] Two More Federal Circuits Consider Impact of Glenn Decision on Standard of Review
Excerpt: "EBIA Comment: The Second Circuit seems to have accepted the Supreme Court's invitation in Glenn to consider an insurer's 'history of biased claims administration' as an important factor in weighing a conflict of interest. It will be interesting to see if other courts also emphasize this factor in future benefits litigation. In the meantime, plan decisionmakers would be well advised to reconsider active steps to reduce potential bias and to promote accuracy in claims administration." (Employee Benefits Institute of America)
[Guidance Overview] More Confusion with Review of ERISA Denial of Benefits
Excerpt: "In taking the case of Metlife v. Glenn, the Supreme Court attempted to bring some clarity to ERISA denial of benefit cases when the insurer is both the one to determine the benefits and pay them. Instead, things are now even more confused. We already reported how the Fourth Circuit took the new language of Glenn and used it to reverse a decision for the plaintiff. Now comes the Second Circuit in McCauley v. First Unum Life Ins. Co., No. 06-5100 (2d Cir. Dec. 23, 2008), doing the exact opposite." (Workplace Prof Blog)
National Health Information Network Set to Launch, Sort Of
Excerpt: "The Nationwide Health Information Network will become reality very soon when the Social Security Administration performs a preliminary test of the new system in February 2009. The NHIN's trial run will be used to determine benefits eligibility for the SSA's 2.6 million annual disability claims. The NHIN's rollout -- even in its limited form -- is considered a major milestone because until now, the public-private 'NHIN Cooperative' has only performed trial implementations based on fictitious patients." (HealthLeaders Media)
[Guidance Overview] McCauley Case Perfect Example of What Supreme Court Had in Mind in the Glenn Case
Excerpt: "Words Cannot Adequately Express. . . How I feel about this case: McCauley v. First Unum Life Insurance Company. Justice at last. . . sorrow that one of my fellow tax attorneys had to fight such a legal battle for over 13 long years when he should have been able to focus on fighting the disease that was ravaging his body. . .gratefulness that the Second Circuit was able to finally deliver a proper result with a little help from MetLife v. Glenn." (Attorney B. Janell Grenier via Benefitsblog.com)
[Guidance Overview] Second Circuit Revises Standard of Review Pursuant to Glenn Holding
Excerpt: "McCauley v. First Unum Life Ins. Co., 2008 U.S. App. LEXIS 26094 (2nd Cir.) (December 24, 2008) is a very significant decision from the Second Circuit. The Court finds UNUM's past history a factor in evaluating the effect of a conflict of interest. . . . This is an excellent example of a court, and a court of appeals, no less, exercising the considerable discretion afforded by Glenn to the benefit of the claimant where the fiduciary is conflicted." (Health Plan Law)
DOL Approves Two Captive Benefits Proposals
Excerpt: "Two big employers have received final Labor Department approval to fund employee benefit risks through their captive insurance companies.The Labor Department approved United Technologies Corp.'s application to use its Vermont-domiciled captive, United Technologies Insurance (Vermont) Inc., to reinsure group term life insurance, accidental death and dismemberment, and long-term disability policies. The group life and AD&D policies will be written by a CIGNA Corp. unit, while the LTD policies will be written by a unit of Liberty Mutual Group Inc." (Business Insurance)
Captive Insurance Companies Offer Cost Savings for Disability, Life and Health Cost Risks
Excerpt: "[C]omplicated Department of Labor (DOL) rules and a rigorous approval pro?cess have meant that, until recently, few companies have used captives to finance employee benefits plans such as disability coverage and life insurance. A series of green lights from the DOL, however, has established a regulatory 'express lane' for employee benefits and captives." (Milliman)
[Guidance Overview] Despite Standard of Review Change, 2nd Circuit Rules Against Disability Denial
Excerpt: "Noting that the U.S. Supreme Court decision in Metropolitan Life Insurance Co. v. Glenn forced it to consider First Unum's conflict of interest as both plan administrator and payor of benefits only 'as a factor' when determining if there was an abuse in discretion, the appellate court still reversed a lower court decision that Unum did not act arbitrarily and capriciously in denying benefits . . . ." (PLANSPONSOR.com; free registration required)
[Guidance Overview] Appeals court rules against Unum in LTD dispute
Excerpt: "[The] New York-based [U.S. Court of Appeals for the Second Circuit] found that in light of a 2008 U.S. Supreme Court decision regarding plans governed by the Employee Retirement Income Security Act, Unum was operating under a conflict of interest." (Business Insurance)
Worker Disability: A Growing Risk to Retirement Security (PDF)
14 pages. Excerpt: "Insecurity strikes at the very heart of the American Dream. It is a fixed American belief that people who work hard, make good choices and do right by their families can buy themselves long?term security. The rising tide of risk swamps these expectations, leaving individuals who have worked hard to reach their present heights facing uncertainty about whether they can keep from falling. With the economy now in its most precarious state in years, insecurity is certain to be one of the most pressing domestic challenges faced in the coming years.In this context, the Council for Disability Awareness has issued an important reminder that one of the most serious risks that workers face is disability. As documented in this report, traditional sources of support for disabled workers have eroded even as the risk of disability has risen. The Council shows that a response will have to come from all of us, because disability is a risk that faces all of us." (The Council for Disability Awareness)
4th Circuit Takes New Approach on Conflict of Interest Case
Excerpt: "A federal appeals court has changed the standard of review it applied to a benefits denial case because of a recent closely watched U.S. Supreme Court decision relating to how seriously judges should consider potential conflicts of interest in cases involving a plan administrator which is also a benefits payer." (PLANSPONSOR.com; free registration required)
Glenn ERISA Benefit Review Standard Starts to Negatively Impact Plaintiffs
Excerpt: "As readers might recall, the Supreme Court case of Metlife v. Glenn from this past [year] basically left the Firestone review standard for denial of benefits alone and held that a conflict of interest that a dual-role insurer has is just one factor to take into account in determining whether the plan administrator abused his discretion in denying benefits to a plan participant or beneficiary. I predicted back then that this would lead to more ERISA plaintiffs losing their denial of benefit claims under Section 502(a)(1)(B) . . . . Unfortunately, it looks like I am turning out to be right. Exhibit A: Champion v. Black & Decker (U.S.) Inc., No. 07-1991 (4th Cir. 12/19/08)." (Workplace Prof Blog)
[Guidance Overview] Fourth Circuit Hands Down Post-Glenn Opinion on Standard of Review
Excerpt: "The Fourth Circuit Court of Appeals has reassess its views on conflicts of interests in view of MetLife v. Glenn. The Court had formerly held that an employer that self funded a benefit plan was not per se conflicted." (Health Plan Law)
[Guidance Overview] Dual Role of Evaluating and Paying Benefits Claims Gives Rise to Conflict of Interest
Excerpt: "A plan administrator that both evaluates and pays benefits claims operates under a conflict of interest in making discretionary benefit determinations, the U.S. Supreme Court has ruled in a 6-3 decision. The conflict does not change the standard of review of a benefits denial from deferential to de novo, but the conflict should be weighed as a factor in determining whether there was an abuse of discretion, the Court held. Accordingly, the Court affirmed the decision of the Sixth Circuit Court of Appeals, which set aside an administrator's denial of benefits (Metropolitan Life Insurance Co v Glenn, USSCt, No 06-923, June 19, 2008)." (Wolters Kluwer)
[Opinion] DOL Office of the Solicitor's Brief for Secretary of Labor as amicus curia (PDF)
22 pages. Excerpt: "The Court should grant en banc review because there is an intra and an inter-Circuit conflict concerning who is a proper defendant in a claim for benefits under ERISA section 502(a)(1)(B) [in Cyr v. Reliance Standard Life Insurance Company.]" (U.S. Department of Labor)
[Guidance Overview] The Conflict Between ERISA Overpayment Claims and Statutory Protection of SSDI Benefits
Excerpt: "This district court opinion involves the common fact pattern in which plan participant and long term disability carrier dispute the carrier's rights to recoup benefits paid based on the LTD policy's provisions requiring reimbursement of LTD benefits where the participant has received Social Security Disability Income ('SSDI') benefits." (Health Plan Law)
Federal Railroad Retirement Disability Board Couldn't Say No
Excerpt: "Operating out of public view, with little scrutiny from Congress and even from its former inspector general, the retirement board has become the agency that cannot say no, last year approving virtually every single disability application it received -- almost 98 percent. . . . An examination of the board by The New York Times, including dozens of interviews and a review of government records, found a disability program plagued by labor-management infighting, weak standards and a failure to use tests that could better weed out specious disability claims." (The New York Times; free registration required)
Oral Argument Recap, AT&T v. Hulteen, Which Involves Service Credit for Pregnancy Leaves Taken in 70s, Which Affected Retirement Benefits
Excerpt: "[T]his case presents a number of complicated and technical questions on some very abstract issues, and it would have been great to have seen the issues put in their most basic terms. The argument was very bogged down in the technicalities, though. Counsel for AT&T began by focusing on the staleness of the claims here, presumably (although not explicitly) arguing that the plaintiffs' cause of action arose either 1. at the time of adoption of the policy that required employees to take personal leave (no service credit for seniority) for pregnancy-related leave while allowing employees to take disability leave for other disabilities (service credit); or 2. at the time that the employees took the leave. If that were true, the 180 day filing limit would have passed over 30 years ago. That made AT&T's argument flow a little strangely: first, the plaintiffs should have sued in the 1970s when they knew that something illegal had happened; but this wasn't a violation of Title VII then anyway." (Workplace Prof Blog)
Supreme Court Justices Hear Bias Case on Maternity, Pensions and Timing
Excerpt: "The case that was argued Wednesday, AT&T v. Hulteen, No. 07-543, raised broadly similar issues [to the 2007 ruling against Lilly M. Ledbetter.]. Noreen Hulteen and three other women took pregnancy leaves from AT&T from 1968 to 1976. When the company calculated their pension benefits on their retirements decades later, it did not give them full credit for the leaves. The women and their union sued under the Pregnancy Discrimination Act of 1978, which made discrimination based on pregnancy-related conditions a form of sex discrimination." (The New York Times; free registration required)
High Court Weighs How Maternity Leaves Affect Pensions
Excerpt: "Several Supreme Court justices questioned on Wednesday whether AT&T Corp. is discriminating against former employees by paying smaller retirement checks to women who took pregnancy leaves in the 1960s and 1970s. The court heard arguments in the case of four women who lost seniority credit when they took maternity leave before passage of a 1979 law that barred the practice of treating pregnancy leaves differently from other disability leaves. The size of retirement paychecks for thousands of women hangs in the balance as the court considers whether to credit decades-old maternity leaves in calculating pension benefits. Justice David Souter asked why payment of the lower retirement benefits now isn't an act of discrimination." (AP via Google)
High Court May Rule in Favor of AT&T on Pregnancy Leave
Excerpt: "The U.S. Supreme Court on Wednesday appeared likely to rule narrowly in favor of an [AT&T Corp.] policy that lowers pension benefits for female workers who took pregnancy leave prior to 1979, when a federal law was enacted barring job discrimination against pregnant women. The eventual ruling, should it favor the telecommunications company, could spark renewed furor in Congress over a 2007 Supreme Court ruling known as Ledbetter that said businesses can't be sued for years-old discrimination, even if such actions continue to harm pay or benefits to an employee." (CNNMoney.com)
[Guidance Overview] Claims Denial Faces Stricter Review Because Sponsor Failed to Meet DOL Electronic Delivery Requirements
Excerpt: "A ruling by the 9th U.S. Circuit Court of Appeals emphasizes the importance of compliance with the U.S. Department of Labor's regulations on delivering plan documents electronically. In Gertjejansen v. Kemper Insurance Companies, Inc., the court applied a stricter standard of review to a claims denial because the employer's delivery of the summary plan description (SPD) did not meet DOL requirements." (Watson Wyatt Worldwide)
[Guidance Overview] Sixth Circuit Holds that Disabled Retirees Not Protected by Title I of the ADA
Excerpt: "The Sixth Circuit picked a side this week in a circuit split about whether retirees are covered by Title I of the ADA in McKnight v. General Motors. The plaintiffs in this case retired from General Motors early and then later became disabled, before they reached the normal retirement age. Their pension plans provided that if they became eligible for social security disability benefits before they reached normal retirement age, their pension benefits would be reduced by the amount of social security disability benefits they received. The plaintiffs argued that reducing their benefits because they became disabled violated Title I of the ADA." (Workplace Prof Blog)
[Guidance Overview] Supreme Court Preview: AT&T v. Hulteen
Excerpt: "Next Wednesday, the Supreme Court will hear oral argument in AT&T v. Hulteen (the ScotusWiki page with links is here), a case involving pregnancy leave and the calculation of years of service for retirement benefits. The plaintiffs are women who worked for AT&T and its predecessor, Pacific Bell, who took leave related to pregnancies before 1979, and who retired between 1994 and 2000. Before 1979, the company limited the amount of pregnancy leave that would count towards service for calculating pension benefits, but did not limit the amount of other temporary disability leave that would count for service. In other words, before 1979, the company treated pregnancy leave differently from other temporary disability leave to calculate pension benefits at retirement." (Workplace Prof Blog)
Worker Absenteeism Shows Up in Bottom Line
Excerpt: "The nation's 300 largest employers estimate that unscheduled absenteeism costs their businesses, on average, more than $760,000 per year in direct payroll costs ? and even more when lower productivity, lost revenue and the effects of poor morale are considered, according to a 2007 survey by the research firm CCH Inc." (The Dallas Morning News)
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