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Fifth Circuit: Plan Administrators Do Not Waive Exclusions That Develop as a Result of Court Decisions Affecting the Disability Claim
Lane Powell PCLink to more items from this source
Nov. 9, 2021

"What happens when an ERISA-governed disability claim is denied solely under the 'own occupation' provision, but a reviewing district court concludes the claimant is entitled to 'own' occupation benefits? Does an insurer 'waive' an evaluation of the 'any occupation' provision because the insurer denied the claim solely on the 'own occupation' standard? ... Can the district court evaluate and award continued benefits under the 'any occupation' standard when the insurer has not yet made that assessment?" [Martinez v. Standard Ins. Co., No. 20-10475 (5th Cir. Oct. 5, 2021; unpub.)]

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