News Archive

"Although the Plan is a non-ERISA governmental plan exempt under 29 U.S.C. Section 1003(b)(1), the court applied an arbitrary-and-capricious standard derived from New York contract law that closely mirrors ERISA review of plans vesting discretion in the administrator. The decision is significant for ERISA practitioners because the panel borrows substantively from ERISA case law to define the scope of judicial review, the limits on discovery, and the treatment of treating-physician opinions." [Martin v. Fed. Rsrv. Bank of Cleveland, No. 25-3518 (6th Cir. May 7, 2026)]  MORE >>

"The court next addressed the insurer's structural conflict of interest because it served as both the LTD plan's administrator and insurer. It noted that abuse of discretion review is 'tempered by skepticism' and that conflict is to be considered. However, the court gave this conflict little weight because the insurer's determination was supported by the results of a thorough, neutral and independent review process." [Wallace v. Hartford Life Ins. Co., No. 25-2716 (9th Cir. Apr. 17, 2026)]  MORE >>

"[T]he Western District of New York concluded after a bench trial that the plaintiff was entitled to long-term disability benefits under an ERISA-governed policy issued by Provident Life and Casualty Insurance Company, with a disability onset date of December 31, 2009 -- even though her husband did not discover the policy and submit a claim on her behalf until September 2021." [Nabi v. Provident Life and Casualty Ins. Co., No. 23-0844 (W.D.N.Y. Apr. 27, 2026)]  MORE >>

"Short-term disability (STD) provides income replacement when you cannot work. The Family and Medical Leave Act (FMLA) provides job protection. These benefits serve different purposes, follow different eligibility rules, and fall under different laws. Understanding how they work together matters."  MORE >>

"This decision from the Eastern District of Michigan demonstrates how a group policy’s choice-of-law provision can determine which state’s law governs the limitations period for an ERISA disability claim — and why filing deadline calculations must begin with the plan’s own terms, not the forum state’s statute of limitations." [Gordon v. Sun Life Assurance Co. of Canada, No. 25-11132 (E.D. Mich. Mar. 31, 2026)]  MORE >>

"[T]he court applied de novo review after finding that First Reliance Standard committed multiple non-inadvertent violations of the [DOL's] claims-procedure regulation ... in processing Booth's internal appeal. The court found that Booth was Totally Disabled under the policy's 'any occupation' standard, and that the insurer's own vocational evidence -- not just the claimant's -- established that she could not perform any occupation her education, training, or experience would reasonably allow." [Booth v. First Reliance Standard Life Ins. Co., No. 24-3927 (S.D.N.Y. Mar. 30, 2026)]  MORE >>

"[The District Court] ruled that when the administrator of a long-term disability (LTD) plan abused its discretion in denying LTD benefits, the employee was entitled to a retroactive reinstatement of benefits from the time his benefits were terminated through the date of the court’s decision." [Ehrlich v. Hartford Life & Accident Ins. Co., No. 20-2284 (N.D. Calif. Mar. 28, 2025)]   MORE >>

"[This case] is a reminder that Hartford's own administrative communications can and will be held against it. When an insurer tells a claimant in writing that administrative remedies are exhausted, it cannot resurrect that argument as a litigation defense. The case also illustrates the tension between ERISA's Section 1132(a)(3) catchall and Section 1132(a)(1)(B) benefits claims -- the court's dismissal of Count I on both limitations and duplicativeness grounds underscores the importance of pleading those claims carefully and timely." [Sakwa v. Hartford Life and Accident Ins. Co., No. 25-4546 (N.D. Ill. Mar. 25, 2026)]  MORE >>

"This decision highlights two practical risks for disability claimants navigating multiple benefit streams. First, a long-term disability insurer's failure to apply an offset -- even for years -- does not necessarily constitute a waiver or a new determination that the claimant can challenge.... Second, claimants who receive more than one Social Security benefit should carefully review their LTD policy's offset language and their insurer's benefit calculations at the outset." [Harling v. Hartford Life and Accident Ins. Co., No. 24-1237 (N.D. Ala. Mar. 26, 2026)]  MORE >>

"Hartford moved for summary judgment on the sole ground that Bianchini failed to exhaust administrative remedies. The court denied Hartford's motion, holding that Hartford's procedural violations of 29 C.F.R. § 2560.503-1 deemed Bianchini's administrative remedies exhausted." [Bianchini v. The Hartford Life and Accident Ins. Co., No. 24-6535 (S.D.N.Y. Mar. 24, 2026)]  MORE >>

"The takeaway for HR is direct. Review how your plan administrators are tracking and meeting ERISA's appeals deadlines. Check whether your vendor agreements include accountability mechanisms for procedural compliance. And make sure your benefits team understands that when an administrator misses a federal deadline, the consequences land on the plan -- and that is a problem that starts with the people who chose and oversee that administrator in the first place." [Cogdell v. Reliance Standard Life Ins. Co., No. 24-1940 (4th Cir. Mar. 3, 2026)]  MORE >>

"LIMRA forecasts slower in‑force premium growth for life and disability products through 2028. Life insurance in‑force premium growth is expected to fall below historical averages, while long‑term and short‑term disability premiums should remain closer to recent norms.... Employers still need competitive benefits packages to attract and retain top talent. Workers increasingly value flexibility, well‑being, and financial security. Advances in technology -- from data analytics to AI -- are enabling more personalized benefit recommendations and communications."  MORE >>

"Even where a condition lacks definitive objective diagnostic testing, plan administrators may reasonably require objective evidence of functional impairment ... and may discount post-elimination functional capacity evaluations if they are not tied to contemporaneous medical findings. The case also highlights the continued importance of plan language defining 'regular occupation' as work performed in the national economy, which can foreclose arguments based on the claimant's real-world job demands or composite occupation theories." [Hans v. Unum Life Ins. Co. of Am., No. 25-3595 (E.D. Pa. Jan. 15, 2026)]  MORE >>

"The court held that a claimant's prior short-term disability (STD) claim file was not part of the administrative record for purposes of reviewing the denial of LTD benefits and that the plaintiff failed to establish a sufficient basis for broad extra-record discovery into the insurer's alleged conflict of interest." [Stallman v. First Unum Life Ins. Co. , No. 23-20975 (D.N.J. Dec. 29, 2025)]  MORE >>

"Taken together, these decisions reinforce that employers and insurers face meaningful ERISA exposure when they accept LTD premiums without clearly enforcing or disclosing EOI requirements. At least at the pleading stage, prolonged premium collection, ambiguous plan administration, and compartmentalized enrollment systems can support claims for waiver, estoppel, and fiduciary breach -- despite plan language disclaiming agency relationship." [Hamilton v. Logic20/20, Inc., No. C24-916RSL (W.D. Wash. Dec. 29, 2025); Hamilton v. Logic20/20, Inc., No. C24-916RSL (W.D. Wash. Dec. 29, 2025)]  MORE >>

"A recent [District Court decision] is a helpful reminder that insurers do not get to 'ERISA-wash' a claim simply because coverage was offered to employees through an employer channel. When the employer stays neutral, employees pay the full premium, and the insurer sells what is functionally an individually owned policy governed by state law, ERISA may never come into play -- no matter how aggressively the insurer invokes it after a claim dispute arises." [Koo v. Unum Grp., No. 25-5797 (C.D. Cal. Dec. 16, 2025)]  MORE >>

"[T]he Fifth Circuit reversed an award of more than $1.8 million in attorneys' fees under ERISA Section 502(g)(1), holding that a claimant who ultimately obtained no substantive relief cannot recover fees based solely on favorable factual findings or judicial criticism of plan procedures." [Cloud v. Bert Bell/Pete Rozelle NFL Player Ret. Plan, No. 25-10337 (5th Cir. Dec. 18, 2025),]  MORE >>

28 pages; Dec. 16, 2025. "What's New: [1] Social security and Medicare taxes for 2026.... [2] Moving expense reimbursements.... [3] Employer contributions to Trump accounts."  MORE >>

"The Eleventh Circuit concluded that the insurer's interpretation overlooks the distinction between receiving medical care for symptoms that are not inconsistent with a preexisting condition and receiving medical care for the preexisting condition itself." [Johnson v. Reliance Standard Life Ins. Co., No. 23-13443 (11th Cir. Nov. 21, 2025)]  MORE >>

"This study is the first to explore the effects of PSL adoption on participation in the Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs, as well as the health of persons with disabilities. We find that statewide PSLs are associated with a 6-9 percent increase in initial claims for SSI and joint SSI/SSDI benefits. These applications translate to an increase in beneficiaries, strongest among children under age 18."  MORE >>

"The participating companies reported $19.9 billion in combined LTD, STD, and PFML in-force premium in 2024, an increase from $19.0 billion reported by the same companies in 2023.... The average LTD in-force PPL increased by 3.5% from 2023 to 2024, whereas the average STD in-force PPL increased by 3.1%."  MORE >>

29 pages; Nov. 24, 2025. "What's New: [1] Social security and Medicare taxes for 2025.... [2] Moving expense reimbursements.... [3] Employer contributions to Trump accounts."  MORE >>

"The court held that the insurer's interpretation of its preexisting condition clause -- which deemed any treatment for any symptom consistent with a later-diagnosed disease as 'treatment for' that disease -- was both wrong and unreasonable, even under the deferential arbitrary-and-capricious standard." [Johnson v. Reliance Standard Life Ins. Co., No. 23-13443 (11th Cir. Nov. 21, 2025)]  MORE >>

"This case will limit ADA claims by retirees against their former employers, but ... Justice Gorsuch opined ... that retired employees may be able to proceed with ADA claims if they can plead and prove that they were disabled and a 'qualified individual' under the ADA when their employer adopted a discriminatory retirement benefits policy, even if they later happen to be retired when they bring suit." [Stanley v. City of Sanford, FL, No. 23-997 (S. Ct. Jun. 20, 2025)]  MORE >>

29 pages. "What's New: [1] Social security and Medicare taxes for 2025.... [2] Moving expense reimbursements.... [3] Employer contributions to Trump accounts."  MORE >>