"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 >>
"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 >>
"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 >>
"The case highlights the consequences of procedural lapses in claim handling and reinforces that remand, not immediate benefits, is typically the appropriate remedy when no administrative record exists." [Chalk v. Life Ins. Co. of N. Am., No. 25-0133 (W.D. Ky. Oct. 27, 2025)] MORE >>
"Courts increasingly recognize that: ... [1] The limitations period typically begins after the full benefit period ends -- not when the disability starts. [2] California law overrides less favorable policy terms.... [3] Courts examine when proof of loss was truly due, whether the claimant had notice of coverage, and if delays were reasonable." MORE >>
"Key Takeaways ... [1] Courts may compel insurers to produce documents required under ERISA's own procedural rules.... [2] Plaintiffs must present evidence suggesting the insurer's conflict actually affected the claim decision.... [3] Plaintiffs who tie discovery requests directly to regulatory entitlements, rather than broad fairness concerns, are more likely to succeed." [Gannon v. Hartford Life and Accident Ins. Co., No. 24-1955 (D. Conn. Oct. 3, 2025)] MORE >>
11 pages. "The current study of 2015-2022 calendar years contains about 294 million life-years exposed and about 1.2 million claims over the study period. The results include analysis of claim incidence and can be used by actuaries in the management of their own group long-term disability business." MORE >>
"In the second quarter of 2025, total workplace life insurance new premium ticked up 1% year over year to $666 million. Year to date (YTD), total workplace life insurance new premium was $2.65 billion, down 7% from the same period in 2024.... Total workplace disability insurance new premium was $618 million in the second quarter of 2025, a 3% increase year-over-year. In the second quarter, short-term disability insurance new premium grew 7% and long-term disability insurance premium fell 3%." MORE >>
"Federal courts normally have jurisdiction over ERISA claims ... However, the [Railway Labor Act] provides that disputes growing out of grievances or the 'interpretation or application' of CBAs ... must be resolved through arbitration before an SBA, not in court.... [T]he court found the LTD plan was 'inextricably intertwined' with the JCBA. While ERISA creates a right to bring claims for benefits, Eldredge's alleged right to LTD benefits existed only because the JCBA required the airline to provide the plan. Thus, the JCBA was the true source of the claim." [Eldredge v. Am. Airlines Inc., No. 25-0823 (D. Ariz. Sept. 4, 2025)] MORE >>
"[Premiums for the short-term disability insurance program administered by the Puerto Rico DOL-HR (SINOT)] are relatively high vis-à-vis its covered benefits. As a result, many, if not most, companies doing business in Puerto Rico prefer to comply with the Mandate through their own STD plans ... This article provides an overview of the Mandate and SINOT; it then describes the process that employers should follow to comply with the Mandate through an STD plan." MORE >>
"[T]he Second Circuit ruled that no reasonable jury 'could conclude that Schuyler actually believed that she was waiving her claim for LTD benefits from Sun Life when she signed the agreement,' and thus she 'didn't knowingly and voluntarily waive her right to pursue her LTD against Sun Life.' The court therefore reversed the judgment below and remanded for further proceedings." [Schuyler v. Sun Life Assurance Co. of Canada, No. 23-498 (2d Cir. Aug. 14, 2025)] MORE >>
"[T]he Second Circuit ... [held] that a former employee's separation agreement with her employer did not amount to a knowing and voluntary waiver of her ERISA claim for long-term disability (LTD) benefits. The court emphasized that the employer's explicit pre-execution assurances that the agreement would not affect the LTD claim were dispositive, even though the contract contained broad release language that arguably covered related entities and ERISA claims." [Schuyler v. Sun Life Assurance Co. of Canada, No. 23-498 (2d Cir. Aug. 14, 2025)] MORE >>
"The court found no clear error in the district court's determination that LINA's medical and vocational evidence outweighed the claimant's proof of disability under [ERISA]." [Walker v. Life Ins. Co. of N. Amer., No. 24-13066 (11th Cir. Aug. 13, 2025)] MORE >>
"[DOL Advisory Opinion 2025-02A found] that the California Association of Professional Firefighters (CAPF) Long Term Disability (LTD) Plan is not an ERISA-covered employee welfare benefit plan.... DOL determined that CAPF does not exist for the purpose of dealing with employers concerning an employee benefit plan. Therefore, CAPF is not an employee organization. [DOL] then ruled that while CAPF has some of the characteristics of an employees' beneficiary association in that it has a formal organization, it generally does not deal with employers ... However, in DOL's view, CAPF membership is not conditioned on employment status nor do employees 'participate' in CAPF." MORE >>
"The court found that the plan's language was unambiguous: a beneficiary is deemed to reside outside the U.S. or Canada if they spend six or more months abroad during any 12-month benefit period.... Despite her arguments about pandemic travel barriers, the court held that U.S. citizens like Archer were exempt from border restrictions and that her failure to return to the U.S. was not legally excused under an 'impossibility' theory." [Archer v. Unum Life Ins. Co. of Am., No. 23-1128 (W.D. Wash. Jul. 28, 2025)] MORE >>
"Unum's argument that Schwartz's condition was 'situational' and not disabling was roundly rejected. The court emphasized that her symptoms persisted both during and after her employment and had worsened upon attempts to return to work. Unum's failure to exercise its contractual right to conduct an in-person examination also undermined the credibility of its denial." [Schwartz v. Unum Life Insurance Company of America, No. 24-2444 (N.D. Cal. Jul. 1, 2025)] MORE >>
"The court agreed with the majority of circuits holding that ERISA Section 1132(g)(1), which governs fee-shifting, does not authorize recovery of attorney's fees incurred during administrative proceedings.... [The case] serves as a cautionary tale for ERISA claimants: successful reinstatement of benefits may not open the door to broader monetary remedies, particularly when a claimant did not fully pursue administrative remedies. " [Stark v. Reliance Standard Life Ins. Co., No. 24-6137 (10th Cir. Jul. 8, 2025)] MORE >>
"For disabled employees, RTO policies don't just represent a change in environment, they can become a tipping point that insurers use to challenge or deny disability claims. Understanding the interplay between workplace demands, disability accommodations, and the definition of disability in ERISA policies is essential to protecting your rights." MORE >>
