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All News > Disability Plans

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A New Lawsuit Against the NFL Disability Plan Survives Its First Challenge
Kantor & Kantor Link to more items from this source
Mar. 27, 2024

"[T]he court refused to dismiss the players' benefit claims for failure to exhaust administrative remedies [concluding] that plaintiffs' argument that it would be futile to do so could not be resolved at this stage given the 'robust backdrop of alleged malfeasance and nonfeasance' spelled out in the complaint. This backdrop included an alleged 'systematic pattern that the more the Defendants compensate their hired physicians, the higher the likelihood that those physicians will render flawed, inadequate, result-oriented opinions adverse to benefits applicants,' as well as a practice of providing 'inaccurate, misleading, and deceptive information about the Plan to Plaintiffs and absent Class members.' " [Alford v. The NFL Player Disability & Survivor Benefit Plan, No. 23-0358 (D. Md. Mar. 20, 2024)]

Tags: Disability Plans

Fifth Circuit NFL Disability Ruling Turns ERISA on Its Head
DeBofsky Law Link to more items from this source
[Opinion]
Mar. 26, 2024

"The [Fifth Circuit] overturned a [district court ruling which followed] a bench trial that contained shocking revelations about how the National Football League adjudicates disability claims filed by football players who have incurred debilitating injuries during their playing careers.... What the district court described in Cloud is so ... contrary to the goal of accurate claims processing that the outcome of this case turns ERISA's purpose on its head.... The Fifth Circuit's opinion ... elevated form over substance." [Cloud v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, No. 22-10710 (5th Cir. Mar. 15, 2024; pet. for rehearing denied Mar. 15, 2024)]

Tags: Disability Plans

Sixth Circuit Finds Unum's Conflict of Interest Did Not Motivate Its Decision to Terminate Long-Term Disability Benefits
Roberts Disability Law Link to more items from this source
Mar. 15, 2024

"The Sixth Circuit found that Unum's decision to terminate Plaintiff's LTD benefits was not arbitrary and capricious where Unum relied on its in-house file-reviewing physician, interpreted Plaintiff's doctor's opinion as supporting Plaintiff's ability to work, and conducted a vocational analysis looking at the jobs available in the area of Plaintiff's new residence." [Harmon v. Unum Life Ins. Co. of Am., No. 23-5619 (6th Cir. Mar. 12, 2024; unpub.)]

Tags: Disability Plans

District Court Finds Unum's Use of Nurse Review to Deny Long Term Disability Claim and Appeal Did Not Comport with ERISA Regs
Roberts Disability Law Link to more items from this source
Mar. 11, 2024

"The Court noted that ... Unum relied on the same physician opinions to initially deny Plaintiff's claim and to deny her appeal. The Court ... stated that while ERISA does not require the reviewing physician to have the exact same specialty as the claimant's treating physician, Unum's reviewer was not a physician, and Unum did not even contend that she had the appropriate training and experience." [Black v. Unum Life Ins. Co. of Am., No. 22-2116 (N.D. Tex. Feb. 29, 2024)]

Tags: Disability Plans

2023 ERISA Advisory Council Report: Long-Term Disability Benefits and Mental Health Disparity (PDF)
Advisory Council on Employee Welfare and Pension Benefit Plans, Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL] Link to more items from this source
Mar. 5, 2024

61 pages. "[Recommendations for DOL actions:] [1] Encourage Congress to adopt LTD insurance parity requirements consistent with the spirit of MHPAEA mandates for MH/SUD and physical conditions, and strongly encourage employers to consider whether exclusions and MH/SUD limitations are necessary in the current environment.... [2] Commission research of LTD plans to address unknown actuarial and cost implications of removing the duration limits and to identify the underlying rationale for these limitations, if any.... [3] Urge the insurance industry to present plan sponsors with coverage options without duration limits for MH/SUD conditions.... [4] Provide education to LTD plan sponsors on impact of duration limitations in LTD plans."

Tags: Disability Plans  •  MHPAEA

The Difficulty of Defining a Disability: Anxiety
Dickinson Wright Link to more items from this source
Mar. 5, 2024

"[T]he plaintiff was a school teacher who alleged that, due to the mask requirements occurring under COVID-19 protocols, she experienced symptoms of anxiety.... In affirming the trial court, the Court of Appeals held that the record did 'not explain how wearing a mask induced anxiety that substantially limited [Plaintiff's] work, sleep or breathing.' " [Tyler v. Kalamazoo Public Schools, No. 363249 (Mich. Ct. App. Jan. 18, 2024)]

Tags: Disability Plans

Court Again Finds Reliance Standard Abused Its Discretion in Failing to Consider Long-Term Disability Claimant's Risk of Future Harm from Cardiac Condition
Roberts Disability Law Link to more items from this source
Mar. 4, 2024

"[T]he Court first found that Reliance disregarded its directive on remand and limited its interpretation of Plaintiff's regular occupation  ... With regard to the consideration of the 'risk of future harm' which Reliance had been directed to consider ... [t]he Court noted that Reliance ... rejected outright that Plaintiff's occupational duties cause any stress, because stress was not literally listed among the material duties returned by its labor market survey specialist nor did the Dictionary of Occupation Titles list 'stress' as a duty." [Aisenberg v. Reliance Standard Life Ins. Co., No. 22-0125 (E.D. Va. Feb. 21, 2024)]

Tags: Disability Plans

When Are Disability Benefit Programs Exempt from ERISA?
Thomson Reuters / EBIA Link to more items from this source
[Guidance Overview]
Feb. 29, 2024

"If a disability program has any of the following features, the payroll practice safe harbor is not available, and the program is most likely subject to ERISA: [1] Trust or separate account.... [2] Insurance ... [3] Paying more than normal compensation.... [4] Paying benefits to former employees."

Tags: Disability Plans

District Court Deems Administrative Remedies to be Exhausted When Plan Failed to Strictly Adhere to Procedural Deadlines
Roberts Disability Law Link to more items from this source
Feb. 26, 2024

"[T]he Court found that by a simple calendar count, [the claims administrator's] extension request was not timely.  ... The fact that [the administrator] waited 29 days before requesting the independent physician review, and then claimed the need to provide Plaintiff with time to rebut the review were unpersuasive reasons when [the administrator's] own actions caused the need for additional time." [Witt v. Intel Corporation Long-Term Disability Plan, No. 23-01087 (D. Ore. Feb. 16, 2024)]

Tags: Disability Plans  •  Health Plan Administration

District Court Grants Plaintiff Limited Discovery Upon Allegation of Insurer Bias In ERISA Benefits Action
Roberts Disability Law Link to more items from this source
Feb. 19, 2024

"[T]he Court noted that, notwithstanding the broad restriction on discovery in ERISA matters, limited discovery is available if the claimant makes a satisfactory allegation of a violation of due process or bias by the plan administrator." [Dotson v. Metropolitan Life Ins. Co., No. 23-0178 (E.D. Ky. Feb. 9, 2024)]

Tags: Disability Plans

District Court Affirms Insurer's Right to Recover Overpaid Long-Term Disability Benefits Based on Award of Social Security Disability Benefits
Roberts Disability Law Link to more items from this source
Jan. 29, 2024

"Plaintiff [contended] that the Court should enjoin Hartford's recovery of the overpayment on equitable grounds.... Facts supporting the Court's conclusion [included] ... a record that supports the finding that Plaintiff was informed of and understood or should have understood that he was being overpaid LTD benefits ... and Hartford's repeated effort to get accurate information and documentation from Plaintiff about his SSDI payments." [Cutway v. Hartford Life & Accident Co., No. 22-00113 (D. Me. Jan. 22, 2024)]

Tags: Disability Plans

Ninth Circuit Rules That Premature Litigation for Disability Benefits Doesn't Bar Subsequent Lawsuit
Kantor & Kantor Link to more items from this source
Jan. 24, 2024

"[If] a plaintiff brings a lawsuit seeking benefits, and the court rules against her because she hasn't yet complied with the benefit plan's claim submission requirements, can she bring a subsequent action for those same benefits after she does comply with the requirements? ... The [Ninth Circuit] concluded that ... Flores' claim regarding LTD benefits did not accrue until LINA denied her claim in 2022, and thus ... it could not have been brought in the prior action." [Flores v. Life Ins. Co. of N. Am. (LINA), No. 22-55779 (9th Cir. Jan. 22, 2024)]

Tags: Disability Plans

District Court's Disability Benefits Ruling Holds Claim Evaluation Lessons
DeBofsky Law Link to more items from this source
Jan. 16, 2024

"[T]he court found that 'even when accorded only ordinary weight,' the treating doctors' findings persuasively established that Haynes was unable to perform the requirements of her occupation.... Unless there is some evidence that would undermine a claimant's reports of pain and fatigue, the insurance company has no basis for disregarding such complaints.... [A] favorable Social Security determination is relevant evidence in support of a claim for disability insurance benefits." [Haynes v. Principal Life Ins. Co., No. 22-2499 (N.D. Texas January 3, 2024]

Tags: Disability Plans  •  Health Plan Administration

ERISA Litigation Highlights, January 2024
Saul Ewing LLP Link to more items from this source
Jan. 5, 2024

"This [post] covers cases relating to [1] the enforceability of contractual statute of limitations provisions described as a 'labyrinth,' [2] ERISA claims when the carrier allegedly misrepresents benefits, [3] federal courts retaining ERISA jurisdiction following a related state court case, [4] a court excusing an administrator's regulatory violations under the arbitrary and capricious standard, and [5] a court enforcing the clear terms of a plan relating to when coverage for benefits ends."

Tags: Death Benefits & Life Insurance  •  Disability Plans  •  Health Plan Administration

Diabetes Disability Insurance Claims: Navigating the Benefits Process
DeBofsky Law Link to more items from this source
Dec. 27, 2023

"Navigating the world of disability insurance claims with diabetes can be complex, as the disease uniquely affects each person's capacity to maintain their professional responsibilities. This article aims to break down the process, providing clarity and support to those grappling with diabetes diagnosis or the disability insurance benefits for diabetes."

Tags: Disability Plans  •  Health Plan Information for Employees

District Court Awards Post-Judgment Interest and Attorneys' Fees to Plaintiff in ERISA Disability Action
Roberts Disability Law Link to more items from this source
Dec. 26, 2023

"LINA eventually approved Plaintiff's claim for STD benefits, but denied her LTD claim ... [T]he Court entered judgment in favor of Plaintiff ... Plaintiff sought interest on unpaid benefits at a rate of 5.46% ... [T]he Court found that the interest rate was appropriate.... [T]he Court agreed that Plaintiff had achieved 'some success on the merits' ... [and awarded] Plaintiff reasonable fees and costs with a reduction in the fee award. " [Reynolds v. Life Ins. Co. of N. Am. [LINA], No. C21-1424 (W.D. Wash. Dec. 18, 2023)]

Tags: Disability Plans

First Circuit Ruling on Benefits Limitations Period Carries ERISA Implications
DeBofsky Law Link to more items from this source
Dec. 18, 2023

"Limitations issues arise in ERISA benefit claim cases only in situations like the one in [this case], which involves a termination of ongoing benefit payments rather than an initial application for benefits ... [T]he First Circuit's concern about allowing a limitations period to accrue before a cause of action is even viable is warranted." [Smith v. Prudential Ins. Co. of Am., No. 23-1168 (1st Cir. Dec. 6, 2023)]

Tags: Disability Plans  •  Health Plan Policy

Workplace Benefits Sales Remain Up After First Nine Months of 2023
LIMRA Link to more items from this source
Dec. 15, 2023

"Third quarter 2023 workplace life insurance new premium was $588 million, down 12%, compared with third quarter 2022. However, year-to-date (YTD) new premium remained 3% ahead of the sales in the same period a year ago ... Total workplace disability insurance new premium for the third quarter was $628 million, 6% higher than prior year results ... [S]upplemental health products ... totaled $501 million in the third quarter, up 5%."

Tags: Death Benefits & Life Insurance  •  Disability Plans  •  Misc. Benefits

Third Circuit Denies Petition for Mandamus Relief from District Court's Appointment of Special Master to Review Hartford's Denial of Disability Benefits
Roberts Disability Law Link to more items from this source
Oct. 31, 2023

"The Third Circuit explained that though the appointment of a Special Master is 'unusual,' the district court appointed her to reinforce its determination that Hartford has a structural conflict and abused its discretion, justifying a remand to Hartford for full consideration of whether Lewis is disabled." [Lewis v. Hartford Life & Accident Ins. Co., No. 23-2431 (3d Cir. Oct. 26, 2023)]

Tags: Disability Plans  •  Health Plan Policy

District Court Grants Defendant's Motion to Transfer Venue to Plaintiff's Resident District for ERISA Disability Benefits Claim
Roberts Disability Law Link to more items from this source
Oct. 2, 2023

"Noting ERISA's broad venue provisions permitting jurisdiction 'where the plan is administered, where the breach took place, or where a defendant resides or may be found' ... the Court found that venue in the District of Utah would be proper as Plaintiff resided and worked in Utah, received benefits checks in Utah, and had his benefits terminated while residing in Utah. As to the second requirement, whether transfer is appropriate and in the interest of justice, the Court considered nine factors ... [and] concluded that the District of Utah was clearly the proper forum for the matter[.]" [Penrose v. New York Life Insurance Company & Life Insurance Company of North America, No. 22-2184 (S.D.N.Y. Sep. 22, 2023)]

Tags: Disability Plans

District Court Critiques Doctor's Bias in Denying Disability Claims
DeBofsky Law Link to more items from this source
Sept. 18, 2023

"AT&T had based its decision on a paper review of the medical evidence performed by Dr. Howard Grattan, whose opinion was challenged due to his frequent retention in AT&T disability claims. Further, although AT&T's claim administrator ... referred Chacko to a vendor for representation in relation to applying for Social Security disability benefits, AT&T ignored the outcome of that proceeding in favor of Chacko and never obtained a copy of the Social Security claim file from its vendor to understand the basis of that determination. The court extensively discussed Grattan's potential conflict of interest." [Chacko v. AT&T Umbrella Benefit Plan No. 3, No. 19-1837 (E.D. Cal., Sep. 7, 2023)]

Tags: Disability Plans

California State Disability Insurance: Removal of Wage Ceiling Set to Impact Employers and Employees in 2024
OneDigital Link to more items from this source
[Guidance Overview]
Sept. 15, 2023

"SDI provides short-term disability and paid family leave wage replacement and is funded through a 0.9% tax withholding on employee wages in CA. Today, wages are taxed up to a maximum of $153,164 which equates to a maximum withholding of $1,378.48 per year ... [S]tarting in 2024, the wage ceiling will be eliminated and all California wages will be subject to the 0.9% tax."

Tags: Disability Plans  •  Local Regulation

District Court Provides Roadmap for Opposing Grant of Attorney Fees Even When Court Grants Benefit Claim
Lane Powell PC Link to more items from this source
Sept. 15, 2023

"Should plaintiffs always recover attorney fees when the ultimate decision to deny benefits 'was a close call' …and both sides' positions had merit? No. And this new case explains the point." [Messing v. Provident Life and Accident Ins. Co., No. 20-0351 (W.D. MI Aug. 25, 2023)]

Tags: Disability Plans

Sixth Circuit Denies Reliance Standard 'Third Bite at the Apple' in Long-Term Disability Benefit Dispute
Roberts Disability Law Link to more items from this source
Aug. 23, 2023

"The court found it problematic that Reliance Standard did not give its reviewers a copy of Jordan's doctor's letter disagreeing with their opinions.... The court found Jordan's doctor's evidence to clearly establish her entitlement to benefits. Rather than a remand to Reliance Standard for 'a third bite at the apple,' the court issued a remand with instructions to enter judgment in favor of Jordan." [Jordan v. Reliance Standard Life Ins. Co., No. 22-5234 (6th Cir. Aug. 18, 2023)]

Tags: Disability Plans

Third Circuit Denies Aetna's Petition Challenging Class Certification for ERISA Disability Plan Claimants
Roberts Disability Law Link to more items from this source
Aug. 16, 2023

"The Third Circuit Court of Appeals found that Aetna's Rule 23(f) petition is untimely because the Reconsideration Order did not materially alter the Class Certification Order.... The court found that these changes were more akin to 'minor clarifications' than material alterations.... Because Aetna did not file its Rule 23(f) petition within fourteen days of [the original class certification order], the court denied it as untimely." [Wolff v. Aetna Life Ins. Co., No. 22-8056 (3d Cir. Aug. 9, 2023)]

Tags: Disability Plans

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