The U.S. Court of Appeals for the Seventh Circuit, in Scanlon v. Life Insurance Company of North America, has ruled that a court must fully consider the nature and the duties of a claimant’s job in...
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Unambiguous Plan Document Overrides Employer’s Misrepresentations
In Higgins vs. Lincoln Electric Company, Inc., the U.S. Court of Appeals for the Sixth Circuit placed a high burden on a plan participant who claimed that his employer was “estopped” (i.e.,...
Seemingly “Minor” Mistake in Claims Procedure Administration Costs Employer
In Witt v. Intel Corp. Long-Term Disability Plan, the United States District Court for the District of Oregon refused to dismiss a long term disability (”LTD”) benefits lawsuit when the plan...
Court Applies “But For” Standard to LTD Mental Health Benefit Limitation
In Weyer v. Reliance Standard Life Insurance Company, the U.S. Court of Appeals for the Eighth Circuit has determined that the “but-for” causation standard is appropriate for determining whether...
Insurer May Rely on In-House Advisors’ Disability Determination
In Harmon v Unum Life, the U.S. Court of Appeals for the Sixth Circuit has ruled that an insurer may rely on its own medical advisors in denying long term disability (“LTD”) benefits, as long as the...
LTD Plan Must Consider Future Harm from Stress
In Aisenberg v. Reliance Standard Life Ins. Co., the United States District Court for the Eastern District of Virginia has ruled that a long term disability (“LTD”) plan must take into account...
State Law Claims Preempted By ERISA
In Steigleman v. Symetra Life, the U.S. District Court for the District of Arizona has ruled that a small business owner could not sue an insurance company under state law for long term disability...
LTD Insurer May Subsequently Reverse Disability Determination
The U.S. District Court for the Southern District of Florida has ruled, in Delucca v. The Guardian Life Insurance Company of America, that a long term disability (“LTD”) plan was not bound by prior...
Plan Penalized for Failure to Follow Its Own Provisions
Plan Penalized for Failure to Follow Its Own Provisions - Marcia Wagner, 401(k) Advisor, Volume 30, No. 9, October 2023
Failure to Follow Claims Regulations Results in De Novo Review
The U.S. District Court for the Southern District of New York, in Rhodes v. First Reliance, has ruled that an insurer’s denial of a long-term disability (“LTD”) claim must be reviewed under the de...
Plan Penalized for Failure to Follow Its Own Provisions
In Laake v. Benefits Committee, Western & Southern Financial Group Co., the U.S. Court of Appeals for the Sixth Circuit determined that the de novo standard of review applies where an employer’s...
Trade Association’s Insurance Program Not Covered by ERISA
Ninth Circuit Court of Appeals has ruled, in Steigleman vs. Symetra Life, that neither an employer nor its trade association created an ERISA-covered plan merely because the employer paid for long...
Pre-existing Condition Exclusion Enforceable Despite Employer Misrepresentation
The Fifth Circuit Court of Appeals, in Bunner v. Dearborn Nat’l Life Ins. Co., has held that a disability insurer properly denied a claim for long-term disability (“LTD”) benefits based on the...
Plan Administrators May Not Adopt Rationales for Benefit Denials Not Raised During the Claims Review Process
The Ninth Circuit Court of Appeals, in Collier v. Lincoln Life Assurance Co. of Boston, has held that when a district court engages in a de novo review of an ERISA plan administrator’s denial of...
Court Defers to Insurer’s Discretionary Authority
The Eleventh Circuit Court of Appeals, in Stewart v. Hartford Life & Accident Insurance Company, has upheld a lower court’s decision to deny a plaintiff’s appeal for long-term disability (“LTD”)...
Ninth Circuit Requires Lower Court to Consider New Evidence in LTD Suit
The Ninth Circuit Court of Appeals, in Kay v. Hartford Life and Accident Insurance Company, has reversed a lower court’s decision upholding an insurer’s termination of long-term disability (“LTD”)...
ERISA Lawsuit Time-Barred Due to Plan’s Limitations Period
The Eleventh Circuit Court of Appeals, in Bakos v. Unum Life Insurance Company of America, has upheld the dismissal of a lawsuit for wrongful denial of long-term disability (“LTD”) benefits because...
Court Finds Employee-Paid LTD Policy Was Part of Employer’s ERISA Plan
A federal district court in the Middle District of Tennessee has held, in Insurance Company of America, that a long-term disability (“LTD”) policy offered under an employer’s group health plan was...
Ninth Circuit Finds Welfare Plan Did Not Abuse Its Discretion In Denying Benefits
The Ninth Circuit Court of Appeals, in Alves v. Hewlett-Packard Comprehensive Benefits Plan, has found that a welfare benefit plan’s claims administrator did not abuse its discretion in denying a...
COVID-19 Long-Haulers May Have Tough Time Getting Long-Term Disability Benefits
COVID-19 Long-Haulers May Have Tough Time Getting Long-Term Disability Benefits – Marcia Wagner, SHRM, February 11, 2022 (PDF)
Insurer Cannot Terminate LTD Benefits Without Additional Information
The United States Court of Appeals for the Eighth Circuit has determined, in Roehr v. Sun Life Assurance Co. of Canada, that long term disability (“LTD”) benefits cannot be terminated by an insurer...