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 term disability (“LTD”) coverage or because the association chose the...
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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’s pre-existing condition exclusion. In particular, the Fifth Circuit...
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 long-term disability (“LTD”) benefits, it must examine the administrative...
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”) benefits, ruling that the LTD insurer’s conclusions, while...
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”) benefits after concluding that the “district court abused its...
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 the lawsuit was time-barred by a provision in the LTD policy. In...
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 subject to ERISA despite the fact that the premiums for the LTD...
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 participant’s claim for long-term disability (“LTD”) benefits because...
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 in the absence of significant new evidence. Facts. A plan participant...