Mealey's Disability Insurance : Mealey's : Legal News & Analysis

Mealey's Disability Insurance

May 20, 2025
Fighting Fees, NFL Plan Urges 5th Circuit To Say Disability Claimant Had No Success

NEW ORLEANS — In its appellant brief urging the Fifth Circuit U.S. Court of Appeals to reverse an award of more than $1.25 million in attorney fees and costs, the Bert Bell/Pete Rozelle NFL Player Retirement Plan called the award “an unprecedented expansion of the availability of attorney’s fees to ERISA litigants who do not succeed on any legal claim and obtain no judicial relief.”
May 16, 2025
6th Circuit Finds No Abuse Of Discretion In Long COVID LTD Benefits Denial

CINCINNATI — Ruling against a claimant who said in her opening brief that “this appears to be the first ‘Long COVID’ disability case to come before the Court,” the Sixth Circuit U.S. Court of Appeals on May 15 affirmed a judgment upholding denial of her claim for long-term disability (LTD) benefits, concluding that the insurer’s “decision was neither procedurally nor substantively unreasonable.”
May 14, 2025
Bad Faith Claims Bifurcated From Breach Of Contract Claim In Disability Suit

LOUISVILLE, Ky. — A Kentucky federal judge granted a disability income insurer’s motion to bifurcate an insured’s breach of contract claim from the insured’s bad faith claims after determining that bifurcation will promote judicial efficiency because the bad faith claims are dependent on the success of the breach of contract claim.
May 14, 2025
Former Physician’s Assistant Whose LTD Benefits Were Nixed Sues For Reinstatement

LYNCHBURG, Va. — Suing the claims administrator that terminated his long-term disability (LTD) benefits, a former emergency room physician’s assistant who says he “underwent a PET/CT scan that indicated Alzheimer’s dementia” argues in part that discovery from other lawsuits has shown that the insurer’s reviewer “denies 85-90% of all disability claims she reviews.”
May 14, 2025
Insurer Gets LTD Benefits Case Transferred To Different California Federal Court

SAN FRANCISCO — An Employee Retirement Income Security Act suit in which a claimant who says she has “disabling symptoms” of long COVID is challenging denial of her claim for long-term disability (LTD) and life insurance waiver of premium (LWOP) benefits will be transferred to a different federal court in California after a judge considered “deference owed to Plaintiff’s choice of forum, convenience, and the local interest in the case.”
May 13, 2025
Judge Upholds LTD Claim Denial Under Policy’s ‘Most Appropriate’ Requirement

TACOMA, Wash. — Ruling in part that a pharmacist who has been diagnosed with functional neurological disorder (FND) and is being treated by naturopaths “has not met her burden of proving that she is under the continuing care of a medical doctor or a medical practitioner with the same authority as a medical doctor, in the most appropriate specialty for her condition,” a Washington federal judge affirmed denial of her claim for long-term disability (LTD) benefits.
May 13, 2025
Deal Reported After Partial Summary Judgment Bids Fail In LTD Row

SANTA ANA, Calif. — Days after a California federal judge denied competing motions for partial summary judgment in a lawsuit asserting bad faith and breach of contract claims over calculation of long-term disability (LTD) benefits, the parties told the court they reached an unspecified settlement.
May 13, 2025
After LTD Case Remand To Plan, Parties Dispute Attorney Fee Request

SAN FRANCISCO — Parties in a long-term disability (LTD) benefits case are disputing a $139,650 attorney fee request, with the claimant contending that “a remand for further administrative proceedings is not a trivial success where it is based on a court determination that ERISA rights were violated,” and the defendant arguing in part that no award is warranted under Hummel v. S.E. Rykoff & Co.
May 09, 2025
On De Novo Review, Judge Rules That LTD Claimant Is Physically Disabled

LOS ANGELES — Taking issue with numerous aspects of an insurer’s decision to terminate long-term disability (LTD) benefits, a California federal judge concluded that “[a] preponderance of the evidence shows [that the claimant’s] medical symptoms related to spondylolisthesis, lumbar region status post lumbar fusion, and chronic pain render him disabled under the terms of the Plan.”
May 09, 2025
Magistrate Would Dismiss STD Benefits Case As Moot But Let Claimant Seek Fees

CINCINNATI — Defendants that voluntarily reversed the challenged termination of short-term disability (STD) benefits and paid up after being sued could still be liable for attorney fees under the recommendation an Ohio federal magistrate judge issued in the Employee Retirement Income Security Act case.
May 08, 2025
Employee Ineligible For Retroactive LTD Benefits, Federal Judge Says

TACOMA, Wash. — A Washington federal judge ruled that a former employee who retroactively filed a long term disability (LTD) claim after multiple diagnoses failed to prove that she was disabled under the terms of her policy on her employment termination date, rendering her ineligible for benefits and prompting the judge to grant the insurer’s motion for judgment, deny the former employee’s cross-motion and deny her request to supplement the administrative record
May 07, 2025
5th Circuit Won’t Dismiss Attorney Fee Appeal In ERISA Disability Benefits Dispute

NEW ORLEANS — Without explanation, a Fifth Circuit U.S. Court of Appeals panel denied a former National Football League player’s motion to dismiss the Bert Bell/Pete Rozelle NFL Player Retirement Plan’s appeal of an award of more than $1.25 million in attorney fees and costs.
May 02, 2025
LTD Insurer Wins Summary Judgment In Dispute Over Nervous Disorders Provision

TRENTON, N.J. — Citing the analysis in a nonprecedential 2009 Third Circuit U.S. Court of Appeals decision, a New Jersey federal judge upheld termination of long-term disability (LTD) benefits for a former clinical nurse instructor under a mental or nervous disorders provision.
May 01, 2025
4th Circuit En Banc Majority Won’t Stay Injunction In DOGE, SSA Records Case

RICHMOND, Va. — A divided en banc Fourth Circuit U.S. Court of Appeals on April 30 denied a motion by the Social Security Administration (SSA) and other federal government agencies and officials to stay a preliminary injunction order pending appeal in a case over the Department of Government Efficiency’s (DOGE) access to SSA data.
April 29, 2025
Recommendation Favors Defendants’ Fee Bid In LTD Lawsuit Involving $30K Offer

TAMPA, Fla. — Concluding in part that a rejected $30,000 offer of judgment made in 2021 was covered by a Florida fee-shifting statute, a Florida federal magistrate judge recommended granting a motion in which defendants in a cardiac surgeon’s lawsuit over denial of a disability benefits claim contend that they are entitled to attorney fees they estimate at $88,148.50.
April 28, 2025
Former Surgeon, Insurer Stipulate To Dismissing Suit For LTD Benefits

TYLER, Texas — After previously reporting that they were “working on finalizing” an unspecified settlement, the parties in a former surgeon’s suit for long-term disability (LTD) benefits and relief for alleged mishandling of her claim on April 25 filed a joint stipulation of dismissal with prejudice in a Texas federal court.
April 28, 2025
Claimant Files Appeal In LTD Documents Case After Insurer Wins Summary Judgment

ATLANTA — A long-term disability (LTD) claimant is taking his case to the 11th Circuit U.S. Court of Appeals after a Florida federal judge sustained an insurer’s objections to a recommendation that competing summary judgment motions be resolved in the claimant’s favor in the dispute involving failure to submit income documents.
April 24, 2025
Defendants Prevail In Suit Over STD, LTD Benefits; Notice Ruled Insufficient

HARRISONBURG, Va. — Resolving three motions in favor of the defendants, a Virginia federal judge upheld denial of short-term disability (STD) benefits on the basis that the plan administrator “engaged in principled and reasoned decision-making while considering sufficient evidence,” also ruling that the claimant didn’t exhaust administrative remedies as to long-term disability (LTD) benefits and is now time-barred from doing so.
April 23, 2025
LTD Claimant Prevails In Interpretation Dispute Over What ‘Insured Earnings’ Means

NEW YORK — Following a bench trial on the stipulated record in a dispute over termination of long-term disability (LTD) benefits, a New York federal judge ruled for the claimant, saying in part on de novo review that “the term ‘insured earnings,’ as used in the Plan” does include earnings reported on a K-1 tax form.
April 16, 2025
Federal Judge Finds ERISA Governs Group Disability Plan, Dismisses State Law Claims

BOSTON — A Massachusetts federal judge granted an insurer’s motion for summary judgment, ruling that an employee’s long-term disability (LTD) insurance plan administered by her religious institute-affiliated employer is governed by the Employee Retirement Income Security Act and not exempt as a church plan, resulting in the dismissal of the coordinator’s state law claims without prejudice.
April 15, 2025
NFL Plan To 5th Circuit: Let Fee Award Appeal Proceed In Disability Benefits Row

NEW ORLEANS — Telling the Fifth Circuit U.S. Court of Appeals that the issues raised are not “grounds for dismissal” and that it “could not have forfeited an appeal of the new fee award and opinion before they existed, when the case was in the opposite posture,” the Bert Bell/Pete Rozelle NFL Player Retirement Plan on April 14 asked to be allowed to proceed with its appeal of an award of more than $1.25 million in attorney fees and costs to a former National Football League player.
April 15, 2025
Engineer To 4th Circuit: Affirm Ruling In Long COVID Disability Benefits Case

RICHMOND, Va. — Contending in part that de novo review was correctly applied because of an “inexcusable failure to issue a timely decision,” a long-term disability (LTD) benefits claimant urged the Fourth Circuit U.S. Court of Appeals to affirm a judgment that she is owed past-due benefits because long COVID symptoms have disabled her from working as an engineer.
March 20, 2025
Insurer To 4th Circuit: Overturn Ruling In Long COVID Disability Benefits Case

RICHMOND, Va. — Arguing that the lower court improperly applied de novo review and wrongly concluded that the claimant showed that she is disabled from working as an engineer because of long COVID symptoms, an insurer urged the Fourth Circuit U.S. Court of Appeals to reverse a judgment that the claimant is owed past-due long-term disability (LTD) benefits.
April 15, 2025
Judge Upholds LTD Benefits Termination For Failure To Show No ‘Working’

WORCESTER, Mass. — Upholding termination of long-term disability (LTD) benefits on de novo review, a Massachusetts federal judge ruled that an independent financial adviser didn’t meet his burden of showing that he had not been “working,” with that term defined as “engaging in activity regularly for wages or salary.”
April 14, 2025
Dismissal Bid Fought In Dispute Over Disability Policy ‘Age 65’ Language

PHOENIX — Arguing in part that the defendants’ “desired interpretation runs counter to the well-pleaded facts, the parties’ expectations, any reasonable consumer’s expectations, and decisional law,” a plaintiff on April 11 urged an Arizona federal court to deny dismissal of his putative class complaint over whether certain individual long-term disability (LTD) benefits must be paid through eligible insureds’ 65th birthdays.