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Mealey's Disability Insurance

  • July 22, 2025

    Ruling Policy Limitation Enforceable, 9th Circuit Upholds LTD Claim Denial

    SAN FRANCISCO — Issuing an unpublished memorandum disposition affirming that the preexisting conditions limitation (PECL) “is enforceable as applied” in the denial of a long-term disability (LTD) benefits claim, the Ninth Circuit U.S. Court of Appeals did not reach a dispute regarding the applicable standard of review.

  • July 15, 2025

    Benefits To Be Reinstated For Claimant In Migraine Disability Lawsuit

    SAN FRANCISCO — On de novo review of the termination of long-term disability (LTD) benefits for an employment law firm partner diagnosed with vestibular migraine and tinnitus, a California federal judge found in favor of the claimant and directed that the benefits be retroactively reinstated.

  • July 15, 2025

    9th Circuit Revives Breach Claim In Disability Row Involving COVID Risk

    SAN FRANCISCO — In an unpublished July 14 memorandum disposition, the Ninth Circuit U.S. Court of Appeals revived a breach of contract claim, but not a bad faith claim, in a suit an oral surgeon filed after unsuccessfully seeking disability benefits on the grounds that his comorbid conditions and inability to access recommended personal protective equipment (PPE) made it necessary to close his practice early in the COVID-19 pandemic.

  • July 15, 2025

    ‘Sheer Number’ Of AI-Faked Cites Noted In Defense Fee Declaration In Disability Case

    SANTA ANA, Calif. — In a July 14 defense fee declaration submitted at the direction of a California federal judge who imposed sanctions on a plaintiffs’ attorney for faked citations attributed to artificial intelligence, a disability insurer’s attorney said, “The sheer number of non-existent cases . . . was exponentially more than we have identified in any other cases discussing AI-generated and/or hallucinated cases.”

  • July 15, 2025

    Summary Judgment Denied In Disability Benefits Row Involving Notice, Cognition

    BUFFALO, N.Y. — Admitting a declaration that was not part of the administrative record and concluding in part “that procedural irregularities call into question the fairness and clarity of the decision-making process,” a New York federal magistrate judge denied cross-motions in a disability benefits case that involves late notice and a claimant who reportedly has cognitive issues after receiving treatment including radiation for an aggressive form of brain cancer.

  • July 14, 2025

    Colorado Federal Judge Upholds Denial Of Attorney’s COVID-Linked LTD Claim

    DENVER — Ruling against an attorney who unsuccessfully sought long-term disability (LTD) benefits because of fatigue and cognitive issues attributed to long COVID-19, a Colorado federal judge concluded that denial of the claim was not arbitrary and capricious; among other things, the judge said she “cannot conclude that Defendant failed to engage in a meaningful dialogue with Plaintiff.”

  • July 14, 2025

    As Recommended, Disability Claimant Wins Summary Judgment On Contract Breach Claim

    BUFFALO, N.Y. — A claimant who sought summary judgment on three of five counts in his suit over termination of disability benefits was granted it on a single breach of contract claim, with a New York federal judge briefly overruling the defendants’ objections to a report and recommendation he adopted; the ruling leaves claims including breach of the covenant of good faith and fair dealing pending.

  • July 14, 2025

    11th Circuit Sets Argument In Exhaustion Appeal Involving NFL Disability Plan

    ATLANTA — The 11th Circuit U.S. Court of Appeals has scheduled oral argument for Aug. 13 in an appeal where a former NFL player who argued that he should have been awarded total and permanent (T&P) disability benefits a decade earlier than he was seeks reversal of a dismissal ruling that was based on failure to exhaust administrative remedies.

  • July 10, 2025

    Order Vacated, Case Dismissed In LTD Benefits Row Involving COVID Risk

    SAN FRANCISCO — After vacating an August 2024 order and judgment that were in favor of a pediatrician who sought long-term disability (LTD) benefits based on her high risk of exposure to COVID-19, a California federal judge dismissed the case with prejudice pursuant to the parties’ stipulation.

  • July 09, 2025

    California Federal Magistrate Rules Claimant Eligible For 2 Years Of LTD Benefits

    SAN FRANCISCO — In a decision that involved weighing the opinions of numerous doctors, a California federal magistrate judge ruled that a claimant who held a “demanding managerial” role before saying that anxiety, depression and atypical autism made her unable to work is entitled to long-term disability (LTD) benefits “for the two-year mental disorder benefit period” and is eligible to seek attorney fees.

  • July 09, 2025

    10th Circuit Won’t Award Attorney Fees For Presuit Appeal In LTD Benefits Row

    DENVER — Affirming dismissal of a case filed under the Employee Retirement Income Security Act, the 10th Circuit U.S. Court of Appeals on July 8 rejected a bid to make a long-term disability (LTD) insurer pay attorney fees for an administrative appeal that got benefits reinstated.

  • July 08, 2025

    Judge Upholds Denial Of ‘Any Occupation’ LTD Benefits On De Novo Review

    MINNEAPOLIS — Upholding denial of long-term disability (LTD) benefits under an “any gainful occupation” standard on de novo review, a Minnesota federal judge said in part that the denial “was in lockstep with” restrictions on the claimant at the time and that a treating physician’s efforts to retroactively “walk back” those restrictions “do not change things.”

  • July 08, 2025

    Judge Says LTD Plan Must Take Another Look At Denial After Deadline Snafu

    SEATTLE — Ruling that equitable estoppel bars an untimeliness argument against a long-term disability (LTD) claimant who was given an incorrect administrative appeal deadline, a federal judge in Washington concluded that the correct remedy is remand “to the LTD plan administrator for review based on the full record, including the now-available post-denial medical information and literature involving long COVID.”

  • July 03, 2025

    California Federal Judge Sanctions Lawyer For AI-Faked Cites In Disability Case

    SANTA ANA, Calif. — A California federal judge imposed sanctions including a $500 payment on a plaintiff’s attorney who told the court that he “failed to scrutinize and oversee the preparation of” memoranda “filed with erroneous case citations that were invented by AI”; the breach of contract suit over termination of total disability benefits is headed toward a jury trial after the judge last month granted summary judgment for the insurer on a bad faith claim.

  • July 01, 2025

    Connecticut Federal Judge Upholds LTD Termination Under ‘Any Occupation’ Standard

    NEW HAVEN, Conn. — Closing a lawsuit filed by a shop fabricator with rheumatoid arthritis and granting judgment in favor of a long-term disability (LTD) insurer, a Connecticut federal judge said that “although this may be a case where a contrary determination would also be supported by substantial evidence,” overall “there was substantial evidence to support [the insurer’s] determination that Plaintiff was not disabled under the ‘Any Occupation’ definition.”

  • July 01, 2025

    Judge Rules For Claimant In LTD Row Involving Own-Occupation Duties

    CHATTANOOGA, Tenn. — Ruling on de novo review for a long-term disability (LTD) claimant who has neck and back pain, a Tennessee federal judge ordered retroactive reinstatement of her benefits in the case, resolving issues including what the duties of her regular occupation as a hospital chief clinical officer (CCO) are.

  • June 26, 2025

    California Federal Judge Gives Disability Insurers Win In Breach, Bad Faith Row

    LOS ANGELES — Granting summary judgment for insurers in an individual disability insurance (IDI) dispute, a California federal judge ruled in part that insurers were prejudiced by late notice of the claim.

  • June 25, 2025

    In ‘Close Call’ Case, Judge Rules For LTD Claimant In Any-Occupation Dispute

    SACRAMENTO, Calif. — In a decision he described as “a very close call,” a California federal judge ruled on de novo review that a claimant was disabled from any occupation under the terms of a long-term disability (LTD) plan; among other things, the judge resolved opposed requests for judicial notice and explained his findings that the opinions of several doctors should be given little to no weight but the claimant’s “reports of pain are entitled to some weight.”

  • June 25, 2025

    LTD Insurer Wins Summary Judgment In Dispute Involving Sedentary Work Ability

    SYRACUSE, N.Y. — Saying in part that “[s]ubstantial evidence supports the Defendant’s determination that Plaintiff can perform sedentary work,” a New York federal judge upheld termination of long-term disability (LTD) benefits for a nurse practitioner under an “any gainful occupation” definition of disability.

  • June 16, 2025

    4th Circuit Upholds LTD Benefits Ruling Involving ‘Objective Evidence’ Exception

    RICHMOND, Va. — Saying in part that “a patient’s self-reported symptoms of pain and fatigue are the exact sort of evidence that the objective-evidence bar is designed to eliminate,” the Fourth Circuit U.S. Court of Appeals issued an unpublished June 13 opinion affirming judgment for a long-term disability (LTD) insurer that terminated benefits under a maximum lifetime limitations provision for neuromuscular, musculoskeletal and soft tissue disorders.

  • June 16, 2025

    4th Circuit Rules 2-1 For LTD Claimant, Avoids Deciding Review Standard Question

    RICHMOND, Va. — In an unpublished opinion that drew a one-paragraph dissent, the Fourth Circuit U.S. Court of Appeals on June 13 upheld summary judgment for a long-term disability (LTD) claimant, saying in part that it didn’t need to decide whether the lower court’s use of de novo review was improper because the insurer’s termination of benefits “does not withstand scrutiny even under the less-rigorous abuse of discretion standard.”

  • June 16, 2025

    Putative Class Lawsuit Challenges Revision To American Airlines LTD Plan

    FORT WORTH, Texas — In a putative class complaint filed in Texas federal court, a disabled pilot sued American Airlines Inc. (AA) and related defendants under the theory that a May 2024 revision of its long-term disability (LTD) plan improperly excluded “vacation, ratification bonuses, profit sharing, one-time supplemental payment, bereavement, grievance payouts, extended sick bank, and Special Assignment” from average monthly compensation, resulting in underpayment of LTD benefits.

  • June 13, 2025

    7th Circuit Affirms Ruling Against LTD Claimant Who Has Fibromyalgia

    CHICAGO — Calling the challenged decision “detailed and diligent,” the Seventh Circuit U.S. Court of Appeals on June 12 ruled that a district court properly found that a former PricewaterhouseCoopers LLP (PwC) director failed to satisfy her burden of proving that she remained disabled from working in a sedentary occupation as a result of symptoms related to fibromyalgia.

  • June 13, 2025

    Claimant With Long COVID To Challenge LTD Benefit Denial In 9th Circuit

    SAN DIEGO — A claimant who unsuccessfully sought long-term disability (LTD) benefits due to symptoms he attributed to long COVID and cardiac issues is taking his case to the Ninth Circuit U.S. Court of Appeals after a California federal judge upheld denial of his claim on de novo review.

  • June 11, 2025

    Judge Denies Transfer Bid LTD Insurer Didn’t Make With ‘Reasonable Promptness’

    MIAMI — Noting that recently produced medical records are generally not admissible in the original jurisdiction but would be where the defendant sought transfer, a Florida federal judge denied a long-term disability (LTD) insurer’s motion, saying it “plainly did not act with reasonable promptness to request transfer.”