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

Mealey's Disability Insurance

July 05, 2024
Failure To Consider Cognitive Issues Was Abuse Of Discretion, Federal Judge Says

BALTIMORE — A Maryland federal judge determined that a disability insurer abused its discretion in terminating a disability claimant’s long-term disability (LTD) benefits because the insurer failed to consider how the claimant’s cognitive issues affect her ability to work in her regular occupation.
July 03, 2024
Termination Of LTD Benefits Not Arbitrary, Capricious, Ohio Federal Judge Says

COLUMBUS, Ohio — A disability insurer’s termination of long-term disability (LTD) benefits after paying benefits for 19 years was not arbitrary and capricious because substantial evidence supports the finding that the claimant was no longer disabled from performing the duties of any occupation and the claimant failed to identify any evidence showing that the termination was arbitrary and capricious, an Ohio federal judge said in granting the disability insurer’s motion for judgment on the administrative record.
July 03, 2024
After Evidence Of Insurability Probes, DOL Reports Settlements With Life Insurers

WASHINGTON, D.C. — Saying in a news release that “[i]nvestigations into other life insurance companies’ practices surrounding evidence of insurability [EOI] are ongoing,” the U.S. Department of Labor (DOL) announced two settlements in which its investigations were resolved by life insurers’ agreements to follow certain procedures.
June 25, 2024
Termination Of LTD Benefits Supported By Evidence In Administrative Record

BOSTON — A disability insurer’s termination of a claimant’s long-term disability (LTD) benefits was not arbitrary and capricious, a Massachusetts federal judge concluded June 24 after determining that the evidence in the administrative record clearly supports the insurer’s finding that the claimant was no longer disabled from performing the duties of any occupation.
June 21, 2024
Claimant Failed To Meet Burden Of Showing He Is Disabled From Own Occupation

CONCORD, N.H. — A disability claimant is not entitled to long-term disability (LTD) benefits because he failed to meet his burden of proving by a preponderance of the evidence that he is disabled as a result of narcolepsy from performing the duties of his own occupation, a New Hampshire federal judge said in denying the claimant’s motion for judgment on the administrative record and in granting the disability insurer’s motion for judgment on the administrative record.
June 21, 2024
Disability Suit Dismissed For Failure To Timely File Suit, Exhaust All Benefits

NASHVILLE, Tenn. — A disability claimant’s suit against a disability insurer and employer must be dismissed because the claim based on a denial of short-term disability (STD) benefits is barred by the disability plan’s one-year limitations period for filing suit and the claim based on a denial of long-term disability (LTD) benefits cannot proceed based on the claimant’s failure to exhaust all available STD benefits under the plan, a Tennessee federal judge said.
June 21, 2024
Termination Of Benefits Under Any-Occupation Standard Was Reasonable, Judge Says

COLUMBIA, Tenn. — A Tennessee federal judge adopted a magistrate judge’s report and recommendation to grant a disability insurer’s motion for judgment on the administrative record, agreeing with the magistrate judge’s finding that the disability insurer’s decision to terminate the claimant’s benefits was reasonable and not arbitrary and capricious.
June 20, 2024
Termination Of LTD Benefits Was Not Abuse Of Discretion, Arizona Federal Judge Says

PRESCOTT, Ariz. — A disability insurer did not abuse its discretion in terminating a long-term disability (LTD) benefits claim because the termination was reasonable based on a lack of medical evidence in support of the claim, an Arizona federal judge said in entering judgment for the insurer.
June 19, 2024
Former NFL Player’s Appeal Dismissed By 11th Circuit For Want Of Prosecution

ATLANTA — The 11th Circuit U.S. Court of Appeals on June 18 dismissed a former National Football League player’s appeal in a dispute over additional disability benefits for want of prosecution because the former NFL player failed to file required disclosures and forms as required by the court.
June 19, 2024
Kentucky Panel Affirms Trial Court’s Offset Ruling In Disability Suit

FRANKFORT, Ky. — A disability insurer incorrectly offset a claim for long-term disability (LTD) benefits by the amount of a claimant’s first round of retirement benefits because the policy is ambiguous as to how multiple sets of retirement benefits should be offset against an LTD claim, the Kentucky Court of Appeals panel said in affirming a trial court’s ruling.
June 19, 2024
Oklahoma Federal Judge Says Disability Claimant’s Suit Fails To State A Claim

OKLAHOMA CITY — An Oklahoma federal judge granted a disability insurer’s motion to dismiss a disability claimant’s suit after determining that the claimant failed to plausibly plead claims for a denial of benefits or a breach of fiduciary duty.
June 07, 2024
LTD Benefits Cannot Be Offset By Social Security Retirement Benefits, Judge Says

ALEXANDRIA, Va. — A disability insurer abused its discretion for a third time by ignoring the language of the disability policy and contending that a claimant’s monthly long-term disability (LTD) benefits amount should be offset by the amount of the claimant’s earned-income Social Security retirement benefits, a Virginia federal judge said after determining that the plan permits an offset only for Social Security benefits paid because of a claimant’s disability.
June 07, 2024
Disability Claimant Says Any-Occupation Benefits Are Owed By Disability Insurer

SAN DIEGO — A disability insurer abused its discretion in determining that a disability claimant is not disabled from performing the duties of any occupation based on symptoms related to the claimant’s diagnoses of fibromyalgia and ankylosing spondylosis because the medical evidence submitted by the claimant supports a finding that the claimant is disabled from performing the duties of any occupation, the claimant maintains in a June 6 complaint filed in California federal court.
June 07, 2024
Oral Arguments Scheduled In Dispute Over Proof Of Continued Disability

PHILADELPHIA — The Third Circuit U.S. Court of Appeals scheduled oral arguments for July 9 in a disability plan’s appeal of a district court’s ruling that the plan abused its discretion when it terminated a claimant’s long-term disability (LTD) benefits for failure to provide proof of a continued disability.
June 07, 2024
Former NFL Player Files Notice Of Appeal After Dismissal Of Suit

ATLANTA — A former National Football League player who claims that he is owed additional disability benefits filed a notice of appeal to the 11th Circuit U.S. Court of Appeals, seeking review of the lower court’s dismissal of his second amended complaint based on a finding that he failed to exhaust all administrative remedies and failed to show that exhaustion would be futile.
June 06, 2024
Mental Illness Limitation Does Not Apply, Disability Claimant Says In Complaint

PORTLAND, Maine — A disability plan participant filed suit in Maine federal court against a disability insurer, claiming that he is entitled to reinstatement of long-term disability (LTD) benefits because the insurer wrongfully applied the plan’s mental illness limitation when it terminated his LTD benefits.
June 06, 2024
Disability Claimant, Insurer Stipulate To Dismissal After Reaching Settlement

KNOXVILLE, Tenn. — A disability insurer and a disability claimant filed a joint stipulation of dismissal in Tennessee federal court following the settlement of the claimant’s long-term disability (LTD) benefits suit.
June 06, 2024
Parties Settle Disability Benefits Suit Stemming From Long COVID Diagnosis

MIAMI — A Florida federal judge ordered the parties in a long-term disability (LTD) benefits suit stemming from a claimant’s diagnosis with long COVID to file a joint stipulation of dismissal and administratively closed the case after the parties notified the court that they reached a settlement.
June 05, 2024
Disability Claimant Seeks De Novo Review, Says Additional STD Benefits Are Owed

TULSA, Okla. — A de novo standard of review should be applied to the review of the denial of a short-term disability (STD) claim because the disability plan administrator committed a number of procedural irregularities in handling the claimant’s second appeal of the denial of his claim, the claimant says in an opening brief filed in Oklahoma federal court.
June 05, 2024
Ex-NFL Player Granted Extension To Petition High Court In Disability Suit

WASHINGTON, D.C. — The deadline for a former National Football League player to file a petition for writ of certiorari in the U.S. Supreme Court was extended by a month, giving the former player until July 13 to seek review of the Fifth Circuit U.S. Court of Appeals’ ruling that he failed to prove that he is entitled to additional disability benefits under the NFL’s benefits plan.
May 22, 2024
Complete Administrative Record Needed To Review Denial Of LTD Claim, Judge Says

PORTLAND, Ore. — A disability claimant’s motion for judgment on the pleadings must be denied because the claimant submitted only portions of the administrative record, an Oregon federal judge said, noting that the complete administrative record, as reviewed by the plan administrator, is necessary to judicially review the plan administrator’s long-term disability (LTD) benefits decision.
May 21, 2024
Insured Is Not Entitled To 2 Monthly Disability Payments, Massachusetts Panel Says

BOSTON — A trial court properly found that an insured is not entitled to both total disability benefits and lifetime total disability benefits under a disability income policy because the policy clearly provides that lifetime total disability benefits are not payable until the maximum amount of total disability benefits is paid or until the insured’s 65th birthday, the Massachusetts Appeals Court said May 21 in affirming the trial court’s summary judgment order in favor of the insurer on breach of contract and bad faith claims.
May 21, 2024
Insured Failed To Show Disability Insurer Acted With Reckless Disregard, Judge Says

LOUISVILLE, Ky. — A Kentucky federal judge granted a disability insurer’s motion to dismiss an insured’s claims for violation of the Kentucky Unfair Claims Settlement Practices Act (KUCSPA) and breach of the covenant of good faith and fair dealing because the insured failed to show that the insurer acted with reckless disregard when it determined that the insured was entitled to only residual disability benefits and not total disability benefits.
May 14, 2024
Life Insurance Benefit Not Available Based On Failure To Prove Total Disability

PASADENA, Calif. — The Ninth Circuit U.S. Court of Appeals on May 13 affirmed a district court’s finding that a life insurance waiver-of-premium benefit was properly terminated because the claimant failed to show that he was totally disabled from working in any occupation as required by the life insurance plan to retain the waiver-of-premium benefit.
May 10, 2024
Claim For Disability Benefits Is Time-Barred, 5th Circuit Panel Says In Affirming

NEW ORLEANS — The Fifth Circuit U.S. Court of Appeals on May 9 affirmed the dismissal of a disability claimant’s breach of contract suit because the claimant failed to filed suit within three years of the initial denial of her claim, as required by the plan at issue, and failed to file suit within four years of the denial of her appeal pursuant to the four-year statute of limitations under Texas law for breach of contract suits.