Newsletter RSS

Mealey's Disability Insurance

  • September 10, 2025

    Judge: Integration Brought Owners-Only LTD Policy Under ERISA

    SAN JOSE, Calif. — Dismissing bad faith and breach of contract claims that a PricewaterhouseCoopers LLP (PwC) equity owner who unsuccessfully sought long-term disability (LTD) benefits because of symptoms he attributed to long COVID asserted under California law, a California federal judge concluded that when “an employer integrates a pre-existing” policy that is not governed by the Employee Retirement Income Security Act “into a broader ERISA-governed plan, the non-ERISA policy becomes a part of the ERISA plan and is subject to the requirements and preemptive effect of ERISA.”

  • September 10, 2025

    LTD Claimant Urges 11th Circuit To Reverse Summary Judgment In Tax Returns Row

    ATLANTA — Urging the 11th Circuit U.S. Court of Appeals to take the position outlined in a report and recommendation that the lower court declined to adopt, a deaf engineer who received long-term disability (LTD) benefits for about a decade before they were terminated due to his refusal to provide personal tax returns argues in part that the insurer isn’t entitled to interpret the term “work” because it is not ambiguous.

  • September 10, 2025

    Insurer Faulted For Terminating LTD Benefits In Case Involving Fatigue, COVID

    TRENTON, N.J. — Citing “procedural irregularities and substantive errors” in an insurer’s handling of a long-term disability (LTD) claim for an individual whose diagnoses include myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, a New Jersey federal judge issued an unpublished opinion directing that the claimant receive about seven months of retroactive benefits and that her claim be remanded for a determination as to whether she remained eligible after her administrative appeal was denied.

  • September 08, 2025

    8th Circuit Affirms Ruling Against Short-Term Disability Claimant

    ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on Sept. 5 briefly affirmed summary judgment against a short-term disability (STD) claimant in an unpublished per curiam opinion, saying in part that the insurer “did not abuse its discretion by relying on the opinions of its nurse consultants over those of [claimant Monty] Jones’s counselor” and was not “required to provide an independent medical examination (IME) of Jones before deciding his claim.”

  • September 04, 2025

    Review Standard Is Focus Of 2nd Circuit Briefing In Appeal Of LTD Benefits Denial

    NEW YORK — Standard of review is the sole issue in a Second Circuit U.S. Court of Appeals challenge to a ruling upholding denial of long-term disability (LTD) benefits, with the insurer arguing in its answering brief first that it had discretionary authority under the plan and second that there are no grounds to disregard that grant because it complied with claim regulations.

  • September 04, 2025

    Judge: Immunocompromised Doctor Deserves LTD Benefits Due To COVID-19 Risk

    WINSTON-SALEM, N.C. — Following a bench trial on the administrative record regarding a clinical anesthesiologist with chronic lymphocytic leukemia (CLL) whose unsuccessful disability claim was based on his risk of exposure to COVID-19, a North Carolina federal judge concluded on de novo review that the anesthesiologist is entitled to retroactive long-term disability (LTD) benefits, prejudgment interest and the costs of the suit.

  • September 03, 2025

    Ruling Challenge Was A New Claim, 7th Circuit Affirms Denial Of LTD Benefits

    CHICAGO — Affirming summary judgment against a professional musician whose long-term disability (LTD) claim was denied under policy terms because she was not an active, full-time employee when she said long COVID symptoms made her unable to work, the Seventh Circuit U.S. Court of Appeals on Sept. 2 said the information submitted in her administrative appeal “in effect requested coverage for a different loss, and that meant she was submitting a new claim.”

  • September 02, 2025

    Judge Trims Attorney Fees, Prejudgment Interest Rate In LTD Lawsuit

    NEW YORK — Saying in part that the requested 21.8% prejudgment interest rate “is far outside the norm in this District,” a New York federal judge awarded modified amounts totaling $230,083.65 for attorney fees and $139,497.54 for prejudgment interest in a long-term disability (LTD) case in which the claimant won $928,954.90 in retroactive benefits.

  • September 02, 2025

    Record With Settlement Info On Former MLB Pitcher’s Deal In PTD Case Is Sealed

    LOS ANGELES — A California judge agreed to seal the written record of court proceedings that contained some terms of a settlement agreement that former Major League Baseball pitcher Matthew S. Garza entered in a suit over a permanent total disability (PTD) insurance policy under which he claimed he was due a $10 million benefit.

  • August 28, 2025

    1st Circuit: Insurer Didn’t Abuse Its Discretion In Ending LTD Benefits

    BOSTON — Saying in part that “[t]he administrative record supportably shows that” a marketing executive who had been awarded long-term disability (LTD) benefits based on chronic back pain “could meet every enumerated physical demand by the time” those benefits were terminated, the First Circuit U.S. Court of Appeals on Aug. 27 upheld summary judgment for an insurer.

  • August 25, 2025

    Parties Stipulate To Dismissing LTD Case Filed Over Commission Calculations

    NEW HAVEN, Conn. — Without substantive explanation, an insurer and disability claimant stipulated to dismissal with prejudice of a suit in Connecticut federal court challenging the discontinuation of long-term disability (LTD) benefits, with “all parties to bear their own costs and attorneys’ fees.”

  • August 25, 2025

    11th Circuit Skirts Exhaustion Issue, Won’t Revive Case Over NFL Disability Benefits

    ATLANTA — Affirming dismissal on two alternate grounds without deciding whether the appellant exhausted his administrative remedies, the 11th Circuit U.S. Court of Appeals in a per curiam Aug. 22 opinion declined to revive a former NFL player’s suit over total and permanent (T&P) disability benefits that he argued he should have been awarded under a 2006 application.

  • August 20, 2025

    LTD Recipient Amends Complaint Over IRA Rollover Offset

    BILLINGS, Mont. — Following a Montana federal court ruling that the Employee Retirement Income Security Act governs the long-term disability (LTD) policy at issue and preempts the previously asserted state law claims, a plaintiff who is challenging an offset that reduced his monthly benefit filed a second amended complaint making a single ERISA claim for recovery of plan benefits.

  • August 20, 2025

    LTD Claimant Wins On Bonus Issue, Loses Bid To Overturn Benefits Termination

    BOSTON — A Massachusetts federal judge ruled that excluding bonuses when calculating benefits for a long-term disability (LTD) claimant “was unreasonable and an abuse of discretion” under the circumstances but affirmed the eventual termination of the benefits under an “any occupation” standard and rejected the claimant’s argument that there were procedural defects in the insurer’s review.

  • August 20, 2025

    1st Circuit Appeal Is Filed Over LTD Termination Under Any-Occupation Definition

    BOSTON — A claimant who unsuccessfully challenged a determination that she wasn’t entitled to long-term disability (LTD) benefits under an any-occupation standard despite being approved for Social Security Disability Income (SSDI) has docketed an appeal in the First Circuit U.S. Court of Appeals.

  • August 18, 2025

    Judge Affirms LTD Benefits Denial In Row Involving Elimination Period Requirement

    CHATTANOOGA, Tenn. — Accepting and adopting “the relevant portions” of an August 2024 report and recommendation, and overruling the objections of a claimant who sought long-term disability (LTD) benefits due to symptoms that arose after her vehicle was rear-ended, a Tennessee federal judge on Aug. 15 granted judgment on the administrative record for an insurer that denied benefits under an elimination period requirement.

  • August 18, 2025

    Split 2nd Circuit Resolves Separation Agreement Row, Revives LTD Benefits Suit

    NEW YORK — Ruling 2-1 “that any release of claims against [insurer Sun Life Assurance Company of Canada] was not knowing and voluntary,” the Second Circuit U.S. Court of Appeals revived a suit over denial of long-term disability (LTD) benefits where Sun Life had won summary judgment because of a separation agreement the claimant signed with her former employer.

  • August 14, 2025

    11th Circuit Affirms Ruling For Insurer In LTD Dispute Involving Sedentary Work

    ATLANTA — Affirming a ruling for an insurer that terminated long-term disability (LTD) benefits based on its determination that the claimant is capable of performing sedentary work, the 11th Circuit U.S. Court of Appeals in an unpublished per curiam opinion issued Aug. 13 concluded that the claimant didn’t show that the lower court erred.

  • August 12, 2025

    Suit Over Airline’s LTD Plan Is Voluntarily Dismissed After Resolution Report

    FORT WORTH, Texas — A putative class complaint that a disabled pilot filed over a May 2024 plan revision that he alleged resulted in underpayment of long-term disability (LTD) benefits was voluntarily dismissed without prejudice on Aug. 11 after the defendants told the Texas federal court in a dismissal motion that the pilot’s union had already gotten the issues resolved through a Railway Labor Act (RLA) dispute-resolution process.

  • August 08, 2025

    Extra-Record Discovery On Purported Conflict Of Interest Is Denied In LTD Row

    NEWARK, N.J. — Concluding that discovery requests “are not only unjustified under the conflict of interest exception to the” Employee Retirement Income Security Act “record rule, but not proportional to the needs of this case,” a New Jersey federal magistrate judge denied a pharmacist’s request to allow discovery beyond the administrative record in her suit challenging termination of her long-term disability (LTD) benefits.

  • August 07, 2025

    Judge Upholds STD Benefits Termination Under Arbitrary And Capricious Standard

    TULSA, Okla. — Rejecting an argument for de novo review, an Oklahoma federal judge upheld termination of short-term disability (STD) benefits in a case where the claimant said he was unable to work because of depression and memory loss.

  • July 31, 2025

    Judge Affirms Insurer’s ‘Incarceration’ Interpretation In LTD Benefits Row

    PITTSBURGH — Saying, “On the record before it, this Court finds that the term ‘incarceration’ is ambiguous, as it could mean post-conviction penal confinement or it could simply mean confinement,” a Pennsylvania federal judge on July 30 upheld termination of long-term disability (LTD) benefits under arbitrary and capricious review upon concluding that interpreting the term to mean confinement was within the insurer’s discretionary authority.

  • July 31, 2025

    Federal Judge Upholds LTD Benefits Termination Under Residency Provision

    SEATTLE — Addressing cross-motions for judgment on the record on de novo review of a long-term disability (LDT) benefits dispute, a Washington federal judge upheld termination of benefits under an international residency provision despite the fact that the COVID-19 pandemic hit during the time at issue.

  • July 28, 2025

    5th Circuit Rules That LTD Benefits Termination Was Sufficiently Supported

    NEW ORLEANS — In an unpublished per curiam opinion noting that the challenged termination of long-term disability (LTD) benefits “was supported by reports from at least four healthcare professionals,” the Fifth Circuit U.S. Court of Appeals affirmed judgment for an insurer in a case over whether the claimant was able to perform any gainful sedentary occupation.

  • July 28, 2025

    11th Circuit Nixes LTD Insurer’s Unjust Enrichment Jury Victory Under Florida Law

    ATLANTA — Issuing a mixed ruling in a dispute where a federal jury sided with a long-term disability (LTD) insurer, the 11th Circuit U.S. Court of Appeals ordered the trial court to vacate a judgment of nearly $450,000 for the insurer on its unjust enrichment claim but upheld dismissal of a breach of contract counterclaim.