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Judge: Benefit Denial Decision Was Not Supported By The EvidenceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
LOS ANGELES - An ERISA-governed disability insurer that terminated benefits to a claimant with chronic neck pain abused its discretion, a federal judge in California ruled Sept. 15, finding that the insurer cited select evidence to support its decision and relied on ambiguous reviews (Graciela Saffon v. Wells Fargo & Company Long Term Disability Plan, et al., No. CV04-1237, C.D. Calif.; 2009 U.S. Dist. LEXIS 84152). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Record Reviews Support Benefit Denial, Maryland Federal Judge SaysEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
BALTIMORE - An ERISA-governed disability insurer that denied benefits to a claimant with back pain did not abuse its discretion, a federal judge in Maryland ruled Sept. 14, saying there is sufficient evidence in the record to support the carrier's benefit denial (Marlene Krajewski v. Metropolitan Life Insurance Co., No. 08-2406, D. Md.; 2009 U.S. Dist. LEXIS 83741). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

6th Circuit Finds Termination Was Supported By RecordEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CINCINNATI - Statements from a claimant's treating physicians that he could return to work supports an insurer's decision to terminate long-term disability benefits to a claimant suffering from chronic pain syndrome, the Sixth Circuit U.S. Court of Appeals ruled Sept. 21 (George Likas v. Life Insurance Company of North America, No. 07-6514, 6th Cir.; 2009 U.S. App. LEXIS 20917). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

ERISA Plan Failed To Adequately Explain Basis For Benefit DenialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHICAGO - A plan administrator that terminated benefits to a claimant with multiple sclerosis did not adequately explain its reasoning for rejecting the claimant's treating physicians' opinions that the claimant was disabled, the Seventh Circuit U.S. Court of Appeals ruled July 23, remanding the claim to the administrator for further review (Nancy Love v. National City Corporation Welfare Benefits Plan, No. 08-1722, 7th Cir.; 2009 U.S. App. LEXIS 16168). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Reconsideration Request Counts As An Appeal, Ohio Magistrate HoldsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
COLUMBUS, Ohio - A request for reconsideration of a benefits decision counts as an appeal and meets the requirement for an exhaustion of benefits, a federal magistrate judge in Ohio ruled Sept. 17 (Lawrence D. Brogan v. The Hartford Life Insurance Co., No. 2:08-cv-765, S.D. Ohio; 2009 U.S. Dist. LEXIS 85101). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Missouri Federal Judge Allows Claim Over LTD Benefits To StandEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
ST. LOUIS - A federal judge on Sept. 14 ruled that a disability claimant that alleges that she was denied the opportunity to apply for long-term disability benefits after her short-term benefits claim was denied did not fail to exhaust her administrative remedies (Donna Blake v. Express Scripts Inc., et al., No. 4:09-CV-563, E.D. Mo.; 2009 U.S. Dist. LEXIS 83491). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Policy's 3-Year Limitations Period Is Enforceable, 6th Circuit SaysEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CINCINNATI - A three-year contractual limitations period in four separate disability policies is valid and enforceable, the Sixth Circuit U.S. Court of Appeals ruled Sept. 2 in an unpublished opinion (Harmond H. Schaefer v. AXA Equitable Life Insurance Co., dba Equitable and Disability Management Services Inc., No. 08-2198, 6th Cir.; 2009 U.S. App. LEXIS 19987). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Divided 9th Circuit: ERISA Requirements Not Met By Summary Plan DescriptionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
SAN FRANCISCO - In affirming that a claim for disability benefits under the Employee Retirement Income Security Act was untimely because it was not filed within the contractual one-year statute of limitations period, a divided Ninth Circuit U.S. Court of Appeals on Sept. 9 found that the placement and display of the statue of limitations in the plan's summary plan description met plan participants' reasonable expectations, assuming that the "reasonable expectation" doctrine applied (Donna Scharff v. Raytheon Company Short Term Disability Plan, et al., No. 07-55951, 9th Cir.; 2009 U.S. App. LEXIS 20130). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

6th Circuit: ERISA Plan's Claim Accrual Date Governs In Disability CaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CINCINNATI - Parties may contract for the date on which a claim under the Employee Retirement Income Security Act accrues, the Sixth Circuit U.S. Court of Appeals ruled Aug. 24 in finding a disability claimant's claim barred by the plan's three-year statute of limitations (Jerry Rice v. Jefferson Pilot Financial Insurance Company, No. 08-4180, 6th Cir.; 2009 U.S. App. LEXIS 18962). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Conflict Of Interest Affected Decision-Making Process, 9th Circuit FindsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
SAN FRANCISCO - An ERISA-governed insurer's conflict of interest affected its decision to terminate benefits to a claimant with back problems, the Ninth Circuit U.S. Court of Appeals ruled Sept. 14, reversing a grant of summary judgment to the insurer. The appeals court held that the insurer abused its discretion in terminating benefits (Robert Montour, et al. v. Hartford Life & Accident Insurance Co., No. 08-55803, 9th Cir.; 2009 U.S. App. LEXIS 20378). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Disability Policy Is Governed By ERISA, Federal Judge HoldsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PHILADELPHIA - A federal judge in Pennsylvania has ruled that two disability policies that were issued to two corporate officers under a split-fee arrangement are governed by the Employee Retirement Income Security Act, holding that the issue over disputed benefits will proceed as an action governed by ERISA. The insurer moved for judgment on the pleadings, and on Sept. 24, the judge ordered the parties to participate in a settlement conference set for Oct. 15 (William D. Spillane v. AXA Financial Inc., et al., No. 08-2151, E.D. Pa.; 2009 U.S. Dist. LEXIS 63739). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Coverage Terminated Because Of Ethical Violation, 6th Circuit RulesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CINCINNATI - A disability insurer that terminated coverage to a claimant whose medical license was suspended acted reasonably, the Sixth Circuit U.S. Court of Appeals ruled Sept. 3 in an unpublished opinion (Niranjan Lal v. United States Life Insurance Co., No. 07-2009, 6th Cir.; 2009 U.S. App. LEXIS 19984). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Protective Order Request Over Disputed Discovery Requests DeniedEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PROVIDENCE, R.I. - A blanket protective order in a discovery dispute involving an ERISA-governed long-term disability insurer is not warranted, a federal magistrate judge in Rhode Island ruled Sept. 15, finding that the disputes should be resolved through the traditional discovery process (Lorene Roccon Thompson v. UBS Financial Services Inc., et al., No. 09-033S, D. R.I.; 2009 U.S. Dist. LEXIS 84347). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

7th Circuit: Disability Plan Administrator Owes No Fiduciary Duty To Plan SponsorEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHICAGO - A disability plan administrator was not a fiduciary with respect to the plan sponsor under the Employee Retirement Income Security Act, the Seventh Circuit U.S. Court of Appeals affirmed Aug. 18 (Sharp Electronics Corporation v. Metropolitan Life Insurance Company, No. 08-2959, 7th Cir.; 2009 U.S. App. LEXIS 18385). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Apparent Bad Faith Claims Meet Requirements Of Federal Jurisdiction, Judge RulesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
COLUMBUS, Ohio - The potential recovery associated with an apparent bad faith claim against an insurer is sufficient to establish federal jurisdiction, an Ohio federal judge ruled Aug. 5, denying a plaintiff's motion to remand her complaint to state court (Estate of William A. Millhon, et al. v. Unum Life Insurance Co., No. 2:08-cv-652, S.D. Ohio, Eastern Div.; 2009 U.S. Dist. LEXIS 68299). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

News From The LexisNexis Insurance Law CenterEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
[Editor's Note: The following items of interest appeared recently on the LexisNexis Insurance Law Center. Devoted to insurance litigation and the insurance industry, the Insurance Law Center is where you can connect with other insurance professionals to discuss the hottest issues. Become a regular contributor. Visit the center on the open Web for insurance-related headlines, discussion, expert commentary and more at: http://law.lexisnexis.com/practiceareas/insurance.] Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - September 29, 2009 Category: Medical Law Source Type: info

Plan Amendment Limits Benefits To 2 Years, 7th Circuit SaysEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHICAGO - A plan administrator that terminated benefits to a claimant with a mental disability based on a limitation of benefits amendment for mental illness acted reasonably, the Seventh Circuit U.S. Court of Appeals ruled Aug. 14 (Michael Marrs v. Motorola Inc., et. al., No. 08-2451, 7th Cir.; 2009 U.S. App. LEXIS 18129). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Panel Affirms Insurer's Denial Of Disability Benefits Was Made In Good FaithEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
LOS ANGELES - A California appeals panel on July 17 found that although triable issues exist as to whether an insured's claimed disability "was not wholly mental," an insurer did not act in bad faith in denying continued benefits under her policy's two-year limit on benefits for "mental, nervous, or emotional disorder[s]" (Linda L. Bosetti v. The United States Life Insurance Co. in the City of New York, et al., No. B206896 c/w B208835, Calif. App., 2nd Dist., Div. 3; 2009 Cal. App. LEXIS 1166). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Claimant Capable Of Sedentary Work, 5th Circuit RulesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on Aug. 18 ruled that a plan administrator that denied benefits to a claimant that was able to work part-time and whose medical record showed evidence that he was capable of sedentary work did not abuse its discretion (Vicente A. Menchaca v. CNA Group Life Assurance Co., et al., No. 08-20658, 5th Cir.; 2009 U.S. App. LEXIS 18627). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

6th Circuit: Claimant Lacked Documentation On AbilitiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CINCINNATI - An ERISA-governed disability insurer that relied on independent record reviews after a claimant's treating physician failed to address the insured's actual functional abilities did not act arbitrarily or capriciously, the Sixth Circuit U.S. Court of Appeals ruled Aug. 20 in an unpublished decision (Linda L. Kiel v. Life Insurance Company of North America, et. al., No. 08-1990, 6th Cir.; 2009 U.S. App. LEXIS 18769). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

3rd Circuit: FCE, Vocational Review Support Termination DecisionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PHILADELPHIA - An ERISA-governed disability plan administrator that terminated benefits to a claimant with chronic back pain did not abuse its discretion, the Third Circuit U.S. Court of Appeals ruled Aug. 18, finding that the administrator acted reasonably by relying on an updated functional capacity evaluation (FCE) and vocational assessment (Judy L. Burk v. Broadspire Services Inc., et al., No. 07-3729, 3rd Cir.; 2009 U.S. App. LEXIS 18403). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

10th Circuit: Administrator Properly Reviewed Records, Sought Expert OpinionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
DENVER - An ERISA-governed disability plan administrator that terminated benefits to a claimant with fibromyalgia acted reasonably, the 10th Circuit U.S. Court of Appeals ruled Aug. 11, finding that the administrator continuously updated the claimant's medical records and conducted clinical record reviews and occupational assessments before its decision to terminate benefits (Barbara Colleen Holcomb v. Unum Life Insurance Company of America, No. 08-6183, 10th Cir.; 2009 U.S. App. LEXIS 17818). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

2nd Circuit Says Reliance On Physician Reports Was ReasonableEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
NEW YORK - An ERISA-governed disability insurer that relied on physician record reviews in its decision to terminate benefits to a claimant with fibromyalgia and other ailments acted reasonably, the Second Circuit U.S. Court of Appeals ruled July 29 (Deborah Hobson v. Metropolitan Life Insurance Co., No. 07-0364, 2nd Cir.; 2009 U.S. App. LEXIS 16677). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

ERISA Plan Failed To Adequately Explain Basis For Benefit DenialEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHICAGO - A plan administrator that terminated benefits to a claimant with multiple sclerosis did not adequately explain its reasoning for rejecting the claimant's treating physicians' opinions that the claimant was disabled, the Seventh Circuit U.S. Court of Appeals ruled July 23, remanding the claim to the administrator for further review (Nancy Love v. National City Corporation Welfare Benefits Plan, No. 08-1722, 7th Cir.; 2009 U.S. App. LEXIS 16168). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Termination Of Disability Benefits Not Arbitrary, 7th Circuit HoldsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHICAGO - An Employee Retirement Income Security Act disability insurer did not act arbitrarily and capriciously in terminating benefits under the plan's mental illness limitation to a claimant suffering memory loss, where seven of 13 experts opined that the sole or primary cause of the claimant's disability was depression, not an organic disease, the Seventh Circuit U.S. Court of Appeals affirmed Aug. 4 (Bruce Fischer v. Liberty Life Assurance Company of Boston, et al., No. 08-2617, 7th Cir.; 2009 U.S. App. LEXIS 17226). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Claimant Was Entitled To Benefits, Judge FindsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
SAN JOSE, Calif. - Medical evidence in the record supports a claim for total disability benefits, a federal judge in California ruled July 17, finding that an insurer's benefit denial was unreasonable (Patricia Galvin v. Provident Life and Accident Insurance Co., No. C-07-5195, N.D. Calif.; 2009 U.S. Dist. LEXIS 61740). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Doctors Failed To Consider 'Chief Complaint,' Federal Judge RulesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
SAN JOSE, Calif. - An ERISA-governed disability insurer that relied on reports by two reviewing doctors in its decision to terminate disability benefits abused its discretion, a federal judge in California ruled July 27, finding that the reports failed to address the claimant's chief complaints of pain in their assessments (James Cushman v. Motor Car Dealers Services Inc., et al., No. 08-5284, C.D. Calif.; 2009 U.S. Dist. LEXIS 66098). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

2nd Circuit: Claimants Cannot Meet Commonality Requirement For Class ActionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
NEW YORK - A federal court that denied class certification of an action seeking interest against a disability insurer for unreasonable delay in paying benefits did not abuse its discretion, the Second Circuit U.S. Court of Appeals ruled Aug. 18, finding that the plaintiffs cannot meet the "commonality" requirement for a class action (Douglas Dobson v. Hartford Financial Services Group Inc., et al., No. 08-0988, 2nd Cir.; 2009 U.S. App. LEXIS 18517). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

7th Circuit Remands Case For Further Review Under MetLife v. GlennEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHICAGO - The Seventh Circuit U.S. Court of Appeals on Aug. 6 remanded to a district court a suit involving the termination of a long-term disability claim, finding that the lower court failed to adequately address the standard of review with regard to the U.S. Supreme Court's ruling in MetLife v. Glenn (Edward Raybourne v. Cigna Life Insurance Company of New York, No. 08-2754, 7th Cir.; 2009 U.S. App. LEXIS 17480). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

5th Circuit Finds Conflict Of Interest Is Not Significant Factor In ERISA CaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals ruled July 16 that where a plan sponsor funds a trust with irrevocable and non-reversionary contributions and the plan takes steps to minimize a conflict of interest created by the sponsor's officer serving as the plan administrator, the structural conflict of interest will not be a significant factor in the court's review of the plan's denial of benefits under the Employee Retirement Income Security Act (Holland v. International Paper Company Retirement Plan, No. 08-30967, 5th Cir.). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Claim Was Sufficiently Reviewed On Appeal, Federal Judge FindsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHARLESTON, W.Va. - An ERISA-governed disability plan that denied benefits to a claimant with bipolar disorder and upheld its decision on subsequent appeals properly notified the claimant regarding the appeal process, a federal judge in West Virginia ruled Aug. 12 (Martha B. Hodel v. The Prudential Insurance Company of America, No. 07-0419, S.D. W.Va.; 2009 U.S. App. LEXIS 17480). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

6th Circuit Says ERISA's Safe Harbor Doesn't Apply To Disability PlanEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CINCINNATI - The Sixth Circuit U.S. Court of Appeals ruled July 24 that the Employee Retirement Income Security Act applies to any insurance plan where an employer contributes to any employee's payment of premiums, rejecting a long-term disability plan participant's argument that a "hybrid" approach should be adopted (Joel Helfman v. GE Group Life Assurance Company, et al., No. 08-2168, 6th Cir.; 2009 U.S. App. LEXIS 16816). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Divided 3rd Circuit: Consideration Of Condition Triggers ERISA Plan ExclusionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PHILADELPHIA - The Third Circuit U.S. Court of Appeals affirmed 2-1 on July 30 that an Employee Retirement Income Security Act long-term disability plan properly denied benefits under the plan's pre-existing condition exclusion because, during the plan's look-back period, the participant's doctor ruled out the condition that subsequently disabled the participant. The participant filed a petition for rehearing and rehearing en banc on Aug. 8 (Jay Doroshow v. Hartford Life and Accident Insurance Company, No. 08-2836, 3rd Cir.; 2009 U.S. App. LEXIS 17010). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Bad Faith Claims Without Specific Facts Deemed Conclusory, DismissedEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
ORLANDO, Fla. - Merely "restat[ing] the statutory language" in an insured's bad faith and misrepresentation claims is not sufficient to survive a motion to dismiss, a federal Florida judge ruled on July 19, granting the insurer's motion for failure to state a claim (Ronnie Hogan v. Provident Life & Accident Insurance Co., No. 6:08-cv-0897, M.D. Fla.; 2009 U.S. Dist. LEXIS 61630). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Remand To ERISA Administrator Not Basis For Fee Award, 4th Circuit HoldsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
RICHMOND, Va. - A federal district court's remand of an Employee Retirement Income Security Act claimant's claim for long-term disability benefits to the insurer for additional consideration did not make the claimant a prevailing party for purposes of an attorney fee award, the Fourth Circuit U.S. Court of Appeals ruled July 14 in an unpublished per curiam opinion (Bridget Hardt v. Reliance Standard Life Insurance Company, et al., No. 08-1896, 4th Cir.; 2009 U.S. App. LEXIS 15478). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - August 26, 2009 Category: Medical Law Source Type: info

Reliance On Consultant Reviews Reasonable, Illinois Judge HoldsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHICAGO - An independent medical exam is an option, not a requirement, under a group disability policy, a federal judge in Illinois ruled July 8, finding that an insurer's decision to terminate benefits to a claimant with fibromyalgia was reasonable (Alice Geiger v. Coordinated Youth and Human Services, Prudential Insurance Company of America, No. 07-CV-681-WDS-DGW, S.D. Ill.; 2009 U.S. Dist. LEXIS 58104). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Action Barred By Policy's Three-Year Limitation PeriodEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
NEW YORK - The Second Circuit U.S. Court of Appeals on July 9 ruled that a plan's three-year limitations period bars a claimant's action for wrongful denial of benefits under a group disability plan that was filed more than three years from the proof of loss (Patricia A. Burke v. Pricewaterhouse Coopers LLP, Long Term Disability Plan, The Hartford Life and Accident Insurance Co., No. 08-1611, 2nd Cir.; 2009 U.S. App. LEXIS 15116). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Federal Judge Finds Claimant Had No 'Colorable Claim'Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PITTSBURGH - A federal judge in Pennsylvania on June 24 granted an insurer summary judgment on a claimant's action alleging failure to disclose plan documents, finding that the claimant did not have a "colorable claim for benefits" (Catherine L. Hill v. Connecticut General Life Insurance Co., No. 07-1706, W.D. Pa.; 2009 U.S. Dist. LEXIS 53831). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Judge: Reliance On Lack Of Objective Evidence Was Abuse Of DiscretionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
SAN FRANCISCO - An ERISA-governed disability insurer that denied benefits to a claimant with fibromyalgia due to a lack of objective evidence abused its discretion, a federal judge in California ruled June 8 (Bud Minton v. Deloitte and Touche, et al., No. C-08-1941, N.D. Calif.). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

MetLife's Termination Decision Is Arbitrary; Attorney Fees AwardedEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
NEW YORK - Metropolitan Life Insurance Co.'s termination of long-term disability benefits to a claimant suffering from chronic fatigue syndrome was arbitrary and capricious because MetLife provided inadequate notice of the type of objective evidence it required, failed to consider objective evidence presented by the claimant and relied on "flawed" reports of independent medical consultants, a federal judge in New York ruled June 22 in remanding the case to MetLife for reconsideration (John Magee v. Metropolitan Life Insurance Company, No. 07-8816, S.D. N.Y.). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Appeals Panel: 'Totally Disabled' Is Defined By Insurance Policies' LanguageEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
NEW YORK - Because an insured is still able to perform "one or more" of his job's duties, a panel in the Second Circuit U.S. Court of Appeals on July 2 affirmed a lower court's finding that Eric Klein is not "totally disabled" and its grant of summary judgment to his insurer (Eric S. Klein v. Northwestern Mutual Life Insurance Co., No. 08-2663, 2nd Cir.; 2009 U.S. App. LEXIS 14580). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Denial Of Disability Benefits Was Abuse Of Discretion, Judge FindsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
LOS ANGELES - An ERISA-governed disability insurer that terminated benefits to a claimant with carpal tunnel syndrome and other ailments abused its discretion, a federal judge in California ruled June 26. The judge found there was no new evidence that supported the insurer's decision to deny benefits after 10 years (Janice Taylor v. SmithKline Beecham Corp., et al., No. 2:07-cv-0809, C.D. Calif.; 2009 U.S. Dist. LEXIS 54204). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Use Of Government Job Description Was Reasonable, Judge FindsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
SAVANNAH, Ga. - A group disability plan administrator that used the Dictionary of Occupation Titles job description in assessing whether a claimant is unable to perform the duties of his regular occupation acted reasonably, a federal judge in Georgia ruled July 7 (Thomas Green v. Reliance Standard Life Insurance Co., No. 408CV068, S.D. Ga.; 2009 U.S. Dist. LEXIS 57340). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Insurer Wrongly Calculated Benefits, Federal Judge HoldsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
OKLAHOMA CITY - An insurer that based its benefit calculation on statements by an employer rather than actual pay documentation acted in error, a federal judge in Oklahoma ruled June 29 (Karen Hollaway v. Principal Life Insurance Co., No. CIV-07-406, W.D. Okla.; 2009 U.S. Dist. LEXIS 54848). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Breach Of Fiduciary Duty Claim Not Viable, Federal Judge HoldsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
MIAMI - A federal judge in Florida on June 24 ruled that a breach of fiduciary claim under ERISA is not a viable claim, allowing the claimant to amend her complaint to state a wrongful denial of benefits claim under ERISA (Ellen Sue Eisenberg, M.D. v. Standard Insurance Co., No. 09-80199, S.D. Fla.; 2009 U.S. Dist. LEXIS 53945). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Claimant Failed To Exhaust Administrative Remedies, Judge RulesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
SACRAMENTO, Calif. - A federal judge in California on June 23 ruled that a claimant failed to exhaust his administrative remedies under the Employee Retirement Income Security Act by filing suit before an appeal decision had been rendered (David Barboza v. California Association of Professional Firefighter, et al., No. 08-519, E.D. Calif.; 2009 U.S. Dist. LEXIS 52848). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

2nd Circuit: Letter Faxed To Attorney Constitutes Notice Of Denial To ParticipantEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
NEW YORK - Letters faxed to an Employee Retirement Income Security Act disability claimant's attorney indicating the procedures for filing a final administrative appeal of the termination of claimant's benefits constituted sufficient notice of the denial, the Second Circuit U.S. Court of Appeals affirmed June 5 in an unpublished order, finding that the claimant's failure to exhaust administrative remedies was not excused (Robin Klotz v. Xerox Corporation, et al., No. 08-3214, 2nd Cir.; 2009 U.S. App. LEXIS 12124). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Claimant Failed To Exhaust Administrative Remedies, 9th Circuit SaysEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals ruled June 23 that a claimant failed to exhaust her administrative remedies under the Employee Retirement Income Security Act before filing suit for the denial of benefits under a short-term disability plan (Laura Werner v. Liberty Life Assurance Company of Boston, et al., No. 08-55127, 9th Cir.; 2009 U.S. App. LEXIS 13486). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

Virginia Federal Judge: Pre-existing Condition Precludes BenefitsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
RICHMOND, Va. - An ERISA-governed disability insurer that terminated benefits to a claimant with back pain relying on the pre-existing condition exclusion acted reasonably, a federal judge in Virginia ruled July 2 (Timothy G. Pegram v. Prudential Insurance Co., No. 3:08cv116, E.D. Va., Richmond; 2009 U.S. Dist. LEXIS 56672). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

7th Circuit: 'De Novo' Review Means 'Independent Decision' In ERISA CasesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CHICAGO - The Seventh Circuit U.S. Court of Appeals on June 29 vacated summary judgment in favor of an Employee Retirement Income Security Act disability plan insurer, commenting that the role of the courts in cases where the ERISA plan does not confer discretion on the plan sponsor or insurer is to conduct an "independent decision" (Paul M. Krolnik v. Prudential Insurance Company of America, No. 08-2616, 7th Cir.). Full story on lexis.com
Source: LexisNexis® Mealey's™ Disability Insurance Legal News - July 18, 2009 Category: Medical Law Source Type: info

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