You already know that the primary responsibility for providing medical proof of disability undoubtedly rests with the claimant.
But does the plan administrator sometimes have an obligation to obtain medical records and information? YES.
Here’s the case of Harrison v. Wells Fargo Bank, N.A., __ F.3d __ (December 5, 2014) (When there is
What happens when a claim denial letter was issued, but the claimant denies ever receiving it, and the administrator can’t produce it?
How does that affect the statute of limitations?
Here’s the case of Witt v. Met Life Ins. Co., __ F.3d __, 2014 WL 6655794 (November 25, 2014)
FACTS: Witt made a claim
Plan fiduciaries may create a fiduciary duty in stock drop cases by incorporating filings with the Securities and Exchange Commission into the Summary Plan Description.
We have been waiting for the Ninth Circuit to rule on a big case concerning stock drop cases.
Here’s the case of Harris v. Amgen, __ F.3d __ (October
Many ERISA plans have venue provisions. The Secretary of Labor has argued in litigation, however, that these provisions are “incompatible with ERISA.”
Are venue selection provisions in ERISA plans enforceable? YES.
Here’s the case of Smith v. Aegon Companies Pension Plan, __F.3d __ (2014 WL 5125633) (6th Cir. October 14, 2014)(PDF).
FACTS: Smith
Can the Plan get reimbursed even when the beneficiary’s settlement funds have been disbursed or commingled?
Yes in the 11th Circuit. But watch out in the 9th Circuit.
Here’s the case of AirTran Airways Inc. v. Elem, __ F.3d __ 2014 WL 4694776 (11th Cir. September 23, 2014)(Willful refusal to abide by the terms
What happens when the district court orders a remand to the ERISA plan administrator?
Can you appeal it? It depends on the circuit.
Here’s the case of Mead v. Reliastar Life Insurance Company, __ F.3d __ (2nd Cir. September 16, 2014) (Remand in this case was not a final order from which an appeal
You already know that in ERISA cases a court may, in its discretion, award attorney fees if a party achieved “some degree of success on the merits.”
Is the mere filing of a lawsuit, before Plaintiff’s ERISA-governed disability benefit claim is granted, sufficient to win an award attorney fees? NO.
Here’s the case of
You have seen this issue before: The court remands the ERISA-governed long term disability claim for further consideration by the claims administrator because the administrative record was insufficient for de novo review.
Is a court’s remand for further review of an ERISA-governed claim by the claims administrator a sufficient “degree of success on the
Does your ERISA claim benefit denial letter preserve the contractual limitations defense?
If your denial letter fails to expressly state the contractual limitations timeframe, it might not preserve that defense.
Here’s the case of Moyer v. Met Life Ins. Co., __ F.3d __ (6th Cir. August 7 2014)(2-1 decision).
FACTS. Moyer made a claim
What sort of “medical treatment” triggers the pre-existing condition exclusion in an ERISA-governed disability policy?
Can taking over-the-counter vitamin supplements trigger the exclusion? YES.
Here’s the case of Kutten v. Sun Life Assurance Company of Canada, __ F.3d __, 2014 WL 3562784 (8th Cir. July 21, 2014) (pdf).
FACTS: Kutten had a progressive