You know that the standard of review applied by courts will significantly impact how courts view an ERISA Plan administrator’s interpretation of an undefined plan term.
But what impact should an insurer’s policy manual have in assessing the “intent” of a plan term? NOT MUCH.
This new case highlights both points.
ERISA plan administrators are constantly pressured by claimants to render decisions quickly…. This is especially true with short term disability claims.
You already know that ERISA regulations require that disability claim benefit decisions be made “within a reasonable time but not later than 45 days after receipt of the claim.” 29 CFR §
You already know that ERISA regulations set specific timelines for the issuance of ERISA-governed long term disability decisions. See, e.g., 29 C.F.R. 2560.503-1(i)(1)(i) (45 days for disability claims and 60 days for others). In special circumstances, the administrator can extend the time by which benefit decisions are made.
An administrator’s failure to issue benefit
What does it mean to be totally disabled from the “regular occupation”?
Is “regular occupation” defined as the duties the claimant is actually doing in his or her specific job? NO.
Each claim should be assessed from the perspective of duties of the job generally in the national economy and not how the job
Disability claimants often attack the ERISA plan’s expert medical reviewer as biased, sometimes seeking discovery in an attempt to show bias.
Here’s a new case that highlights what can happen in a de novo review case: No discovery about a medical expert allowed.
Shaikh v. Aetna Life Ins. Co., 2019 WL 1571876 (N.D.
Practicing law can create real headaches.
But do headaches constitute a disabling condition justifying ERISA-governed long term disability benefits?
This new case explains the correct process in assessing “job duties” in the “Own Occupation” analysis…
Foster v. Principal Life Ins. Co., 920 F. 3d 298 (5th Circuit April 4, 2019)(Benefit denial when based on
When does evidence of malingering justify denial of a long term disability claim? It depends. A physician’s subjective opinion regarding malingering may have less weight than objective neuropsychological testing.
Key Take Away: When the claimant’s neuropsychological testing is rendered invalid due to “failed validity tests,” that may be enough to deny the claim.
You already know that ERISA sets forth a 180-day time limit for internal administrative appeals of benefit denials.
And failure to pursue a timely internal administrative appeal can subject the claimant (in a later federal lawsuit) to the defense of failure to exhaust administrative remedies.
But can a claimant save an untimely administrative appeal by
From time to time you may see ERISA benefit claimants seeking declarations from the Court regarding “future benefits.”
But there is that old rule, recently recognized again, that such claims should be dismissed because there is no “live case or controversy.”
To highlight this point, here’s the recent case of Peer v. Liberty Life Assurance
You already know that in ERISA cases the court has discretion to award reasonable attorney fees if the claimant shows “some degree of success on the merits” and this success is more than ‘trivial success on the merits’ or ‘purely procedural.’”
So, what happens when the Court remands the claim for further consideration by the