You know that in ERISA claims where the court is applying the abuse of discretion standard, the court may allow “conflict discovery.” This might include discovery of claims manuals, for example.
But even if the court allows conflict discovery, the court likely may still prohibit Plaintiff from supplementing the administrative record with this discovery
As you know, on April 1, 2018 new regulations from the U.S. Department of Labor’s governing Employee Retirement Income Security Act of 1974 (ERISA) disability benefit claims became effective.
How will these new regulations affect litigation? New issues will develop new analysis, but in our continuing effort to flag new litigation issues, here are two
You know that ERISA requires the Summary Plan Description to explain eligibility clearly enough so that an “average plan participant” can understand it.
So, who is an “average plan participant” and what is the standard for compliance with ERISA disclosure requirements?
Here’s the recent case of Abrams v. Life Insurance Company of North America; UBS
You already know that opinions by independent medical reviewers play a big role in the decision to grant or deny benefits.
The reasons why the independent medical reviewer came to the conclusions made are as important as the conclusion itself.
Don’t rely on the mere conclusions by the independent reviewer and inform your independent medical
What happens when a claimant asserts totally disability… caused by subjective physical pain and mental illness?
For example, sometimes claimants allege total disability from the combined conditions of subjective pain complaints (with provable back abnormalities) and depression caused by the pain.
This is when you want to take a closer look at the impact
Yesterday the United States Supreme Court allowed a Seventh Circuit decision to remain in effect that determined that a forum choice provision in an ERISA plan is enforceable, despite ERISA’s statement that suits “may be brought” in courts tied to the plan or plan beneficiary.
Continue Reading Are Forum Selection Clauses in ERISA Plan Documents Enforceable?
It’s that time of year again… when you may see ERISA plans amending policies or plans— during the time employees are receiving benefits.
Employers have the right to amend long term disability plans at any time, and to apply the amended version even to employees receiving benefits under the original plan.
But which policy applies
You already know that in ERISA life, health and disability claim determinations, “‘[i]n most cases…the district court should only look at the evidence that was before the plan administrator at the time of the determination.’” (There are many exceptions.)
Sometimes during the later lawsuit, the claimant may seek to supplement the administrative record. For example,
You already know that since December 2016 the United States Department of Labor (DOL) has been reworking regulations governing disability plan administration.
New ERISA claims requirements were issued, which were to take effect and apply to disability claims filed on or after January 1, 2018.
Continue Reading BREAKING NEWS — ERISA: DOL Publishes TODAY Proposed Rule to Delay Implementation of New ERISA Claims Regulations?
You know that most ERISA plans, and most supporting insurance policies, have provisions that allow for an offset of Social Security disability benefits.
Can the court invalidate these offset provisions because of “unconscionable” conduct? It depends.
Here’s the case of Hart v. Unum Life Insurance Co. of America Catholic Healthcare West LTD Disability Plan