The Department of Labor’s Employee Benefits Security Administration just published final regulations that change the ERISA disability claims and appeals process.
Here are 10 things you should know about these new regulations.
What happens when an employer provides a disabled employee continued regular wages, paid out of general employer assets? This is known as a “payroll practice”… and ERISA may not apply.
A new case that highlights the point is Foster v. Sedgwick Claims Management Services, Inc. and Sun Trust Bank Short Term and Long Term Disability
So how do you define “sedentary work”? Can you define it by using a Functional Capacity Assessment?
Can you disregard the Dictionary of Occupational Titles (DOT) in your assessment? Probably not.
Here’s the case of Armani v. Northwestern Mutual Life Insurance Company, __ F.3d __ (9th Cir. November 4, 2016)(District Court erred by
You know that courts can expect a claimant to establish “objective evidence of impairment” from a physical condition.
But does this apply to claims arising out of a mental condition?
Courts can require the claimant to establish objective impairment related to a diagnosable mental condition, too.
Here’s the case of Gailey v Life Insurance Company
Are Social Security Administration disability determinations, issued after the final appeal decision, part of the ERISA administrative record? NO.
Plaintiffs often seek reversal of a denial of ERISA-governed disability benefits because the claim administrator failed to conduct an independent medical exam (IME).
But is the failure to conduct an IME fatal to a
In an ERISA case, what does it take to assert a claim for equitable relief? If the complaint does not assert an alleged breach of fiduciary duty, the claim for equitable relief should be dismissed…
Here’s the case of Owens v. Liberty Life Assurance Co., 2016 WL4746212 (W.D. KY. September 12, 2016)(In an
You know that in ERISA cases most courts typically will limit review to the administrative record, absent special circumstances. Courts may also allow limited discovery when assessing whether a “conflict of interest” affected the claim determination. A conflict of interest can arise, for example, when the insurer of the ERISA governed benefit is both
Alaska’s prompt pay statute—which requires insurers to pay benefit claims within 30 days of submission—is preempted by federal laws governing employer-provided benefits and benefits for government workers, a federal judge ruled.
The case is Zipperer v. Premera Blue Cross & Blue Shield of Alaska, 2016 BL 265226, D. Alaska, No. 3:15-CV-00208 JWS, 8/16/16. (Kudos
You know that many insurance policies and ERISA-governed plans exclude from coverage disabilities “resulting from, or related to…any accident related to the voluntary influence of any drug, narcotic, intoxicant or chemical….”
The next time you are enjoying a fine beer or wine, a single malt scotch or even a Kamikazi, ponder this question…
Is it
The Department of Labor (“DOL”) just increased civil monetary penalty amounts that may be assessed for violations of Title I of the Employee Retirement Income Security Act of 1974 (ERISA).
The new penalties apply to DOL assessments made on or after August 2, 2016, for violations occurring after November 2, 2015.
Here are some of