You already know that the final battleground in lawsuits seeking ERISA-governed long term disability (LTD) benefits is whether a prevailing plaintiff should be awarded prevailing party attorney fees.
Should plaintiffs always recover attorney fees when the ultimate decision to deny benefits “was a close call” …and both sides’ positions had merit? No. And this …
You know that the ERISA regulations set out claims procedural requirements.
Whether the claims administrator complied with the claims procedure requirements is often a key battleground when a court is determining if the long term disability claim was improperly denied.
This new case highlights the arguments Plaintiffs’ may make in challenging claims handling, and how…
Can a district court consider new arguments justifying claim denial that were not articulated in the initial claim denial or appeal? NO. In fact this new Ninth Circuit decision indicates for the first time that it is “clear error” for a district court to adopt “newly presented rationale when applying de novo review.”…
Can a district court consider new arguments justifying claim denial that were not articulated in the initial claim denial or appeal? NO. In fact this new Ninth Circuit decision indicates for the first time that it is “clear error” for a district court to adopt “newly presented rationale when applying de novo review.”
Even…
Can the ERISA claims administrator “cure” inadequacies, made during its initial claim denial, during the appeal process? Yes.
Did a claims administrator’s recommendation, that a claimant receive a job-accommodation, constitute sufficient proof of disability? No.
This new case highlights these issues: Canter v. AT&T Umbrella Benefit Plan No. 3, 33 F.…
Sometimes an ERISA-governed disability benefit claim is denied on a specific issue that precludes the need for a full development of the record on the merits of the claim. E.g., claimant was not eligible for benefits because he was not a full-time employee at the time of disability.
But when should courts order remand…
What is the most efficient way to invite the district court to resolve ERISA-benefit claims?
What’s the difference between using Rule 56 motions for summary judgment, versus a Rule 52 Motion for Judgment?
This new case highlights why Rule 52 motions may be the preferred motion to efficiently resolve ERISA benefit claims. Avenoso v. Reliance…
What happens when an ERISA-governed disability claim is denied solely under the “own occupation” provision, but a reviewing district court concludes the claimant is entitled to “own” occupation benefits?
Does an insurer “waive” an evaluation of the “any occupation” provision because the insurer denied the claim solely on the “own occupation” standard? NO.
Can the…
You already know that many state laws ban the “abuse of discretion” standard of review in denials of ERISA-governed long term disability benefits.
But self-funded ERISA plans may still apply the discretionary standard of review.
And “incorporating by reference” the Summary Plan Description (SPD) is effective in making the SPD part of the ERISA plan.…
We all are seeing more “breach of fiduciary duty claims” asserted in lawsuits seeking ERISA-governed benefits. As you know, ERISA allows participants, beneficiaries, and the Secretary of Labor to obtain relief against ERISA fiduciaries for breaching the fiduciary duties they owe to the plan or its participants. ERISA fiduciaries can also be liable under §…
