Does telling a claimant that you “will be happy to reconsider the claim” waive a contractual limitations provision? No.
Here is a great new case that highlights virtually every argument that could be used to trump (unsuccessfully) a statute of limitations or contractual limitations provision. Engleson v. Unum Life Insurance Company of America, __ F.3d…
How do you handle a claim supported only by “subjective” evidence?
Can you reject the claim outright? No. You must weigh the subjective evidence. That’s a key point highlighted in a recent case.
Miles v. Principal Life Insurance Company [pdf], __ F.3d __ (2nd Cir. June 26, 2013) (Merely pointing out that the evidence…
Here is a statistic worth noting: The number of people on Social Security Disability is at the highest point ever.
You know that many ERISA governed plans provide basic life insurance benefits.
But what happens when the plan offers employees the choice to purchase supplemental life insurance? If the employee pays the entire premium for the supplemental benefit, is that benefit still governed by ERISA?
Here’s the case of Cox v Reliance Standard Life Insurance…
Gabe Baker and Steve Jensen give a good analysis of this case.
In Judge v. Metropolitan Life Insurance Company [PDF], 710 F.3d 651 (6th Cir. 2013), the Sixth Circuit rejected plaintiff’s proposed bright-line rule requiring plan administrators to obtain vocational evidence and an IME before making their determination. However, those steps may be required…
You already know that an employee benefit plan qualified as a “government plan” is exempt from ERISA’s framework.
But what is the definition of “government”? Some employers may not actually be government entities, and public private partnership may inject ERISA back into the framework.
This new case gives you the tests to apply to determine…
You already know that an individual disability policy may nevertheless be governed by ERISA, even when the employee pays her own premium. This can occur when the employees benefit from a rate structure or premium discount the employer was able to negotiate in obtaining group benefits.
But does ERISA apply when the employee “converts” a…
The U.S. Supreme Court yesterday strengthened the ability of employer health insurance plans to recoup payments for medical expenses paid for an injured plan participant who later sues to recover damages from a third party.
The case is US Airways v. McCutchen, U.S. Supreme Court, No. 11-1285.
http://www.supremecourt.gov/opinions/12pdf/11-1285_i4dk.pdf
This decision helps resolve a conflict…
The claimant seeking long term disability benefits under your ERISA Plan was found to be disabled by the Social Security Administration.
Does that automatically mean the claimant is entitled to disability benefits under the ERISA Plan? No, but you must explain why you are taking a position different from the Social Security Administration. Met …
What does “full and fair” review during an ERISA appeal mean?
Before the appeal decision is made, does the administrator have to disclose to the claimant medical opinions obtained during an appeal? Not if that opinion merely reaffirms or supplements the basis for the initial claim denial.
Here’s the recent case of Lee v. Hartford…
