What happens when the claimant refuses to seek and accept medical care that might enable the claimant to return to work?
Does the claimant have a duty to seek out and accept medical care aimed at returning to work? YES.
But there are nuances.
Take a look at the recent case of Metropolitan Life…
Yesterday, Jordan Weissman’s excellent article, “Disability Insurance: America’s $124 Billion Secret Welfare Program,” published March 25, 2013 in The Atlantic, explains how the number of former workers enrolled in Social Security Disability has doubled in 20 years. He states:
“Since the early 1990s, the number of former workers receiving payments under it has more…
You know already that a plan administrator can be liable for statutory penalties under ERISA for failing to provide requested plan documents.
But what if the claims administrator failed to provide documents Will the claims administrator have to pay statutory penalties? NO.
But what if an agent of the plan administrator failed to provide documents? …
Can ERISA apply to the claims made on individual policies purchased with discounted premiums? YES.
Here is a great new case that highlights the analysis to establish that ERISA applies when employees purchase individual policies, with group discounted premiums. McCann v. UNUM Provident, __ F.Supp. 2d __ (D. New Jersey January 31, 2013)
FACTS…
Here’s a unique twist:
Does that workers’ compensation settlement agreement release the ERISA disability claim? Probably not, unless the release explicitly mentions ERISA claims and the ERISA Plan.
Here’s the case of Duncan v. Hartford Life and Accident Insurance Company, 2013 WL 506465 (E.D. Cal. February 8, 2013)(workers’ compensation release did not eliminate ERISA…
How does an ERISA claimant start an administrative appeal?
Can a mere request for medical records, and a reference to an “appeal in the future tense,” trigger the appeal? No.
Here’s the case of Reindl v. Hartford Life and Accident Insurance Co., –F.3d __, 2013 WL 425356 ( 8th Cir. February 5, 2013) [PDF].…
What happens when an ERISA claimant submits contradictory statements to the Social Security Administration and the ERISA plan administrator? Can these contradictory statements be used to deny the ERISA claim? YES.
What’s the difference between a “Commission” and a “Bonus” in calculating a claimant’s monthly benefit? The dissent in this new decision provides guidance……
Will courts enforce Plan language even when a 24 month limitation is “not what a reasonable employee would expect” to see in a disability plan? YES.
Here’s an interesting, recent case showing the power of Plan language. The opinion also supports the effect of “choice of law” provisions in Plans.
Many ERISA plans contain “subrogation” or “reimbursement” provisions. Can equitable defenses change the Plan’s reimbursement rights?
You need to know about US Airways Inc. v. McCutchen — a critical case before the United States Supreme Court, with oral argument set for tomorrow.
THE ISSUE: Whether “equitable defenses” can limit a plan’s recovery under ERISA…
We know that an ERISA plan administrator both administering and funding the plan is operating under a “structural conflict of interest.” This “structural conflict of interest” may lower the deference a trial court will give to the plan administrator’s benefits decision.
So, ERISA plans frequently delegate a plan administrator different from the funding source of…
