We all know that ERISA claim administrators must consider and weigh a claimant’s Social Security Administration (SSA) disability determination when deciding whether the claimant is “disabled.”
But what happens when the SSA’s favorable disability determination arrives after the Plan has denied the final appeal?
Do you have to reopen the claim to assess this…
Are in-house consultations on plan term interpretation, before a final appeal denial, privileged and confidential? NO says the Ninth Circuit…
Here’s the attached case of Stephan v. Unum Life Insurance Company of America, __F.3d__, 2012 WL 3983767 (9th Cir. September 12, 2012) that highlights the point.
The case also shows that:
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You know you are having a bad day when you have LOST the administrative file for a claim seeking ERISA disability benefits.
But is it fatal to the Plan’s defense of a decision terminating benefits?
Maybe not.
Here’s the case of Schorsch v. Reliance Standard Life Insurance Co., __ F.3d __ (7th Cir. August 28,…
You probably already know that an ERISA Plan that fails to properly delegate administrative duties to another party may lose discretionary review.
But does the delegation of authority have to be in writing? Maybe not, so long as the Plan allows for delegation.
The recent case of Aschermann v. Aetna Insurance Company [PDF], __ F.3d__,…
Are claims manuals “confidential business information” or “trade secrets” entitled to a protective order restricting dissemination? YES
Can the Plaintiff’s attorney keep the claims manual for use on another case? NO.
Here’s the recent opinion issued in Takata v. Hartford Comprehensive Benefit Service Company and Battelle Memorial Institute, __ F.Supp. 2d __ (E. D.…
When does ERISA govern short term disability payments?
Take a look at this recent case, Behjou v. Bank of America et. al, [PDF] __ F.Supp. 3d __ (N.D. California May 1, 2012).
FACTS: Behjou brought short term disability and long term disability claims under the Bank of America (BOA) ERISA plan. When the benefits…
We all know that ERISA disability claim decisions can hinge on the definition of the claimant’s “regular occupation” or “own occupation.”
But how do you define a claimant’s “regular occupation”? Must you use the claimant’s actual duties, or can you rely upon the Department of Labor’s generic definitions contained in the Dictionary of Occupational Titles? …
What equitable remedies are available to plan participants?
As you probably know, CIGNA v. Amara, 131 S.Ct. 1866, 1878-80 (2011) contains dicta that can be viewed as expanding the range of “equitable relief” available to ERISA plan participants under Section 502(a)(3). This relief may include estoppel, reformation and surcharge.
But what proof is needed …
An update on ERISA Life, Health, Disability matters from BOOM: The ERISA blog. https://www.boomerisablog.com/
We all know that ERISA disability claimants must exhaust administrative remedies before bringing a suit. Exhausting administrative remedies typically includes seeking an internal appeal.
But…what is required in the claimant’s letter to the Plan to constitute an “appeal”?
Here’s a…
A continuing discovery battle in ERISA cases involves the production of claims manuals, internal policies and procedures.
What can you do when a claimant seeks claims manuals, policies and procedures? Seek an agreed protective order.
What if the Plaintiff will not agree to a protective order? Move for a protective order to assure the documents…
