What happens when the claimant is “disabled” from performing her job with her current employer… but can perform that same job with another employer?
This issue highlights the importance of the “national economy” definition of disability as found in most long term disability policies.
Here’s the case of Holden v. Unum Life Ins.
You know that a claimant must exhaust administrative remedies before filing a suit. But is an appeal “optional” when the denial letter says that claimant “may request a second level review”? NO.
And what’s with 502(a)(3) breach of fiduciary claims anyway? “‘[A] review of the [ERISA] legislative history confirms that Congress did…
What happens when the ERISA claimant files suit after the disability claim has been denied, and then the ERISA claims administrator reinstates benefits retroactively?
Doesn’t reinstatement “moot” the issues in the lawsuit, or make claims regarding future benefits unripe — requiring dismissal of the suit? YES it should.
And a Plaintiff’s decision to …
You know that claims administrators retain experts to review a claimant’s medical and mental health condition to assess whether a claimant is sufficiently impaired to be eligible for disability benefits.
But what happens when the claimant argues that a medical opinion should be rejected due to the sheer volume of opinions the expert has provided…
You know that claimants seeking ERISA-governed benefits sometimes assert “breach of fiduciary” duty claims under ERISA Section 502(a)(3)(b).
This case highlights some arguments that can be used to defeat breach of fiduciary duty claims. Staropoli v. Metro. Life Ins. Co., 465 F. Supp. 3d 501 (E.D. Pa., June 8, 2020).
Key takeaways:
…
You know the Ninth Circuit has taken the position that an “employee who cannot sit for more than four hours in an eight hour workday cannot perform ‘sedentary work that requires ‘sitting most of the time.’” Armani v. NW Mut. Life Ins. Co., 840 F.3d 1159, 1163 (9th Cir. 2016) (Emp. added.)…
Some of the more challenging disability claims involve impairment resulting from Chronic Fatigue Syndrome. There are no tests for Chronic Fatigue Syndrome, and the impairment assessment often relies heavily on self-reported symptoms and…the credibility of the claimant and the treating physician.
But there are distinct ways to help the court assess these claims. This new…
You know that typically claimants seeking ERISA-governed benefits make claims for recovery under Section 1132(a)(1)(B).
Now you are likely seeing more simultaneous assertions of equitable claims for breach of fiduciary duty and disgorgement under Section 1132(a)(3). A successful claimant asserting this theory may recover additional forms of monetary relief, and may get broader discovery.
But…
You already know that ERISA plans frequently delegate discretionary authority to an administrator or fiduciary to make benefit decisions.
When reviewing the claim decision, courts may examine whether the ERISA Plan administrator properly designated authority to a claims administrator to make benefit decisions for the Plan.
If the delegation of authority is not done according…
You already know that an ERISA plan recipient may recover attorney fees when prevailing in an action to enforce rights under the plan.
But to win attorney fees, the claimant must show:
…
