As you know, on April 1, 2018 new regulations from the U.S. Department of Labor’s governing Employee Retirement Income Security Act of 1974 (ERISA) disability benefit claims became effective.

How will these new regulations affect litigation? New issues will develop new analysis, but in our continuing effort to flag new litigation issues, here are two

You know that ERISA requires the Summary Plan Description to explain eligibility clearly enough so that an “average plan participant” can understand it.

So, who is an “average plan participant” and what is the standard for compliance with ERISA disclosure requirements?

Here’s the recent case of Abrams v. Life Insurance Company of North America; UBS

What happens when a claimant asserts totally disability… caused by subjective physical pain and mental illness?

For example, sometimes claimants allege total disability from the combined conditions of subjective pain complaints (with provable back abnormalities) and depression caused by the pain.

This is when you want to take a closer look at the impact

It’s that time of year again… when you may see ERISA plans amending policies or plans— during the time employees are receiving benefits. 

Employers have the right to amend long term disability plans at any time, and to apply the amended version even to employees receiving benefits under the original plan.

But which policy applies

You already know that in ERISA life, health and disability claim determinations, “‘[i]n most cases…the district court should only look at the evidence that was before the plan administrator at the time of the determination.’”  (There are many exceptions.)

Sometimes during the later lawsuit, the claimant may seek to supplement the administrative record. For example,

You already know that since December 2016 the United States Department of Labor (DOL) has been reworking regulations governing disability plan administration.

New ERISA claims requirements were issued, which were to take effect and apply to disability claims filed on or after January 1, 2018.
Continue Reading BREAKING NEWS — ERISA: DOL Publishes TODAY Proposed Rule to Delay Implementation of New ERISA Claims Regulations?

You know that most ERISA plans, and most supporting insurance policies, have provisions that allow for an offset of Social Security disability benefits.

Can the court invalidate these offset provisions because of “unconscionable” conduct? It depends.

Here’s the case of Hart v. Unum Life Insurance Co. of America Catholic Healthcare West LTD Disability Plan

You already know that most ERISA plans require an assessment, say after 24 months, whether the claimant can perform “any occupation.”

This review usually involves a Vocational Assessment examining what “other occupations” and earnings are available given the claimant’s education, skills and experience.

HOT TIP: Courts are placing higher burdens on vocational experts