You know that courts can expect a claimant to establish “objective evidence of impairment” from a physical condition.
But does this apply to claims arising out of a mental condition?
Courts can require the claimant to establish objective impairment related to a diagnosable mental condition, too.
Here’s the case of Gailey v Life Insurance Company…
Are Social Security Administration disability determinations, issued after the final appeal decision, part of the ERISA administrative record? NO.
Plaintiffs often seek reversal of a denial of ERISA-governed disability benefits because the claim administrator failed to conduct an independent medical exam (IME).
But is the failure to conduct an IME fatal to a…
In an ERISA case, what does it take to assert a claim for equitable relief? If the complaint does not assert an alleged breach of fiduciary duty, the claim for equitable relief should be dismissed…
Here’s the case of Owens v. Liberty Life Assurance Co., 2016 WL4746212 (W.D. KY. September 12, 2016)(In an…
You know that in ERISA cases most courts typically will limit review to the administrative record, absent special circumstances. Courts may also allow limited discovery when assessing whether a “conflict of interest” affected the claim determination. A conflict of interest can arise, for example, when the insurer of the ERISA governed benefit is both…
You know that many insurance policies and ERISA-governed plans exclude from coverage disabilities “resulting from, or related to…any accident related to the voluntary influence of any drug, narcotic, intoxicant or chemical….”
The next time you are enjoying a fine beer or wine, a single malt scotch or even a Kamikazi, ponder this question…
Is it …
The Department of Labor (“DOL”) just increased civil monetary penalty amounts that may be assessed for violations of Title I of the Employee Retirement Income Security Act of 1974 (ERISA).
The new penalties apply to DOL assessments made on or after August 2, 2016, for violations occurring after November 2, 2015.
Here are some of…
You know that claimants have the burden to establish eligibility for ERISA-governed disability benefits.
Sometimes gaps in coverage can occur when, for example, a claimant alleges disability while using accrued vacation. These gaps can result in denial of a disability claim.
Here’s the case of Cheney v. Standard Insurance, __ F.3d __, (7th Cir.
Who can challenge an ERISA benefit denial? Does a physician have standing to challenge the denial of a patient’s coverage? It depends.
Here’s the case of American Psychiatric Association v. Anthem Health Plans, 821 F. 3d 352 (2nd Cir. 2016)(Physicians and physician associations lacked standing to sue health plans under ERISA.)…
Is it wrong to take an offset for Social Security benefits received by the children of a long term disability claimant? No, says a new decision.
And… just because you reinstate benefits does not mean you have to provide Pannebecker payments…
Here’s the case of Jones v. Life Insurance of North America,…
These Section 502(c) penalty claims seem to be added to most every ERISA lawsuit…
Does a claimant have to prove “actual injury” to win ERISA Section 502(c) penalty claims? MAYBE. Here’s why:
As you know, if a plan administrator fails to provide plan-related documents within 30 days of a written request, then ERISA section…
