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Headline Disability Insurance Legal News from LexisNexis®

• U.S. Supreme Court: ERISA Insurer's Dual Role Creates Conflict Of Interest
  WASHINGTON, D.C. - The U.S. Supreme Court on June 19 ruled in a divided decision that an ERISA long-term disability benefits plan insurer that both evaluates and pays claims acts under a conflict of interest and that the conflict should be considered as a factor in determining whether the plan administrator abused its discretion in denying benefits (MetLife [Metropolitan Life Insurance Company] and Long Term Disability Plan for Associates of Sears, Roebuck and Company v. Wanda Glenn, No. 06-923, U.S. Sup.; See April 2008, Page 8). Full story on lexis.com
• Record Supports Benefit Denial, Philadelphia Judge Says
  PHILADELPHIA - An ERISA-governed disability insurer that denied benefits based on the opinion of a reviewing physician, office notes and a functional capacity evaluation (FCE) did not act arbitrarily and capriciously, a federal judge ruled June 3 (Deborah K. Alford v. Hartford Life Insurance Co., No. 07-4527, E.D. Pa.; 2008 U.S. Dist. LEXIS 43654). Full story on lexis.com
• Pennsylvania Judge Finds Evidence Supports Benefit Denial
  HARRISBURG, Pa. - A federal judge on June 9 upheld an administrator's decision to terminate benefits to a claimant with kidney problems during the any-occupation coverage period, finding that the decision was reasonably supported by the medical evidence (Rita Humble v. Liberty Life Assurance Company of Boston, No. 3:07cv1464, M.D. Pa.; 2008 U.S. Dist. LEXIS 45221). Full story on lexis.com
• 9th Circuit: Vocational Evidence Needed To Evaluate Benefit Denial Decision
  SAN FRANCISCO - In light of a claimant's significant limitations on his abilities, vocational evidence is needed to determine whether an insurer's denial of benefits was proper, the Ninth Circuit U.S. Court of Appeals ruled June 13 in an unpublished opinion (Kelvin Moore v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, No. 05-CV-01180-AHS, 9th Cir.; 2008 U.S. App. LEXIS 12882). Full story on lexis.com
• Panel Reverses Court's Upholding Of Insurer's Benefits Determination
  PASADENA, Calif. - The Ninth Circuit U.S. Court of Appeals on May 23 reversed and remanded for a lower court to award long-term disability benefits based on an insured's "basic monthly earnings" of $7,500, further remanding for the lower court to determine the onset date of the insured's cognitive disability and award long-term benefits from that date (Richard Hineman v. Long Term Disability Plan of E*Trade Group Inc., an Employee Welfare Benefit Plan established pursuant 29 USC 1001, No. 07-55079, 9th Cir.; 2008 U.S. App. LEXIS 11643). Full story on lexis.com
• District Court Applied Wrong Standard Of Review, 4th Circuit Rules
  RICHMOND, Va. - The Fourth Circuit U.S. Court of Appeals on June 11 reversed a grant of summary judgment to an ERISA-governed disability insurer, finding that the lower court applied the wrong standard of review. The district court should have applied a de novo standard of review, not an abuse of discretion standard, the appeals court held (Patricia Woods v. Prudential Insurance Company of America, No. 07-1580, 4th Cir.; 2008 U.S. App. LEXIS 12423). Full story on lexis.com
• Illinois Judge Reverses Herself, Finds Denial Not Arbitrary
  CHICAGO - A federal judge on June 16 reversed her earlier ruling denying summary judgment to a disability insurer that terminated benefits to a claimant suffering from memory and attention problems. The judge found that under Seventh Circuit U.S. Court of Appeals precedent, she did not give enough deference to the insurer under the required arbitrary and capricious standard of review (Bruce Fischer v. Liberty Life Assurance Company of Boston, et al., No. 05-C-3256, N.D. Ill.; 2008 U.S. Dist. LEXIS 46528). Full story on lexis.com
• ERISA Preempts Bad Faith Claim, Georgia Judge Holds
  SAVANNAH, Ga. - A federal judge on June 3 held that a claim for benefits allegedly due under a group disability plan is governed by the Employee Retirement Income Security Act, dismissing state bad faith claims as preempted (Thomas Green v. Reliance Standard Life Insurance Co., No. CV-408-068, S.D. Ga.; 2008 U.S. Dist. LEXIS 43319). Full story on lexis.com
• Judge Dismisses Bad Faith Claim
  PHILADELPHIA - A federal judge on June 10 dismissed bad faith claims against a disability insurer, finding that the evidence showed that it conducted a reasonable investigation and evaluation of claimant's disability status. The judge, however, let stand claims for breach of contract, finding that issues of fact exist (Michael Schaeffer v. Allianz Life Insurance Company of North America, No. 07-cv-1303, E.D. Pa.; 2008 U.S. Dist. LEXIS 44939). Full story on lexis.com