Although mental health parity claims have been proliferating in federal courts for more than a decade, it wasn’t until last year that a federal appeals court laid out pleading standards for mental health parity cases.[1] Another appellate decision has now joined the chorus. In Ryan S. v. UnitedHealth Group Inc.,[2] the U.S. Court of Appeals […]
Employee benefit claimants’ entitlement to a full and fair review of claim denials prior to judicial intervention is embedded in the Employee Retirement Income Security Act.[1] Regulations promulgated by the
U.S. Department of Labor flesh out the specifics as to what constitutes such a review. […]
Protecting LGBTQ rights is of great importance for this country, and the legal issues related to transgender healthcare can be particularly complicated. Many employer-sponsored healthcare plans now explicitly cover transgender-related healthcare. Part of the reason is likely economic. According to the Williams Institute, there are currently just under 1.4 million Americans who identify as transgender, […]
The 9th U.S. Circuit Court of Appeals’ ruling in Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 2004 U.S.App.LEXIS 10626 (June 1), is one of those cases where plaintiff lawyers are able to learn an important lesson even though this particular plaintiff was unsuccessful.
Disabilities occur as the result of an accident or illness. When trauma results in disability, the date of disability can usually be related to the date when the employee suffered an accidental injury. Disability due to illness, especially chronic illness, is more complicated, though. Most employees struggle to remain employed for as long as they […]
When is a life insurance forfeiture ineffective despite the insured’s failure to make a timely premium payment? The answer was provided in Harwick v. AXA Equitable Life Ins. Co., 2020 WL 7698367 (N.D. Ill. December 27, 2020), where the court cited an Illinois statute that embodies a public policy against undue forfeiture of life insurance coverage. […]
In Cerone v. Reliance Standard Life Ins.Co., 2014 U.S.Dist.LEXIS 46529 (S.D.Cal. March 28, 2014), after the plaintiff’s accidental death claim based on the death of her husband was denied and her appeal exhausted, Debra Cerone filed suit against Reliance Standard Life Insurance Company. The issue decided in this opinion was whether the de novo or abuse of discretion standard of review applied.
Ever since the Supreme Court’s ruling in Varity Corp. v. Howe, 516 U.S. 489 (1996), courts have grappled with whether plaintiffs who file suit under the Employee Retirement Security Act of 1974 (“ERISA”) can plead simultaneous claims for benefits under § 502(a)(1)(B) along with claims for equitable relief under § 502(a)(3), and if so, under […]
An inadvertent ambiguity in an insurance policy can be costly as Federal Insurance Co. learned in Tyll v. Stanley Black & Decker Life Insurance Program, 2019 WL 3081061 (D. Conn. July 12, 2019). There, the court resolved a motion for summary judgment seeking a determination as to the amount of business travel accident insurance owed […]
To qualify for Social Security disability benefits, a claimant must prove an inability to engage in “any” meaningful work, a standard considered extremely difficult to meet. However, as a recent case shows, the FedEx disability benefit plan imposes qualification standards that are even harder than Social Security’s. In Oliver v. Aetna Life Insurance Co., 2015 […]
In a short, but highly instructive ruling, U.S. District Judge Gerard Lynch ordered that CIGNA disclose its disability insurance claim manual without a protective order, overruling an objection that the insurer might suffer ”competitive injury” if such information was disclosed. Levy v. INA Life Insur.Co. of N.Y., 2006 U.S.Dist.LEXIS 83060 (S.D.N.Y. Nov. 14, 2006). Because […]