This month’s Friday Five covers cases relating to personal liability of medical reviewers, when notice violations arise to a claim for relief, how plans must delegate discretionary authority, the rights of plans to terminate...more
This month’s Friday Five discusses cases that explore some fundamental principles of disability benefit litigation. While players and fans return to the favorite fall pastime of football, albeit in the “new normal” under...more
This month’s Friday Five discusses cases that address the admissibility of an expert opinion, the calculation of pre-disability earnings, the definition of disability earnings, circumstances where a court will transfer venue...more
This month’s Friday Five covers recent cases addressing: (1) a fiduciary’s right to bring an ERISA § 502(a)(3) equitable relief claim against a beneficiary; (2) when a life insurer may avail itself of Florida’s “facility of...more
This month’s Friday Five covers cases relating to: a court’s decision to hold an evidentiary hearing where factual disputes precluded summary judgment; dismissal of a claim for life insurance benefits of an ex-spouse who...more
This month’s Friday Five covers cases relating to an incarcerated individual’s entitlement to benefits, the relevance of post-decision evidence, hearsay objections to documents in the administrative record, the requirement of...more
This month’s Friday Five explores two decisions concerning claims for breach of fiduciary duty arising from subrogation, exhaustion of administrative remedies, a challenge to the calculation of benefits and alleged violation...more
This month’s Friday Five discusses cases that explore the bounds of claims administrators’ discretion. Several cases highlight the divergent outcomes possible in light of the deferential arbitrary and capricious standard of...more
This month’s Friday Five discusses cases that address the meaning of de novo review, the relative weight to be given to initial denial correspondence versus appeal correspondence, the necessity of a claims manual, the...more
This month’s Friday Five addresses a myriad of issues including whether returning to work post-injury automatically invalidates a disability claim, what information an administrator must provide before elevating the opinions...more
This month's Friday Five covers recent cases addressing: (1) the scope of ERISA’s administrative exhaustion requirement; (2) whether ERISA permits a claim for “equitable estoppel through silence”; (3) the reasonableness of an...more
This month's Friday Five covers cases relating to the standard for triggering an administrative appeal, exemptions to the exhaustion of administrative remedies requirement of ERISA, artful pleading in an attempt to avoid...more
This month’s Friday Five covers recent cases addressing class certification, pre-existing condition limitations, consideration of extrinsic evidence on a motion to dismiss a purported ERISA action, fee awards, and what level...more
This month’s Friday Five covers recent cases addressing eligibility requirements to qualify for disability benefits, the application of plan-prescribed time limits for filing suit, partial versus total disability and a...more
This month's Friday Five discusses cases that probe the issue of what is appropriately considered in litigation regarding LTD benefits. Some cases seem to state the obvious, for example when a court issues an order directing...more
This month's Friday Five covers recent cases addressing: (1) the impact on the standard of review of a failure to adhere to regulatory deadlines for claims decisions; (2) foreign nationals’ ability to avail themselves of...more
This month's Friday Five covers recent cases addressing: (1) the propriety of a remand for an administrative determination regarding a claimant's "any occupation" disability claim; (2) the viability of breach of fiduciary...more
This month’s Friday Five covers recent cases relating to interpretation of the term, "own occupation," the appropriate remedy for termination of benefits where the administrator’s review was limited to the "own occupation"...more
This month's Friday Five brings a quartet of court of appeals decisions: a pair from the Ninth Circuit relating to standard of review, an Eighth Circuit decision upholding a mental illness limitation, and a Sixth Circuit case...more
This month's Friday Five covers three cases that address issues that can be critical for LTD insurers litigating matters in federal court, specifically issues related to injunctions, statutes of limitations and ERISA...more
This month’s Friday Five covers recent cases ruling on the scope of discovery, what qualifies as an "appeal" by a plaintiff and the applicability of California law precluding discretionary language in insurance policies....more
This month’s Friday Five covers recent cases ruling on the enforceability of self-reported symptom limitations in policies, the scope of the term "plan document," the propriety of an insurer’s reliance on surveillance over...more
One court recently analyzed the extent to which an insurer can rely on a reviewing physician over a treating physician, and why it is important to take note of any recommendations made by the reviewing physician....more
This month’s Friday Five covers cases relating to fee shifting in favor of defendants, interpretation of AD&D policy provisions, a strict take on the language required to initiate an administrative appeal, and a reiteration...more
This month's Friday Five covers cases relating to preemption, anti-assignment provisions, discretionary clause bans and the "de facto" administrator theory. We also examine a case upholding a denial of accidental death...more