The Chartwell Chronicles: Permanent Disability
Physician Employment Agreements: Focus on Financial Planning
An Overview of New Jersey Workers' Compensation
An Overview of Massachusetts Workers' Compensation
Workers' Compensation Academy: Requests by Defense Counsel – A Defense Analysis of Materials Needed from Carriers and Clients for NJ Workers' Compensation Claims
An Overview of New York Workers' Compensation
Workers' Compensation Academy: Pennsylvania COVID-19 Update: Layoff or Furlough from Light Duty as a Result of COVID-19
When an employee becomes disabled, a variety of questions arise regarding that employee’s entitlement to compensation and benefits. As a member of your company’s human resources or employee benefits department, employees and...more
This month’s Friday Five explores decisions from around the country discussing the concept of reasonableness in various forms. One court rejected the parties’ proffered definitions of the term “working” and instead determined...more
The April Friday Five covers cases determining futility of exhausting administrative remedies, the nuances of the pre-existing condition exclusion, ERISA preemption, and genuine issue of material fact over an employee’s...more
Bowman v. Allen Harim Foods, IAB No. 1541176 (Dec. 18, 2024) - On November 4, 2023, the claimant injured his left knee in a compensable work accident that required surgery to his patella. He had to switch doctors after his...more
This month’s Friday Five discusses cases addressing the effect of continuing to receive benefits during the period of alleged disability, reliance on an employer’s records in making a disability determination, the...more
This month’s Friday Five explores recent decisions with issues spanning physician power of attorney to preexisting exclusions and the fiduciary duty of an insurance company....more
Life Policy Lapse Shortly Before Insured’s Death - In Simon v. USAA Life Insurance Co. (Mar. 29, 2024), the insurer denied death benefits under a term life insurance policy, which had lapsed for nonpayment of premium two...more
This month’s Friday Five covers cases relating to petitions for attorneys’ fees, unpersuasive self-reported evidence of disability, and a dilatory attempt to augment the administrative record....more
This month’s Friday Five explores decisions regarding the timeliness of appeals, the support necessary to sustain an LTD termination decision, a court’s discretion to credit and discredit expert opinions, the circumstances...more
This month’s Friday Five addresses two cases involving disability claims that touch on Covid-19, a Circuit Court ruling for an insurer, a district court ruling that a 20-year-old regulatory settlement precluded an insurer...more
In Sturdivant v. NC Department of Public Safety (No. COA22-421), the North Carolina Court of Appeals affirms Full Commission Opinion and Award denying extended benefits under N.C.G.S. 97-29 (c)...more
This month’s Friday Five covers cases relating to discovery in ERISA benefits cases, an appellate court strictly interpreting ERISA regulatory deadlines, a district court authorizing an ERISA breach of fiduciary duty claim...more
In Newsom v. Reliance Standard Life Ins. Co., the Fifth Circuit clarified when it is appropriate for a district court to remand an ERISA dispute to a plan administrator for development of a merits record. 26 F.4th 329 (5th...more
This month’s Friday Five explores recent decisions tackling a myriad of issues, including: (1) whether reclassification of a claimant’s health status constitutes an adverse benefit determination; (2) whether remand is the...more
In Hall v. Aetna Life Ins. Co., 2021 U.S. Dist. LEXIS 117331 (N.D. Cal. June 23, 2021), a California district court held that an ERISA claim administrator properly terminated long-term disability (LTD) benefits after the...more
This month’s Friday Five covers cases relating to: (1) whether a state statute prohibiting discretionary authority in disability benefit plans applies to non-state residents; (2) how a court may weigh multiple denials and...more
In Carlile v. Reliance Standard Life Ins. Co., 988 F.3d 1217 (10th Cir. 2021), the Tenth Circuit found the term "active" full-time employee ambiguous and awarded disability benefits to an employee who became disabled after...more
This month’s Friday Five discusses cases that address the meaning of “active, full-time employee,” whether remand is required where an improper standard of review was applied, the standard for capacity in reference to a...more
In Castillo v. Metro. Life Ins. Co., 2020 U.S. App. LEXIS 25985 (9th Cir. Aug. 17, 2020), the Ninth Circuit held that attorneys' fees incurred during the administrative review process cannot be recovered as "other equitable...more
In McClure v. Country Life Ins. Co., 795 Fed. Appx. 548 (9th Cir. 2020), the Ninth Circuit affirmed a $6.5 million bad faith verdict against a disability insurer that included a $1.29 million award for emotional distress...more
Workers’ compensation benefits in Pennsylvania and New Jersey are calculated using a statewide average weekly wage (SAWW) that is published by the Departments of Labor every year. The year of the worker’s injury will...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
Much has been written about the Department of Labor’s final rule regarding disability benefit claims procedures (the “Final Rule”), which took effect on April 2, 2018. And by now, most employers – and all disability insurance...more
Este mes de mayo, el Instituto Mexicano del Seguro Social (IMSS) anunció nuevas herramientas digitales que dan la posibilidad tanto al asegurado como a las empresas de consultar en línea el historial de las incapacidades...more
Earlier this month, the Mexican Institute for Social Security (IMSS) announced new digital tools that enable both employers and insured employees to review records concerning the employees' disabilities certified by the IMSS,...more