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
This month’s Friday Five covers cases relating to: (1) whether a plaintiff may be entitled to AD&D benefits when their spouse died of an illegal drug overdose; (2) when a plaintiff can supplement the administrative record...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
This month’s Friday Five covers cases relating to the exhaustion of administrative remedies set forth only in a denial of benefits letter, the scope of information required to be provided to medical reviewers, whether...more
This month’s Friday Five covers cases relating to disputes between beneficiaries to life insurance policy proceeds, an insurer’s use of independent medical reviewers and in-house nurses to evaluate claims, the preexisting...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
This month’s Friday Five covers cases relating to: what constitutes adequate consideration by an insurer of a disability claimant’s Social Security disability award; an analysis of various factors for consideration when a...more
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) 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 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 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 claims handling and the standard of review, as well as the proper parties to litigation.
Does using the same physician for initial claim review and appeal violate ERISA...more