Since the recent decisions on the DOL’s fiduciary rule are now old news, I want to take this Monday to highlight two district court decisions on the issue of exhausting administrative remedies. The first is from a district court in the Second Circuit, Tuttle v. The Prudential Insurance Company of America, No. 3:17-CV-00100-VAB, 2018 WL 1245731 (D. Conn. Mar. 9, 2018). In Tuttle, the court determined that Plaintiff exhausted his administrative remedies where he appealed Prudential’s initial determination denying his long-term disability benefits but did not appeal Prudential’s subsequent decision to partially overturn its initial determination. The second determination upheld a substantial part of Prudential’s previous decision to deny benefits. The court agreed with Plaintiff that requiring him to appeal a second time would create “a continuous cycle of appeals from appeals.”
Continue Reading Courts Define the Meaning of “Exhausting Administrative Remedies” In Long-Term Disability Disputes
Insurance Company Must Pay AD&D Benefits for Death By Autoerotic Asphyxiation
This week’s notable decision is Tran v. Minnesota Life Ins. Co., No. 17-CV-450, 2018 WL 1156326 (N.D. Ill. Mar. 5, 2018), a case involving a denial of accidental death & dismemberment (AD&D) benefits on the basis of policy exclusions for intentional injuries. Here, the insured’s death was caused by “Asphyxia due to hanging, autoerotic in nature.” Following his death, the insured’s wife submitted a claim for AD&D benefits under the insured’s group policies. As you might have guessed, Defendant Minnesota Life denied the claim. Its rationale was that the insured intentionally put a rope around his neck to cut off the air flow to the lungs and blood flow to the brain, resulting in lost consciousness and death. Since the death resulted from a self-inflicted injury, the policies’ exclusions for death caused by self-inflicted injuries apply.
In appealing the claim denial to Minnesota Life, Plaintiff submitted evidence showing that her husband’s death was accidental in nature and that he did not intend or attempt to self-inflict injury to himself. She explained, “[a]lthough perhaps more unusual, autoerotic asphyxiation is no different than sky-diving, motorcycle riding, or sailing, in that they are activities people take part in for enjoyment, but which may conceivably lead to their death in the event of accident.” Defendant obtained a report from a doctor who explained that the risk of death from autoerotic asphyxia is high because the practitioner is alone and unconscious. Defendant upheld its claim denial and Plaintiff filed suit.
Continue Reading Insurance Company Must Pay AD&D Benefits for Death By Autoerotic Asphyxiation
Supreme Court Hands a Loss to Retirees In Dispute Over Lifetime Health Care Benefits
A dispute over retiree healthcare benefits which has been hotly litigated for 14 years reached the end of the road with the Supreme Court’s decision in CNH Indus. N.V. v. Reese, No. 17-515, __S.Ct.__, 2018 WL 942419 (U.S. Feb. 20, 2018). In this case, retirees brought suit against their employer, CNH Industrial N.V. (“CNH”) seeking a declaratory judgment that they were entitled to lifetime health care benefits, a permanent injunction requiring CNH to maintain the level of retiree health care benefits then in effect, and damages for injuries the retirees might sustain if benefits were terminated.
The United States District Court for the Eastern District of Michigan granted summary judgment to the retirees and awarded them attorneys’ fees. CNH appealed to the Sixth Circuit Court of Appeals which affirmed in part, reversed in part, remanded, and denied rehearing. The District Court again granted summary judgment to the retirees. The Sixth Circuit reversed and remanded. The District Court then awarded summary judgment to CNH, but on reconsideration awarded summary judgment to the retirees. CNH appealed again and the Sixth Circuit affirmed and remanded.
Continue Reading Supreme Court Hands a Loss to Retirees In Dispute Over Lifetime Health Care Benefits