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Peter Sessions

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Peter S. Sessions is a partner at Kantor & Kantor who has been with the firm since 2004. Peter represents individual clients seeking health, life, and disability benefits, typically under employee health plans.

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The New Year is off to an exciting start with two noteworthy appellate decisions, one favorable to a plan participant and one favorable to a plan sponsor. First up is a case in which the Eighth Circuit reversed a denial of disability benefits to a long-term recipient of such benefits: Roehr v. Sun Life Assurance Co. of Canada, No. 21-1559, __ F.4th __, 2021 WL 6109959 (8th Cir. Dec. 27, 2021) (Before Circuit Judges Kelly, Erickson, and Grasz). 

Insurers who are stuck with long-term expensive disability claims are often looking for ways to get rid of them. However, in this new decision from the Eighth Circuit, the court has warned insurers that they must be careful in how they deny those claims. While an insurer is not obligated to keep paying benefits just because it has done so in the past, it needs to have a good explanation for reversing itself, especially if it has been paying for almost a decade and the medical evidence has remained largely unchanged.
Continue Reading Eighth Circuit Warns Disability Administrators to Think Twice Before Terminating Disability Benefits, While Eleventh Circuit Allows Employer to Terminate Life Insurance Benefits Despite Written and Oral Promises That Such Benefits Would be Maintained

ERISA Watch has two highlights this week: one is a win by a disabled plan participant, represented by Kantor & Kantor, at the Fourth Circuit, and the other is an examination of Monday’s argument at the Supreme Court in Hughes v. Northwestern.

Shupe v. Hartford Life & Accident Ins. Co., No. 19-1854, __ F.4th __, 2021 WL 5774728 (4th Cir. Dec. 7, 2021) (Before Circuit Judges Wilkinson, Agee, and Floyd).

Robert Shupe was an Executive Sous Chef for the Hyatt Corporation in San Diego. In 2003 he began experiencing symptoms of osteomyelitis, an infection in his spinal cord. He sought treatment, but nothing was effective and in 2004 he was forced to stop working. He submitted a claim to Hartford, the insurer of Hyatt’s long-term disability benefit plan, which approved his claim.
Continue Reading A Victory for a Disabled Plan Participant at the Fourth Circuit, and a Summary of the Supreme Court Argument in Hughes v. Northwestern

Noga v. Fulton Fin. Corp. Emp. Benefit Plan, No. 19-3855, __ F.4th __, 2021 WL 5540848 (3d Cir. Nov. 26, 2021) (Before Circuit Judges Ambro, Krause, and Phipps).

Attorneys who represent benefit plan participants have an uphill battle. Because the courts are often deferential to the decisions of plan administrators – using the abuse of discretion standard of review – participants often have to prove not only that the decisions denying their benefit claims were wrong, but also that they were “unreasonably wrong.”

One way a participant can chip away at this standard is to demonstrate that the administrator has a conflict of interest, or that it handled the claim in a way that calls into question its impartiality. However, it can be difficult to know what kinds of procedural errors are worth highlighting, as a substantial mistake in front of one judge can be a harmless error in front of another. In this published opinion, the Third Circuit has given practitioners some guidance on this issue.
Continue Reading Third Circuit Rules That Reliance Standard’s Conflict of Interest and “Irregular” Claim Handling Led to Unreasonable Claim Denial