Disability Benefit Claims

Subscribe to Disability Benefit Claims via RSS

Miller v. Reliance Standard Life Ins. Co., No. 20-30240, __ F.3d __, 2021 WL 2221347 (5th Cir. June 2, 2021) (Before Circuit Judges Haynes, Duncan, and Engelhardt).

Continuity of coverage provisions in benefit plans seem fairly straightforward – if you have coverage under your employer’s plan, when your employer switches insurance companies you should still maintain your coverage. However, employees, through no fault of their own, often get tripped up in these transitions and sometimes lose their coverage despite years of service to their employers. In this case, the Fifth Circuit prevented that from happening.
Continue Reading Fifth Circuit Construes Continuity of Coverage Provision in Favor of Disabled Participant

Gustafson-Feis v. Reliance Standard Life Ins. Co., No. C20-5336 BHS, ___F Supp. ___, WL 1561690, at *1 (W.D. Wash. Apr. 21, 2021) (Judge Benjamin Settle).

This week’s notable decision is a victory for the plaintiff, represented by Kantor & Kantor, in the Western District of Washington. It revolves around how an insurer determines whether a claim is barred by a pre-existing condition.  Plaintiff Lisa Gustafson-Feis had been hit by car in 2016, breaking several bones in her pelvis and sacrum. She worked for Microsoft, contracted through different employers. Her role required regular international travel and often moving heavy displays. She had multiple surgeries in 2016 to fix her spine and pelvis, went to physical therapy, and was released by her doctor in December 2017 to work full time with no restrictions.
Continue Reading An Insurer Can’t Just Say It’s So for Purposes of a Pre-Existing Condition Exclusion

I am happy to report two notable decisions this week, both resounding wins for plan participants. The first is a favorable Ninth Circuit decision obtained by ERISA Watch subscriber Laurence Padway, telling Unum Life Insurance Company that it must live up to its 2005 promises to the California Department of Insurance (“CDOI”). Cox v. Allin Corp. Plan, __ Fed. Appx. __, No. 18-16975, 2021 WL 613799 (9th Cir. Feb. 17, 2021) (Bybee and R. Nelson, Circuit Judges, and Whaley, District Judge). In Cox, the Ninth Circuit overturned a district court decision in Unum’s favor with respect to plaintiff Elgin Cox’s claim for long-term disability benefits based on his diagnoses of vertigo and dizziness.

Unum was the plan administrator for an ERISA-governed disability plan sponsored by Allin Corporation, for which Mr. Cox worked prior to becoming disabled. Unum terminated Mr. Cox’s benefits after 24-months based on an exclusion in the governing policy for self-reported symptoms. Unum did so despite its 2005 California Settlement Agreement (“CSA”) with the CDOI which, among other things, prohibits such self-reported symptom limitations in “existing California Contracts.” The Ninth Circuit held that the CSA applied to the Allin Plan. 
Continue Reading Two Wins for LTD Plaintiffs