Disability Benefit Claims

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Good morning ERISA Watchers! Changes are afoot here. Michelle Roberts, the founder and editor of ERISA Watch, is passing the torch, which Peter Sessions and I, along with all the contributors here at Kantor & Kantor, will endeavor to carry forward in the enlightening tradition for which this newsletter is known. While most things will remain the same for you, our esteemed readers, we do plan some special issues and other exciting changes in the future, so stay tuned.

For the very first edition under the new editors, it is fitting that this week’s notable decision is a favorable one obtained by your departing editor, Michelle Roberts, and Kantor & Kantor Associate Monica Lienke, in a difficult disability case. Hamid v. Metropolitan Life Ins. Co., No. 20-CV-01601-VC, 2021 WL 405225 (N.D. Cal. Feb. 5, 2021), was heard by the Honorable Vince Chhabria. In ruling for the plaintiff, the court reaffirmed that objective evidence was not required to prove disability. The court also determined that certain evidence in the record contained objective indications of disability that MetLife had ignored. Additionally, the court found that MetLife’s failure to engage with Hamid’s favorable Social Security disability determination in a meaningful way further undermined its finding of no disability.
Continue Reading New Editors and a K&K Victory

This week’s notable decision is a recent Kantor & Kantor victory in the matter of Myers v. Aetna Life Insurance Company, No. CV 19-9555 DSF (KSx), 2020 WL 7423109 (C.D. Cal. Dec. 17, 2020); a case involving a denial of long-term disability benefits. The action was heard by the Honorable Dale S. Fischer on October 27, 2020. In its ruling, the court reaffirmed that objective evidence was not required to prove a disability. Judge Fischer also found that the evidence of Plaintiff’s treaters to be more compelling than that of Aetna’s record reviewers. Notably, the court also found that Dr. Gary Nudell’s opinion (Aetna’s reviewer), which denied the notion of disabling fibromyalgia, to be contrary to established authority which recognized the disabling potential of the disease.
Continue Reading District Court Rules Against Aetna in Long-Term Disability Dispute; Objective Evidence is Not Necessary to Prove Disability

This week’s first notable decision is Davis v. Hartford Life & Accident Ins. Co., No. 19-6091, __F.3d__, 2020 WL 6789448 (6th Cir. Nov. 19, 2020), where the Sixth Circuit held that the arbitrary-and-capricious standard of review applied to Hartford’s decision to terminate Davis’s long-term disability (“LTD”) benefits and that Hartford’s decision was not arbitrary and capricious.

Davis stopped working due to chronic back pain, neuropathy, and fatigue caused by multiple myeloma. Hartford approved his LTD claim and paid him 24 months of benefits under the policy’s Own Occupation definition of disability. While investigating whether Davis would continue to qualify for benefits when the policy’s definition of disability changed from Own Occupation to Any Occupation, Hartford conducted surveillance, obtained two reviews of Davis’ medical records, and had Davis examined by an orthopedic surgeon. Hartford showed some of the surveillance footage to Davis’s treating doctors. After viewing surveillance video, Davis’s primary care doctor and neurologist both responded to Hartford that Davis was capable of full-time work.
Continue Reading Sixth Circuit Applies Deferential Standard of Review to Hartford’s Decision to Terminate Long-Term Disability Benefits