Disability Benefit Claims

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This week’s notable decision is another Kantor & Kantor victory in a long-term disability benefit matter, Groch v. Dearborn Nat’l Life Ins. Co., No. 2:18-cv-06614 CBM (Ex), __ F. Supp. 3d __, 2020 WL 6374619 (C.D. Cal. Oct. 29, 2020).

Plaintiff brought this action for long-term disability (“LTD”) benefits under an ERISA-governed employee benefit plan insured by Defendant Dearborn National Life Insurance Company (“Dearborn”). As is typical of most LTD policies, Plaintiff was initially entitled to benefits if he demonstrated that he was unable to perform the duties of his “own occupation.” After 24 months of benefits, he had to demonstrate he was disabled from “any occupation” for which he might be qualified to continue receiving benefits.
Continue Reading District Court Rules Against Dearborn for “Moving Target” Claims Analysis in Disability Benefit Dispute

Good morning, ERISA Watchers! There were no notable circuit court decisions this past week, so we have chosen to highlight two published district court decisions from matters involving disability claims. The first is favorable to plan participants and the second is not. Is it any surprise that the former is from within the Ninth Circuit? 

Enjoy the long read of the summaries below. Until next week. Stay safe and be well.

The first case:  Jones v. Life Ins. Co. of N. Am., No. CV-19-04669-PHX-DLR, __ F. Supp. 3d __, 2020 WL 2126498 (D. Ariz. May 5, 2020). The almost Sisyphean topic of discovery in ERISA benefits cases added a new page when, on de novo review, the court required LINA “to respond to discovery that delves into the number of times it retained and the amount of money it paid to third-party vendors in disability and LWOP claims and medical reviewers utilized here, LINA-generated performance evaluations of the vendors and medical reviewers, the number of times they concluded that a claimant could perform work, LINA-generated performance evaluations for LINA employee Mary Faltaous, and any guidelines and manuals used by LINA in evaluating this claim, including the ‘DMS Expert Resource Professional conduct Statement’ and any guidelines and manuals.” 
Continue Reading District Court Permits Vast Conflict Discovery in Life Waiver of Premium Dispute Subject to De Novo Review

Good morning, ERISA Watchers! This was a slow week in the circuit courts for ERISA decisions so this week’s notable decision is the unpublished decision in Strickland v. AT&T Pension Benefit Plan, No. 18-15336, __F.App’x__, 2020 WL 1873358 (9th Cir. Apr. 15, 2020). 

Plaintiff Vanmark Strickland appealed a district court ruling upholding the denial of his claim for pension disability benefits under the AT&T Pension Benefit Plan (“the Plan”). The Plan is administered by Sedgwick Claims Management Services, which operates as AT&T Integrated Disability Service Center (“IDSC”). The district court reviewed the benefits decision applying an abuse of discretion standard of review. 
Continue Reading Ninth Circuit Upholds Denial of Pension Disability Benefits Under AT&T Pension Benefit Plan