Disability Benefit Claims

Subscribe to Disability Benefit Claims via RSS

This week’s notable decision is Card v. Principal Life Insurance Company, No. 18-6095, __F.App’x__, 2019 WL 5618182 (6th Cir. Oct. 31, 2019), where the Sixth Circuit concluded that Principal Life Insurance Company was arbitrary and capricious when it denied Plaintiff Card’s claim for disability benefits.  

Card was a registered licensed practical nurse who worked the night shift providing patient care and supervising nursing assistants.  In February 2013, a specialist in hematology/oncology diagnosed her with chronic lymphocytic leukemia, a type of blood and bone marrow cancer.  Over the following six months, Card began experiencing a worsening of symptoms, including night sweats, fatigue and exhaustion.  Bloodwork showed an increase in Card’s white blood cell count and lymphocytes.  She could not afford to see the specialist again nor afford more bloodwork as recommended by her primary care physician.  Though her doctor recommended disability, Card continued to work with accommodations.  She stopped working in December 2013 due to fatigue and weakness that left her feeling unable to perform her job.  
Continue Reading Sixth Circuit Revives Nurse’s Disability Benefit Claim Against Principal Life Insurance Company

Should an employee’s disability caused by malignant melanoma be subject to a disability policy’s pre-existing condition exclusion where during an alleged “look-back” period the employee was referred to a dermatologist on suspicion of having basal-cell carcinoma?  The First Circuit recently answered this question in today’s notable decision, Lavery v. Restoration Hardware Long Term Disability Benefits Plan, No. 18-1885, 2019 WL 4155038 (1st Cir. Sept. 3, 2019).  In short, the answer is no.

Facts:  Lavery worked for Restoration Hardware as a Construction Associate and then as a Regional Facilities Manager effective May 14, 2014.  In his new position he became eligible for long-term disability (“LTD”) coverage as of June 1, 2014 under a policy insured by Aetna Life Insurance Company.  The LTD Policy contains the following pre-existing condition exclusion:  

Long Term Disability Coverage does not cover any disability that starts during the first 12 months of your current Long Term Disability Coverage, if it is caused or contributed to by a “pre-existing condition.”
Continue Reading First Circuit Holds that Aetna Life Insurance Company Abused its Discretion in Applying Pre-existing Condition Exclusion to Malignant Melanoma

This week’s notable decision is Wilson v. Safelite Grp., Inc., No. 18-3408, __F.3d__, 2019 WL 3000995 (6th Cir. July 10, 2019), where the Sixth Circuit answers the question of what constitutes an employee pension benefit plan under ERISA.  At issue is a deferred compensation plan for executive employees that the district court determined to be an employee pension benefit plan under 29 U.S.C. § 1002(2)(A)(ii) and not a bonus plan exempted from ERISA under 29 C.F.R. § 2510.3-2(c).  Analyzing the plain text of ERISA and the bonus plan regulation, the Sixth Circuit affirmed the district court’s decision.
Continue Reading Sixth Circuit Finds that Deferred Compensation Plan for Executive Employees is an Employee Pension Benefit Plan