Disability Benefit Claims

Stratton v. Life Insurance Co. of North Am., No. 20-CV-2037 JLS (NLS), 2022 WL 712926 (S.D. Cal. Mar. 8, 2022) (Judge Janis L. Sammartino).

This week’s case of the week is a significant long-term disability win for plaintiff Maureen Stratton, represented by our talented colleagues at Kantor & Kantor, Corrine Chandler and Andrew Kantor. 

Ms. Stratton, who worked as a senior executive partner at Gartner Inc., began experiencing significant back pain in 2011. This pain progressed to such a point that, by early 2017, she was calling in sick to meetings and could no longer tolerate plane travel or extended sitting. Around that time, she stopped working and applied for disability benefits.
Continue Reading Court Credits Treating Physician Over Retained Experts

Newsom v. Reliance Standard Life Ins. Co., No. 20-10994, __ F.4th __, 2022 WL 500403 (5th Cir. Feb. 18, 2022) (Before Circuit Judges Higginbotham, Stewart, and Wilson).

When an ERISA administrator denies a benefit claim because the claimant is not an eligible plan participant, what happens when a court later rules that this decision was wrong? Does the court order that benefits be approved? Or does the court give the administrator a second chance to deny the claim by allowing it to determine whether the now-covered participant met the plan benefit criteria? The title gives this one away, but read on to find out how the Fifth Circuit decided the issue.
Continue Reading Fifth Circuit Rules That Insurer Gets a “Second Bite at the Apple” After Making Faulty Coverage Determination

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