Disability Benefit Claims

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Harris v. Lincoln Nat’l Life Ins. Co., No. 21-13186, __ F.4th __, 2022 WL 3009199 (11th Cir. July 29, 2022) (Before Circuit Judges Jordan and Rosenbaum, and District Judge John Steele).

ERISA is very specific about some things, but on others it is famously vague. For example, ERISA says that plan participants are allowed to bring a civil action for benefits, but it doesn’t give much guidance as to how the courts should handle those actions. Are they handled the same way as other civil cases under the Federal Rules of Civil Procedure? Do claimants have the right to a jury? What standard of review should the courts use? 
Continue Reading Eleventh Circuit Holds That De Novo Review Requires Courts to Consider All Relevant Evidence, Regardless of Whether It Was Submitted to a Claim Administrator

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