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In this week’s notable decision, Kaminski v. UNUM Life Ins. Co. of Am., No. 19-CV-1997-SRN-DTS, 2021 WL 411438 (D. Minn. Feb. 5, 2021) (Judge Susan Richard Nelson), a district court in Minnesota examines whether UNUM can evade the State’s ban on discretionary language in disability policies issued or renewed in the state after January 1, 2016 by the insurer’s practice of amending and replacing its disability policies rather than renewing them. The court’s answer: nice try UNUM, but de novo review applies. 

In the summer of 2008, Peter Kaminski was paralyzed in a diving accident. After surgery and physical therapy, Kaminski was able to regain most of his strength but was plagued by chronic pain. In 2016, Kaminski made a claim for short-term disability (“STD”) benefits with UNUM under his employer’s STD plan. Kaminski’s STD claim was approved, and UNUM paid him STD benefits for the maximum time allowed under the plan. When his STD benefits were exhausted, Kaminski made a claim for long-term disability (“LTD”) benefits in April of 2017. 
Continue Reading Unum Unsuccessfully Attempts to Evade Minnesota’s Ban on Discretionary Clauses

This week the Eighth Circuit’s decision in McIntyre v. Reliance Standard Life Ins. Co., No. 19-2367, __F.3d__, 2020 WL 4951028 (8th Cir. Aug. 25, 2020), clarified that when circumstances demand “less deferential review,” this cannot mean de novo review. Why? After all, de novo review is less deferential than abuse of discretion review and multiple Eighth Circuit opinions appeared to sanction this seemingly logical finding. 

After approving Plaintiff’s disability claim for two years, Reliance terminated Plaintiff’s long-term disability claim under the “any occupation” definition of disability. Plaintiff appealed and Reliance upheld its original determination. That finding that came almost seven months after the appeal was submitted—well outside the 90 days allowed. Plaintiff filed suit and the district court ruled in her favor under the de novo standard of review despite the Plan containing a grant of discretionary authority. 
Continue Reading Eighth Circuit Jettisons Prior Circuit Precedent Holding that Procedural Irregularities Can Justify a De Novo Standard of Review

Good morning, ERISA Watchers! We have two notable decisions to report again this week, including one that is a firm victory. 

Let us start with the good news. The first notable decision, Katherine P. v. Humana Health Plan, Inc., No. 19-50276, __F.3d__, 2020 WL 2479687 (5th Cir. May 14, 2020), revives life into a claim by a young woman seeking mental health benefits for partial hospitalization treatment. Katherine received partial hospitalization treatment in 2012 for multiple mental health disorders including an eating disorder. Humana paid for the first 12 days of partial hospitalization treatment and then denied benefits, claiming such treatment was no longer medically necessary based on two Mihalik Criteria. The parties filed cross-motions for summary judgment and the magistrate judge recommended judgment for Humana. The district court accepted the recommendation. Katherine P. appealed. 
Continue Reading Fifth Circuit Revives Claim Against Humana for Denying Eating Disorder Treatment