I’m pleased to report this week’s notable decision is a firm victory in the case of Dowdy v. Metro. Life Ins. Co., No. 16-15824, __F.3d__, 2018 WL 2223722 (9th Cir. May 16, 2018), which involved a denial of benefits under an AD&D Plan.  Dowdy was involved in an automobile accident and sustained a serious injury to his left leg, which was eventually amputated below the knee.  Dowdy and his wife sought accidental dismemberment benefits under an insurance policy provided by his employer and insured and administered by Metropolitan Life Insurance Company.  MetLife denied the benefits on the basis that Plaintiff’s diabetes contributed to the decision to amputate Plaintiff’s leg and the AD&D policy has an exclusion for any loss caused or contributed to by an illness or infirmity.  The district court declined to consider evidence outside of the “administrative record.”  On the merits, the district court found that diabetes caused or contributed to the need for amputation and Plaintiff’s loss was excluded under the policy. Continue Reading Ninth Circuit Holds That Substantial Contribution Standard Applies to AD&D Policy Exclusion and Reverses Denial of Benefits

This week’s notable decision is a short and sweet read in the matter of Reed v. KRON/IBEW Local 45 Pension Plan, No. 17-17176, __F.App’x__, 2019 WL 2145652 (9th Cir. May 16, 2019), where the Ninth Circuit reversed the district court’s decision finding that it was not an abuse of discretion for Defendant to deny survivor-spousal benefits to a same-sex domestic partner.

By way of background, Plaintiff David Reed and Donald Lee Gardner, an employee of KRON-TV, were registered as domestic partners in California on 2004.  Mr. Gardner retired in 2009 and elected a single-life annuity pension under the KRON/IBEW Local 45 Pension Plan (the “Plan”).  Reed claimed that KRON-TV’s HR department never mentioned the availability of a joint-and-survivor form of benefit although they knew he and Gardner were registered domestic partners.  In May 2014, Reed and Gardner got married and then Gardner passed away five days later.  Reed submitted a claim for a survivor benefit to the KRON/IBEW Local 45 Pension Plan (the “Committee”), which it denied. Continue Reading Ninth Circuit Holds that Same-Sex Domestic Partner Is Entitled to Joint-and-Survivor Pension Benefits

Happy Mother’s Day!  This is the one day a year where I can say “But it’s Mother’s Day!” to get my kids to comply without (much) protest.  They also did give me a few hours of peace and quiet today so I could wrap up today’s notable decision.  This week I want to highlight a district court decision, Khan v. Provident Life & Accident Ins. Co., 2019 WL 1970516 (W.D.N.Y. May 3, 2019), that contains a treasure trove of findings for those of us who represent claimants in long-term disability claims.  

The court’s decision comes from its review of the Magistrate Judge’s Report and Recommendation (R&R) denying the parties’ cross-motions for judgment and recommending a plenary bench trial before the district court.  The court rejected and accepted in part the R&R and granted Plaintiff’s Motion for Summary Judgment.  On de novo review of Provident’s decision, the court found that Plaintiff Khan, who became disabled from his career as a hospital neurologist at the age of 49 due to relapsing polychondritis and polyarthralgias, was entitled to Own Occupation and Any Occupation benefits, denying Provident the opportunity on a remand to consider the Any Occupation claim in the first instance.   Continue Reading Court Denies Insurance Company Chance to Decide “Any Occupation” Disability Claim for Disabled Neurologist; Orders Payment of Benefits