This week’s notable decision is a Ninth Circuit decision in the matter of Cuaresma, Jr. v. Farmers Group Disability Income Plan, et al., No. 16-16946, __F.App’x__, 2018 WL 2439529 (9th Cir. May 31, 2018).  Although it is an unpublished decision, the fact pattern is a novel one and it presents a good roadmap for how an unwary claimant can get around the strictly applied exhaustion requirement. 

In this case, Liberty Life denied Plaintiff’s claim for long-term disability (“LTD”) benefits prior to the expiration of his time to provide proof of claim and a date earlier than the date Liberty Life told him it would make a decision.  Specifically, prior to the end of the policy’s elimination period (while he was receiving short-term disability benefits), Liberty Life wrote to Plaintiff on September 19, 2014 and advised him that it would begin reviewing his LTD benefit claim.  Liberty Life gave Plaintiff until November 2, 2014 to return claim forms and submit medical records.  Continue Reading Premature Denial of Long-Term Disability Benefit Claim Mitigates Claimant’s Failure to Exhaust Administrative Remedies

Happy Memorial Day!  Hope you all are reading today’s newsletter from the comfort of your lawn chair sipping mimosas.  No matter what you have on the agenda, please take a moment to honor and remember everyone who has died serving in the American armed forces.

Today’s notable decision is Gorbacheva v. Abbott Laboratories Extended Disability Plan, et al., No. 5:14-CV-02524-EJD, 2018 WL 2387852 (N.D. Cal. May 25, 2018), where the court grants in part Plaintiff’s motion for attorneys’ fees and denies Defendants’ request for attorneys’ fees, even though Defendants were ultimately successful on the merits of the underlying long-term disability dispute.  Continue Reading Court Awards Six Figures in Attorneys’ Fees to Claimant Who Achieved a Remand of Long-Term Disability Claim that was Ultimately Denied

The Sixth Circuit is back in the news.  This week’s notable decision is Clemons v. Norton Healthcare Inc. Ret. Plan, No. 16-5063, __F.3d__, 2018 WL 2142640 (6th Cir. May 10, 2018), an upset to the Plaintiff-Retirees who had prevailed on behalf of a certified class at the district court on their claim for underpaid pension benefits.  This lengthy opinion is succinctly summarized by the Court as follows:

This appeal is the latest installment in an ERISA litigation saga that has spanned almost ten years. At the risk of oversimplifying their case, the Plaintiff–Retirees claim that Defendant Norton Healthcare, Inc. Retirement Plan (“Norton”) underpaid them under the terms of the plan. The district court found that the plan was unambiguous in the Retirees’ favor. We agree with the district court on most issues. Continue Reading Sixth Circuit Holds that Contra Proferentum and Firestone Deference Are Incompatible on Issues of ERISA Plan Interpretation