This week’s notable decision is another Kantor & Kantor victory in a long-term disability benefit matter, Groch v. Dearborn Nat’l Life Ins. Co., No. 2:18-cv-06614 CBM (Ex), __ F. Supp. 3d __, 2020 WL 6374619 (C.D. Cal. Oct. 29, 2020).

Plaintiff brought this action for long-term disability (“LTD”) benefits under an ERISA-governed employee benefit plan insured by Defendant Dearborn National Life Insurance Company (“Dearborn”). As is typical of most LTD policies, Plaintiff was initially entitled to benefits if he demonstrated that he was unable to perform the duties of his “own occupation.” After 24 months of benefits, he had to demonstrate he was disabled from “any occupation” for which he might be qualified to continue receiving benefits. Continue Reading District Court Rules Against Dearborn for “Moving Target” Claims Analysis in Disability Benefit Dispute

This week’s notable decision is the district court opinion in Fitzwater, et al., v. Consol Energy, Inc., et al., No. 1:17-CV-03861, 2020 WL 6231207 (S.D.W. Va. Oct. 22, 2020), a case involving two key issues: (1) whether Plaintiffs, seven former employees of CONSOL Energy, Inc., were misled by ERISA plan fiduciaries about the nature and duration of their health benefits; and (2) whether Defendants discriminated against Plaintiffs based on health status-related factors in violation of ERISA. Specifically, Plaintiffs allege that Defendants made promises of lifetime medical insurance coverage to “non-union miners” and their beneficiaries, while Defendants dispute that any such representations were ever made. Defendants moved to dismiss all seven of Plaintiffs’ causes of action.  Continue Reading District Court Permits Retirees’ Breach of Fiduciary Duty Claim Based on Misrepresentation of Lifetime Health Benefits

This week’s notable decision is Mickell v. Bert Bell/Pete Rozelle NFL Players Retirement Plan, No. 19-10651, __F.App’x__, 2020 WL 6074329 (11th Cir. Oct. 15, 2020), where the Eleventh Circuit reversed the district court’s determination that an ERISA plan did not abuse its discretion in denying disability benefits. Plaintiff Darren Mickell spent nine years in the NFL as a defensive end in which he sustained countless injuries, including multiple blows to the head. In September 2013, Mickell submitted a claim for permanent and total disability (“PTD”) benefits under the NFL Player Retirement Plan (the “Plan”). The Plan provides that initial decisions are made by an Initial Claims Committee (the “Committee”). Players may appeal the Committee’s decision to the Plan’s six-member board (the “Board”) which reviews the claim de novo. The Plan also provides that a player may be referred to one or more “neutral” physicians whose opinions will be a “substantial factor” in the Board’s decision. Finally, the Board is vested with “full and absolute discretion . . .”   Continue Reading Eleventh Circuit Holds NFL Retirement Plan Abused its Discretion by Failing to Consider Evidence and Combined Effects of Plaintiff’s Impairments