We recently covered the use of AI in reviewing ERISA claims. (Spoiler alert: we were decidedly skeptical.) Stories are already popping up about insurers using AI to save money rather than help paying customers with their disability claims. Well, add another story to...
ERISA
Epic NFL disability lawsuit ends in player’s defeat
A longstanding lawsuit between former NFL running back Michael Cloud, which we’ve cited in previous posts, and the NFL Player Retirement Plan came to a startling and disappointing end. The decision, which defies reality and common sense, is a massive blow to disabled,...
How will Prudential using AI for ERISA claims affect applicants?
Barely an hour passes these days without a company giddily announcing a new AI partnership to improve its performance. But does the current state and limitations of AI belong in long-term disability benefits, a realm where crucial financial security and even people’s...
Three-part ERISA saga finally ends in plaintiff receiving benefits
Buckle up because this story could easily be adapted into a three-hour dramatic film starring Reese Whitherspoon and directed by Oliver Stone. And if you think reading this story takes a long time, imagine how the plaintiff feels. The main takeaway from this case is...
It’s not always bad news: ERISA lawsuit success stories
We spend a lot of time on this blog discussing the dubious, sometimes nefarious tactics insurance companies will use to deny or terminate long-term disability benefits, especially those claims covered by ERISA. Although every claimant has a right to sue the insurance...
Navigating the ERISA appeals process for long-term disability claims
An unfortunate fact in the ERISA long-term disability world is that many people will find themselves appealing decisions which deny or terminate benefits. Whether the insurance company denied your initial application, or your benefits were cancelled later, you must...
Judge tosses claim denial for provider’s catch-22 logic
Anyone familiar with the sometimes inexplicable state of disability insurance claim denials won't be shocked by a recent case where an insurer's arbitrary machinations ended in a swift summary judgment. A seemingly unremarkable benefits application In Mucciacciaro v....
Health insurance claim denials are getting more brazen
Most people over 40 remember a time when health insurance was simple. We paid our monthly premiums and received coverage for almost every doctor visit and procedure that wasn’t obviously elective. Today, that arrangement is but a happy memory of a simpler time. The...
Courts find fault with 6 in every 10 Social Security denials
If you’ve been struggling with a baseless, inexplicable Social Security disability claim rejection in recent years, you’re not alone. The highest rate of Social Security Disability Insurance (SSDI) claim rejections in years is gumming up courtrooms nationwide. Citing...
Even an ERISA courtroom win can be a bureaucratic nightmare
ERISA disputes are perhaps the worst-timed legal challenges a person can encounter. People with incapacitating illnesses or injuries, often involving a cognitive impairment, must become proficient in legal jargon and the convoluted world of long-term insurance...