Two recent “own occupation” versus “any occupation” judgments, in addition to cases from late last year, while not resounding successes, seem to indicate a trend of the courts favoring claimants over insurers. An insurer’s conflicting determinations In Robinson v....
ERISA
New ruling nullifies historic ERISA mental health protections
The seismic 2019 ruling in Wit v. United Behavioral Health (UBH), which compelled UBH to reprocess more than 50,000 denied claims for psychiatric conditions due to noncompliance with generally accepted standards of care and treatment, has been undone by a new opinion...
A new report reveals tactics the NFL uses to not pay injured players
An almost unbelievable pattern of deception and misrepresentation has defined the NFL's approach to compensating disabled former players. And players argue that their union has been in on the plot. A familiar ERISA story The Washington Post has published an exhaustive...
Fibromyalgia remains an ERISA long-term disability minefield
People submitting long-term disability claims for fibromyalgia are frequently denied benefits and those who have taken their claims to court have found that judges often side with insurers. Why is fibromyalgia so frequently viewed as a non-disabling condition? Niemuth...
Right-to-know prevents insurer from bringing new evidence to court
We recently wrote about a case where, through exceptional determination, an ERISA claimant was able to challenge a denial of benefits and win a chance at another appeal after the insurance company attempted to amend their denial of benefits in court with previously...
A lesson in persistence when challenging ERISA claim denials
Resolute determination resulted in a recent court victory in an ERISA denial case. In Collier v. Lincoln Life Assurance Co. of Bos., the plaintiff's attorneys overcame denials from both plan administrators and a district court judge to revive their client's claim for...
‘Own occupation’ vs. ‘any occupation’ in long-term disability
Two recent cases - Bedwell v. Schlumberger Grp. Welfare Benefits Plan and Logan v. The Prudential Ins. Co. of Am. - have highlighted the small but pivotal distinction between one’s ability to perform duties in their “own occupation” versus “any occupation” regarding...
Can your insurance company watch you for claim denial evidence?
A common scene in TV shows and movies is a couple of guys sitting in a van down the street from an unsuspecting person’s home, conducting surveillance. Usually it’s law enforcement, but sometimes it’s a private company. Does this happen in real life? Absolutely....
A doctor’s poor notes resulted in the loss of disability benefits
An insurance company’s decision to end a patient’s long-term disability benefits was upheld in a recent ruling due to his doctor’s poor post-appointment report. The case is a prime example of how something as simple as quickly dashed-off notes can be weaponized by...
Claimants must meet filing deadlines for ERISA disability
Employees in New Jersey who are covered by employer-sponsored disability insurance plans must exercise their rights within the deadlines outlined in the Employee Retirement Income Security Act of 1974 (ERISA). This act establishes your rights to access benefits and...