You already know that the final battleground in lawsuits seeking ERISA-governed long term disability (LTD) benefits is whether a prevailing plaintiff should be awarded prevailing party attorney fees.
Should plaintiffs always recover attorney fees when the ultimate decision to deny benefits “was a close call” …and both sides’ positions had merit? No. And this new…
You know that the ERISA regulations set out claims procedural requirements.
Whether the claims administrator complied with the claims procedure requirements is often a key battleground when a court is determining if the long term disability claim was improperly denied.
This new case highlights the arguments Plaintiffs’ may make in challenging claims handling, and how…
You already know that the Elimination Period in long term disability cases is a key focus in assessing eligibility for benefits.
This new Sixth Circuit case explains:
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As you know, the federal circuits have varying approaches to resolving ERISA denial-of-benefit cases. Some circuits use Rule 56 summary judgment as a process to resolve these cases, while the trend has been to use Rule 52 bench trials to resolve cases.
A new case highlights that, in cases applying de novo review, Rule 52…
Can a district court consider new arguments justifying claim denial that were not articulated in the initial claim denial or appeal? NO. In fact this new Ninth Circuit decision indicates for the first time that it is “clear error” for a district court to adopt “newly presented rationale when applying de novo review.”
Even rationale…
Can a district court consider new arguments justifying claim denial that were not articulated in the initial claim denial or appeal? NO. In fact this new Ninth Circuit decision indicates for the first time that it is “clear error” for a district court to adopt “newly presented rationale when applying de novo review.”
Even rationale…
Can the ERISA claims administrator “cure” inadequacies, made during its initial claim denial, during the appeal process? Yes.
Did a claims administrator’s recommendation, that a claimant receive a job-accommodation, constitute sufficient proof of disability? No.
This new case highlights these issues: Canter v. AT&T Umbrella Benefit Plan No. 3, 33 F. 4th 949 (7th…
Sometimes an ERISA-governed disability benefit claim is denied on a specific issue that precludes the need for a full development of the record on the merits of the claim. E.g., claimant was not eligible for benefits because he was not a full-time employee at the time of disability.
But when should courts order remand, after…
What is the most efficient way to invite the district court to resolve ERISA-benefit claims?
What’s the difference between using Rule 56 motions for summary judgment, versus a Rule 52 Motion for Judgment?
This new case highlights why Rule 52 motions may be the preferred motion to efficiently resolve ERISA benefit claims. Avenoso v. Reliance…
What happens when an ERISA-governed disability claim is denied solely under the “own occupation” provision, but a reviewing district court concludes the claimant is entitled to “own” occupation benefits?
Does an insurer “waive” an evaluation of the “any occupation” provision because the insurer denied the claim solely on the “own occupation” standard? NO.
Can the…
