Different laws apply to each of two types of disability insurance policies. The first kind of policy is governed by the federal law ERISA, short for the Employee Retirement Income Security Act of 1974, which applies to almost all policies offered through employment....
court of appeals
Nurse anesthetist with drug addiction could not work because he put patients at risk
A federal appeals court on April 5, 2021, agreed with the trial court that the insurer had denied the short- and long-term disability insurance claimant’s applications wrongly and without the required substantial evidence to do so. Last year, we talked in this space...
Pre-existing condition and disability need substantial link to deny claim
Most disability insurance policies contain clauses that provide for the denial of disability claims for the first policy year if the disabling impairment was a pre-existing condition during a period of time immediately before the policy took effect – called the...
Disability Insurance Law Group wins 11th Circuit Appeal against the NFL
On October 15th, the U.S. Court of Appeals for the 11th Circuit ruled in favor of our client, Darren Mickell, in the case, Mickell v. Bell/Pete Rozelle NFL Players Retirement Plan, holding that the NFL abused its discretion when it denied disability benefits to...
Long-term disability claimant’s debilitating pain had subjective and objective support
The U.S. Court of Appeals for the Sixth Circuit recently held in favor of a long-term disability (LTD) claimant whose insurance company denied his claim based largely on severe, chronic back pain. Disability insurance companies often improperly discount credible...
Disability Insurance Law Group wins lawsuit and secures disability benefits for claimant suffering from cervical and lumbar pain after MetLife terminated benefits
Our client, Mrs. Y was covered under her employer-provided Short-Term and Long-Term Disability Insurance Policy, issued by Metropolitan Life Insurance Company (“MetLife”). Ultimately, Ms. Y became disabled from her occupation and any occupations due to cervical and...
LTD insurer’s failure to disclose key report triggers de novo review
On January 21, an Alabama federal court decided that the proper standard of judicial review in an appeal of a long-term disability insurance benefit termination was “de novo” review. In an appeal of a federal disability insurance denial or termination, the court must...
Policy language limits disability insurer administrator’s power
A recent court opinion sheds light on the ramifications of disability insurance policy language that describes what powers the insurer's administrator has to decide claims. We recently posted a blog about the standards of review courts apply when considering an appeal...
Court uses de novo standard of review when insurer blew deadline
A federal appeals court decided that because a disability insurance plan administrator missed a strict ERISA deadline for issuing a benefits decision on review, the correct standard for the court reviewing the denial of benefits to use is "de novo" rather than...
Court holds LTD claimant did not have a pre-existing condition
On Sept. 3, the U.S. Court of Appeals for the 1st Circuit held that Aetna had wrongly denied long-term disability insurance coverage to a claimant with malignant melanoma. The opinion turns on a legal issue that comes up often in LTD cases — whether the claimant...