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Author: Seltzer & Associates

Federal Judge Rules in Favor of Terminated Long-Term Disability Claimant with Fibromyalgia

Feb 19, 2015 in Articles by

Sedgwick Claims Management Services, the Plan Administrator for the ERISA-governed Long-Term Disability Plan for employees of Eli Lilly and Company (“Lilly”), terminated former Human Resources Director Cathleen Kennedy’s Long-Term Disability benefits once she entered the “any occupation” definition phase of the disability plan. Ms. Kennedy suffered from fibromyalgia that had been long established through her regular medical care and prior Independent Medical Examination’s performed at the request of the Plan. Following termination of her disability benefits, Ms. Kennedy filed an administrative appeal with Sedgwick for reinstatement of her benefits. As part of the appeal process, Ms. Kennedy underwent an Independent […]

California Federal Judge on Monday Said Kaiser Could Amend Its Answer to an ERISA Complaint

Feb 13, 2015 in Articles by

U.S. District Judge Samuel Conti on Monday granted Kaiser leave to amend its answer in an ERISA lawsuit brought by retired cardiothoracic surgeon Thomas Gonda. Dr. Gonda was seeking benefits and damages following termination of his long-term disability benefits. The parties had previously entered into a settlement agreement that Kaiser used as a basis for seeking summary judgment in the present case. Judge Conti previously ruled that Kaiser must amend its complaint if it sought to use the settlement agreement as an affirmative defense. As Courthouse News Service notes: Conti granted Kaiser leave to amend its answer on Monday. “The […]

What Are the Risks for Physician Suicide?

Nov 14, 2014 in Articles by

The November 2014 edition of the Newsletter of the Missouri Physician’s Health Program highlights a recent Vanderbilt study on physician suicide risk. “[The] recent study done by Vanderbilt University of 141 Tennessee physicians evaluated for fitness-for-duty assessments found an “astoundingly” high rate of suicide if the physician was 1) found unfit to practice, 2) was in solo practice, or 3) if he/she was taking benzodiazepines (anti-anxiety drugs).” Associate Professor of Clinical Psychiatry and Medical Director of the Vanderbilt Comprehensive Assessment Program, Reid Finlayson, M.D., said, “Being found unfit for practice means a loss of income, loss of social contact and […]

You Must Exhaust All Administrative Remedies Before You Can Sue Your Disability Insurer

Sep 2, 2014 in Articles by

The 10th Circuit Court of Appeals recently reaffirmed ERISA’s requirements that when your Long Term Disability benefits are denied or terminated, you must follow your plan’s rules for administrative remedies before you can bring suit against your LTD insurance company. ERISA requires LTD insurance carriers to provide you with the opportunity to appeal your claim administratively to the insurance company. ERISA also requires the company to notify you of this right to administratively appeal before you bring suit against the company. Generally, the Summary Plan Description, i.e. the document that summarizes your policy for you, should contain the requirements for […]

Are Lawyers Drinking Too Much?

Sep 2, 2014 in Articles by

Many lawyers may recall being told at some point during law school that they were preparing to enter the profession with the highest rate of substance abuse in the county. Now, the National Law Journal reports that lawyers may “suffer addiction at double the rate of the general population.” The Journal states that the ABA and Hazelden Betty Ford Foundation will begin surveying lawyers about addiction, anxiety, and depression to determine the rates at which lawyers suffer from substance abuse and mental illness. This is the first time this type of data will be gathered since 1990. A 2012 report […]

Professional Impairment: Licensure and Disability Insurance

Aug 20, 2014 in Articles by

Mark F. Seltzer, Esq., presented the poster, “Professional Impairment: Licensure and Disability Insurance Issues,” designed to help guide monitors and practitioners. This presentation focused on the complex interaction between factual disability that is a result of injury or sickness — often with a psychiatric and/or addiction component — and the frequently concurrent legal issues a medical professional faces regarding their license to practice. Disability policies require that an insured physician establish that he or she is “factually disabled” and receiving appropriate care in order to be entitled to total or residual/partial benefits. On the other hand, state boards of medicine […]

Did You Know? You Only Have A Limited Amount of Time To File A Civil Suit When Your Long-Term Disability Claim Is Denied…

Aug 15, 2014 in Articles by

The 6th Circuit Court of Appeals1 recently reaffirmed that Long-Term Disability insurance carriers are required to notify you of your rights for a review and its time limits when they deny your disability claim. The federal law ERISA provides rules governing claims procedures that Insurers must follow when denying your disability claim. MetLife can’t use its own failure to properly notify an individual of his policy rights to deny his right of judicial review. MetLife’s failure to comply with the ERISA rules requiring notice of the policy provisions allowed the individual to sue MetLife, regardless of the time-limitation clause in […]

8th Circuit Reverses District Court In Favor of Sun Life’s Interpretation of “Pre-Existing Condition”

Jul 28, 2014 in Articles by

On July 21, 2014, the Eighth Circuit Court of Appeals reversed the District Court for the Eastern District of Missouri’s decision in Kutten v. Sun Life Assurance Co. of Canada. Marc Kutten had sued Sun Life in U.S. District court alleging that Sun Life had improperly denied him Long Term Disability benefits under an ERISA governed group disability plan. The District Court granted summary judgment for Kutten and denied summary judgment for Sun Life. The Eighth Circuit determined that the District Court had erred in granting Kutten’s motion for summary judgment in interpreting the meaning of medical treatment under the […]

Are You Entitled to Disgorgement of Profits When Your Insurance Company Improperly Denies You Long-Term Disability Benefits?

Mar 10, 2014 in Articles by

The United States Court of Appeals for the Sixth Circuit recently examined whether or not a claimant who is arbitrarily and capriciously denied ERISA disability benefits is later entitled to an equitable accounting of the disability insurer’s profits and disgorgement of those same profits. Focusing on the portion of the decision that examined the relief available under ERISA, the Sixth Circuit found the plaintiff/claimant was entitled to recover benefits due to him and disgorgement of the Life Insurance Company of North America’s (LINA) profits resulting from the denial of benefits. The Sixth Circuit began their examination of relief available under […]