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Author: Seltzer & Associates

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 […]