In December, the U.S. Department of Labor (“DOL”) released its Final Rule amending the Claims Procedure rule regulating claim handling for ERISA governed disability benefits. In conjunction with the release of the Final Rule, the DOL released a Fact Sheet explaining the changes to this rule, 29 CFR 2560.503-1. Beginning in January 2018, ERISA governed plans will be required to make a number of changes to their claim handling that should be beneficial to disability claimants. Below are highlights from the fact sheet, along with an explanation of how these new rules affect you, the claimant. Improvement to Basic Disclosure […]

In a November 4, 2016 ruling, The Ninth Circuit Court of Appeals reversed a Central District of California ruling when it concluded an individual who cannot sit for four hours a day cannot perform sedentary work. In 2011, Avery Armani suffered a back injury while at work. He was covered under a group long-term disability insurance policy issued by Northwestern Mutual provided by his employer. Following his back injury, Mr. Armani sought treatment from chiropractors, pain specialists, and physicians. Each treatment provider confirmed Mr. Armani was not capable of sitting more than four hours per day because of his lumbar […]

The United States Court of Appeals for the 3rd Circuit recently vacated the summary judgment opinion of the District Court of New Jersey in Baker v. Sun Life and Health Ins Co. Following Sun Life’s denial of continued long-term disability benefits, Kenneth Baker filed suit against Sun Life in New Jersey District Court. At conflict was whether Mr. Baker’s policy of disability insurance contained language granting discretionary authority to Sun Life in determining whether to award Mr. Baker disability benefits. If the policy contained discretionary language, a court could only review Sun Life’s decision under the arbitrary and capricious standard […]

A plan participant sued MetLife claiming an improper denial of his long-term disability benefits under ERISA. Participant Dionisio Santana-Díaz was a financial analyst at Shell Chemical and a participant in the company’s employee welfare benefit plan issued by Metropolitan Life Insurance Company (“MetLife”). Mr. Santana-Díaz suffered from major depression, high blood pressure, asthma and various other physical and mental conditions and stopped working. He received sick leave and then short-term disability benefits. After being out of work for five months, Mr. Santana-Díaz submitted his claim for long-term disability benefits and was eventually awarded LTD benefits. About a year and a […]

The U.S. District Court for the Northern District of Texas, on February 19, 2016, granted in part and denied in part Dewayne Curtis’ motion to compel discovery from MetLife. While discovery in ERISA actions is generally limited, in this case, the court required MetLife to answer some of Mr. Curtis’ questions in the form of interrogatories. The court required MetLife “to more fully describe the policy and methods used to determine compensation for the claims and appeals specialists who handled Plaintiff’s claim, such as any policy or method for determining and calculating bonuses, pay increases, or gain sharing.” However, MetLife […]