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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

You are a physician who has been suffering from a medical condition, for which you have asked your Disability Insurance Company to pay you benefits, under your Disability Insurance Policy. You have contacted your Company, you have provided it with all the pertinent information that it requested in a timely fashion; you have done “everything by the book”.  You may have met with its Field Representative, or even been evaluated by one or more of your Company’s chosen Independent Medical Examination doctors.  But, notwithstanding your compliance, the Company has methodically asked for endless amounts of additional information, or “dragged its […]

Having Residual Disability (or Partial Disability) provisions in your policy can be the most important decision you (or your insurance consultant) make when you bought (or if you are considering buying) your Individual Disability Insurance policy. If you are eligible for Long Term Disability Insurance (Group) coverage from your employer, most probably, the definition of Disability includes a Residual component. However, having the coverage and getting paid under that coverage may cause you to be subjected to some creative refinancing of your financial information as assessed by your Disability Insurance Company. The beauty of Residual Disability coverage is that it […]

Believe it or not, the summer is already more than half over. With all of us thinking about when it is going to be our turn to “hit the beach”, you, the disabled physician, don’t want those words to apply to your claim with your Disability Insurance Company, as if it were “D-Day” at Normandy. The simultaneous crash of our stock, financial, and real estate markets and the significant long term recession in which we are currently mired, have likewise had a significant and adverse financial impact on your Disability Insurance Company. As a result of this “new economy”, you […]

If you are, or have been, involved in a disability insurance claim, you are keenly aware of the pitfalls and difficulties in prosecuting and maintaining your claim. But, if you think the claim’s process is difficult, try being involved in a professional licensure action at the same time. In most disability insurance cases that involve either a psychiatric, and/or an addiction component, there is often times a concurrent legal issue involving professional licensure. Both of these issues can be extremely complex in their own singular sense. The problem is, that in most cases, these issues can not be singularized and, […]