In lawsuits challenging an ERISA plan’s denial of long-term disability benefits, can claimants who have qualified for Social Security disability benefits use that as evidence in their case? Or, to put it another way, can a decision from the Social Security Administration (SSA) on a claimant’s disability status be a…
Even when plaintiffs win ERISA disability lawsuits, their attorney’s fees can cut into their awards. In some ERISA disability cases, however, plaintiffs can recover their attorney’s fees (and costs) under federal law. What do plaintiffs need to show in order to be awarded their attorney’s fees in an ERISA disability…
In an ERISA disability case, a court will not overturn an insurer’s decision to deny a claimant benefits unless it is clear from the administrative record that the decision was “arbitrary and capricious.” This can be a tough bar for someone covered by a disability policy. In fact, courts in…
A serious and important question in a life insurance policy case can be: Is a death caused by a drug overdose an “accident” or is it an intentional act that can permit an insurer to deny benefits under the terms of the policy? Courts in the Sixth Circuit have wrestled…
If you have a disability insurance policy governed by ERISA and you are challenging an insurance company’s denial of disability benefits, you’ll have to convince a court that the decision was “arbitrary and capricious” and not just incorrect. This is a tough bar to meet in disability insurance cases in…
Many disability insurance policies provide two eligibility standards for benefits. The first is sometimes referred to as the “Your Occupation” (or “Own Occupation”) standard. Under this standard, a claimant is eligible for benefits only if the disability prevents him or her from performing the essential duties of his or her…
In an ERISA disability case, an insurance company cannot deny a claim without any explanations. Instead, under 29 U.S.C. §1133, it has to provide written notice of the “specific reasons” for the denial, and it must allow a “full and fair review” of any denial, i.e., an administrative appeal. An…
In an ERISA disability case, a claimant who challenges a denial of long-term disability benefits by filing a court action is generally not able to present evidence to the court that is not in the administrative record. The administrative record is legalese for all of the medical records, documents and…