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Articles Posted in insurance litigation

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Waiver by Insurance Companies Resulting from Acceptance of Premium Payments and/or the Providing of Benefits

An insurance company may waive its right to deny benefits when it accepts premiums for coverage that its policy did not actually provide. It may also waive its right to deny benefits where, even for a short period of time, it provides the very benefits it later seeks to deny…

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Whether a Life Insurance Case is Decided Under Common Law or Federal ERISA Law Can Make a Big Difference

In Travelers Ins. Co. v. Webb (1996), the Court of Appeals of Tennessee noted that a life insurance policy is a contract between the insured and the insurance company and, as such, courts will construe insurance policies from their “four corners.” In Webb, the decedent had a life insurance policy…

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Helpful ERISA Disability and Healthcare Coverage Cases for Plaintiff’s Lawyers

In an ERISA disability case, a federal district court reviews a decision to deny benefits under “an arbitrary and capricious” standard. Under this standard, a court will not overturn a denial of long-term disability benefits if a plan administrator can offer a “reasoned explanation” for its decision. Simply put, even…

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Why Determining the Proper Beneficiary of a Life Insurance Policy Is Not Always Simple

Many life insurance lawsuits involve disputes over the designation of beneficiaries. In Humana Ins. Co. of Kentucky v. O’Neal (2018), the Sixth Circuit Court of Appeals had to evaluate two competing claims for life insurance proceeds under an ERISA plan (“Plan”). Under the Plan, the decedent (“Decedent”) could name a…

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The Importance of Denial Letters in Long-Term Disability Litigation

In an ERISA disability lawsuit, the plan administrator’s “denial letter” is one of the most important documents for a plaintiff. The letter is supposed to explain why the plan administrator denied a claim for disability benefits. A denial letter may also describe why the plan administrator rejected an administrative appeal…

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You May Qualify for Total Disability Benefits, Even If You’re Able to Hold a Full-Time Job

Plan administrators will often deny claims for total disability benefits on the basis that the claimant is still able to work. However, under precedent in Tennessee and in the Sixth Circuit, you can hold a full-time job and still qualify for total disability benefits, unless your policy says otherwise. In…

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Remand vs. Award: How Courts Determine Whether To Award Disability Benefits or to Order the Plan Administrator to Review the Claim All Over Again

In an ERISA disability case in which a plaintiff is challenging a plan administrator’s denial of long-term disability benefits, a court can do one of three things: (1) It can uphold the plan administrator’s decision; (2) it can reverse the decision and award the plaintiff disability benefits; or, (3) it…

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Sixth Circuit Rules That Claimants Do Not Have To Appeal a Denial of ERISA Benefits If The Plan Does Not Discuss Internal Appeal Procedures

Most ERISA disability plans require claimants to file an administrative appeal of any denial of long-term disability benefits prior to filing a lawsuit. Under Sixth Circuit case law, if you fail to file an administrative appeal (also referred to as failing to exhaust administrative remedies), the court will likely dismiss…

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How Insurers Rely on Exclusions to Deny Coverage Under Accidental Death and Dismemberment Policies

Many life insurance policies provide for benefits, in addition to the face amount of the policies, when an insured dies as a result of an accident. These extra benefits can be significant, as many policies will pay twice the face amount of the policy, where the insured’s death is by…

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ERISA and The Fiduciary Duties of a Plan Administrator With Respect to Life Insurance

            Maintaining life insurance through an employee benefit plan can be a difficult process. Many plans set out complicated administrative requirements that can trip up an employee, resulting in a loss of coverage. The good news is that, under ERISA, plan administrators must discharge their…

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