In Harlow v. MetLife, Judge Bernal Brings Clarity to Disputes Involving “Reasonable” Attorneys’ Fees Adopting Standards Favorable to ERISA Claimants

Posted in: Attorneys Fees, Disability Insurance, Disability Insurance News, ERISA, Insurance Litigation Blog, Legal Articles June 19, 2019

The topic of attorneys’ fees has long been of interest to insurance lawyers and clients alike.  Recently, the courts have grappled with issues such as: When are attorneys’ fees recoverable? What types of billing practices are reasonable?  What are reasonable hourly rates?  Attorneys want the assurance that the fees they charge will be deemed “reasonable,” and defendants (the insurance companies) want to know when they can raise defenses to the amount of an attorneys’ fees they may be expected to pay.  In this article, we will consider a recent case that has helped bring some clarity to the issue of “reasonable” fees for legal work.  Robert J. McKennon of McKennon Law Group PC acted as an expert in this case …

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“Own Occupation” Duties in a Long-Term Disability Policy Governed by ERISA: Does a Court Favor Those Listed in the Description of One's Actual Job, or Those Performed in the National Economy?

Posted in: Disability Insurance News, Insurance Litigation Blog April 12, 2019

“Own Occupation” Duties in a Long-Term Disability Policy Governed by ERISA: Does a Court Favor Those Listed in the Description of One’s Actual Job, or Those Performed in the National Economy?

Sometimes a legal dispute comes down to the simple interpretation of the meaning of two words.  The case of Christopher Patterson v. Aetna Life Insurance Company, 2019 WL 479209 (3d Cir. February 7, 2019) is such a case.  There, the Third Circuit Court of Appeals upheld summary judgment in favor of the plaintiff, ruling that, as used in plaintiff’s long-term disability policy underwritten by Aetna under ERISA, the plain meaning of “own occupation” is the job duties related to one’s actual job, as opposed to some generalized “national economy” …

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Breach of Fiduciary Duty under ERISA: Ninth Circuit Clarifies That Mere Disclosure of Plan Documents Is Insufficient “Actual Knowledge” to Trigger Statute of Limitations

Posted in: Disability Insurance News, ERISA, Fiduciary Duty, Insurance Litigation Blog, Pension Benefits, Statute of Limitations January 23, 2019

In pension and savings plan cases, it can often take several years before an employee realizes that there has been a breach of fiduciary duty.  Typically, an employee’s financial loss triggers an investigation that later reveals the facts of the breach.  But how long does an employee have to bring a claim in court?  The answer depends on the employee’s “actual knowledge” of the facts of the breach or violation.  There is a conflict among federal circuit courts of appeal on whether an employee should be deemed to have knowledge of 401(k) prospectuses and fund information simply because the employer makes this information available to the employee.  In a recent decision by the Ninth Circuit, Sulyma v. Intel Corp. Investment

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Court Says the Development of a Disabling Condition after Surgery for an Unrelated Condition Does Not Preclude Recovery of ERISA Disability Benefits under Pre-Existing Condition Exclusion

Posted in: Disability Insurance News, ERISA, Insurance Litigation Blog, Pre-existing Conditions January 16, 2019

Insurance companies often seek to exclude insureds from coverage through their long-term disability (“LTD”) plans by asserting the pre-existing condition exclusion.  If an applicant for LTD benefits has a non-disabling condition or becomes disabled as a result of a condition that developed after corrective surgery for an unrelated condition, is the applicant excluded from receiving benefits?  In a plaintiff-friendly decision, Hines v. Unum Life Ins. Co. of Am., 2018 WL 6599404 (N.D. Ohio Dec. 17, 2018), the court held that the plaintiff-disability claimant could not be excluded from coverage due to a vision disability on either the basis that she had received a diagnosis for a non-disabling condition before she became disabled or that she had developed a new …

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Court Rules That an Insurer Failed to Use Proper “Reasonable Continuity” Standard in Evaluating a Preexisting Condition that Disabled the Claimant

Posted in: Disability Insurance, Disability Insurance News, ERISA, Insurance Litigation Blog November 29, 2018

Under many long-term disability insurance policies, the insured is considered disabled if he or she is unable to perform “with reasonable continuity” the important tasks, functions, and operations of his or her occupation for a specified period of time. If a plaintiff seeks long-term disability benefits based on a claim that the insured was disabled as a result of a condition that existed before the insured stopped working, must the plaintiff demonstrate a change in the insured’s circumstances, such as a significant worsening of the preexisting condition? In Lyttle v. United of Omaha Insurance Co., No. 17-cv-01361-WHO, 2018 WL 4519949 (N.D. Cal. Sept. 19, 2018) (“Lyttle”), the court held that the plaintiff, who was the insured’s surviving …

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Sitting: If you are Unable to do it, are you Totally Disabled Under a Long-Term Disability Policy?

Posted in: Disability Insurance News, ERISA, Insurance Litigation Blog, Policy Interpretation August 03, 2018

While most people tend to have a common-sense view of what it means to be disabled, under long-term disability (“LTD”) policies, an insured must satisfy the terms of a disability policy and its specific definitions of “disability” to receive LTD benefits.  Within the first two years of a disability claim, “disability” in a policy is normally defined as the inability to perform the essential duties of one’s own job. Thereafter, “disability” is usually defined as being prevented from performing one or more essential duties of any occupation for which an insured is qualified by education, training and experience.  This “own occupation” versus “any occupation” analysis is the source of a substantial amount of judicial opinion.

Insurance companies typically argue that

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When Guarding the Henhouse, Some Foxes Go Rogue: When an Insurer’s Conflict of Interest Factors into Administrating Group Long-Term Disability ERISA Plans

Posted in: Abuse of Discretion, Accidental Death or Dismemberment, Conflict of Interest, Disability Insurance, Disability Insurance News, ERISA, Health Insurance, Insurance Litigation Blog, Life Insurance, News July 25, 2018

Few Americans can retire on their savings alone.  Many workers participate in an employee benefits plans, which serve to provide financial security in case of disability or retirement.  In the case of insurers that decide who qualifies for life, health and disability insurance benefits, there exists a major concern about the significant conflict of interest that exists when these insurers make these decisions and also pay for these benefits.  Will these insurers exalt their own interests of bottom line profitability over the interests of ERISA plan participants and beneficiaries who file claims for life, health and disability benefits? It is not a leap of logic that this conflict of interest results in insurance companies wrongfully denying ERISA benefit claims.

In

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Opportunistic Rescission: When Do Insurers Waive their Right to Rescind an Insurance Policy?

Posted in: Accidental Death or Dismemberment, Agent/Broker, Disability Insurance, Disability Insurance News, Health Insurance, Insurance Litigation Blog, Life Insurance, News, Waiver & Estoppel July 12, 2018

All too often, we see insurance companies deny insurance claims by attempting to opportunistically rescind insurance policies. This practice has become more prevalent in recent years as insurers look for ways to deny insurance claims.

Anyone who has purchased a disability, life or health insurance policy is likely familiar with the significant paperwork involved in the insurance application process. The paperwork includes policy notices, policy applications, supplemental policy applications, personal history questionnaires, policy warnings, medical examination documents, etc. These will include numerous and detailed questions relevant (and often not so relevant) to the risk being insured. An insurance agent or broker will ask questions on the policy application and often additional questions not on the application. Only after the applicant …

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A District Court Rejects Insurer’s Denial of a Long-Term Disability Claim Based Only on a Paper Review of Medical Records and Blind Adherence to the Dictionary of Occupational Titles

Posted in: Disability Insurance, Disability Insurance News, ERISA, Insurance Litigation Blog June 21, 2018

A “battle of the experts” is common in legal disputes.  But what happens when your doctor determines you are disabled and unable to work, while the insurer’s doctor determines you are not disabled based on a review of your medical file, leading to a denial of your claim for long-term disability (“LTD”) benefits?  Under the Employee Retirement Income Security Act of 1974 (“ERISA”), you may have a case for improper denial.

In a recent LTD insurance case governed by ERISA, Popovich v. Metropolitan Life Insurance Company, 281 F.Supp.3d 993 (C.D. Cal.  2017), Judge Andre Birotte explained the limitation of a paper review of a claimant’s medical record, as well as the limitation of relying solely on the definitions of occupations …

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Part-Time Work: Is this Sufficient to Preclude a Claim for Long-Term Disability Benefits Under the “Any Occupation” Standard of Total Disability?

Posted in: Disability Insurance News, ERISA, Insurance Litigation Blog June 16, 2018

Long-term disability insurance policies are an important safety net for employees. In the event of an accident, long-term disability helps to bridge the gap in income when an employee is no longer able to work. But to what extent does it mean for an employee to be no longer able to work? While insureds may be unable to continue fully working in their usual occupation, insurers often argue an insured can perform some other sedentary occupation to account for claimed disability, allowing them to deny the benefit claim.

In the 2003 Northern District of California case, Bruce v. New York Life Ins. Co., 2003 WL 21005313 (N.D. Cal. 2003), the court addressed this very issue. In Bruce, the …

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