Tenth Circuit Finds that Policy Terms in an ERISA Plan Did Not Unequivocally Grant an ERISA Administrator Discretion to Interpret Plan Terms, Applies De Novo Review

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog, Policy Interpretation, Standard of Review May 17, 2019

Insurance companies acting as ERISA plan administrators often are guilty of abusing their discretion to interpret policy language related to the level of benefits payable to a claimant under a long-term disability (“LTD”) policy in a manner most beneficial to them, rather than the claimant.  In a recent decision by the Tenth Circuit Court of Appeals, Hodges v. Life Insurance Company of North America, 920 F.3d 669 (10th Cir. 2019), the court addressed the ability of insurance companies such as Life Insurance Company of North America (“LINA”) from interpreting policy language that may determine the level of benefits payable to a claimant.

In Hodges, the Tenth Circuit Court of Appeals affirmed the ruling of the district court that …

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Ten Things to Consider and Look For in Your ERISA Short-Term and Long-Term Disability Plans When Selecting Benefits or You Want to File a Claim

Posted in: Administrative Record, Disability Insurance, ERISA, Insurance Litigation Blog, Insurance Questions and Concepts, Statute of Limitations February 28, 2019

1. Obtain a full copy of your plan and administrative record. The full plan will not typically be a benefit summary or a print-out from a website.  It will be fairly long and many definitions and it will recite your ERISA plan terms, policies and procedures for filing a claim and handling the claim, claim denials, appeals of claim denials, etc.  The claims administrator will likely not have a copy of the full plan.  You can request a copy of the full plan from your Employer’s Human Resources department or often from the claims administrator (the insurer or third-party administrator).  You can request a copy of the administrative record from the claims administrator, which is often an insurance company such …

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USA Today Publishes Article—Why millennials should consider disability insurance

Posted in: Disability Insurance, Insurance Litigation Blog February 08, 2019

On January 29, 2019, USA Today published an article, “Why millennials should consider disability insurance,” by Robert Powell.  The article argues for the importance of purchasing disability insurance at a young age, since most insureds are left with the financial strain of not having a stable income stream after disability.  These insureds often never consider purchasing disability insurance, or think they have enough coverage.  At McKennon Law Group PC, we see the impact of the denials of our client’s benefits every day, and fight to overturn the denial decisions of insurance claims our clients expected insurance companies to pay upon becoming disabled.  As we have seen, purchasing additional private disability insurance can prove to be crucial.

The article describes how …

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Discovery Disputes in ERISA Breach of Fiduciary Duty Cases: Do the Usual Limitations Apply?

Posted in: Accidental Death or Dismemberment, Administrative Record, Disability Insurance, Discovery, ERISA, Insurance Litigation Blog, Life Insurance December 27, 2018

Discovery Disputes in ERISA Breach of Fiduciary Duty Cases: Do the Usual Limitations Apply?

The Employee Retirement Income Security Act of 1974 (“ERISA”) manages many of the benefits people receive from their employers.  These benefits include short-term and long-term disability insurance, health insurance, life insurance, accidental death and dismemberment insurance and pension plans.  When a claim under an ERISA plan is denied, the beneficiary usually must file an administrative appeal with the Claims Administrator for the benefits.  If, after filing an administrative appeal, the Claims Administrator still denies the claim, the beneficiary may sue the Claims Administrator to obtain the benefits in question.  ERISA claims differ from more traditional law suits.  A judge, not a jury, determines whether the beneficiary …

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If You Must Miss Work Two Days a Month Due to a Disabling Condition, Are You Precluded from Working in Any Occupation Under a LTD Policy?

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog, Policy Interpretation December 19, 2018

Facing a long-term disability (“LTD”) claim, ERISA plan participants under LTD policies can count on the fact that insurance companies will search for ways to escape payment of the monthly LTD benefits they promised their insureds.  These insurers often point out that insureds continue to work in their occupation between their initial diagnosis and the claim date, or that an insured’s job is sedentary and thus he or she is not precluded from performing light physical activities, or that an insured’s disabling condition is episodic and the symptoms do not render the insureds continuously disabled.  Most disability claimants have days where symptoms are better than others and therefore they cannot work continuously in any given month, missing several days of …

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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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Los Angeles Daily Journal Publishes Article on October 26, 2018 by Robert McKennon Entitled “Court says insurer can’t dodge coverage through ‘technical escape hatch’”

Posted in: Accidental Death or Dismemberment, Disability Insurance, ERISA, Insurance Litigation Blog, Legal Articles, Life Insurance, News October 29, 2018

In the October 26, 2018 issue of the Los Angeles Daily Journal, the Daily Journal published an article written by the McKennon Law Group’s Robert J. McKennon.  The article addresses a recent case by the California Court of Appeal, which held that the notice-prejudice rule precluded the denial of life insurance benefits based upon the insured’s failure to give timely notice of disability as required under a disability premium waiver provision in the life insurance policy.  Insurers often attempt to argue that a technical violation of the notice requirements voids their claim where there exists no prejudice to them.  This recent opinion helps to reinforce the notice-prejudice rule in California and helps to protect insureds.

This article is posted with …

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McKennon Law Group PC Insurance Litigation Blog Ranked as Top 50 Insurance Law Blog in the U.S.

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog, Legal Articles, News September 26, 2018

On September 21, 2018, Feedspot created a list of the Top 50 Insurance Law Blogs, News Websites and Newsletters to Follow in 2018.  McKennon Law Group PC | Insurance Litigation Blog was selected by the panelists at Feedspot as one of the Top 50 Insurance Law Blogs and was selected the 13th overall Law Blog among thousands on the internet.  Feedspot ranked the Insurance Law Blogs on the web using Google reputation and search ranking, influence and popularity on social media, quality and consistency of posts and Feedspot’s own editorial team and expert review.  The article is posted below:

This article is posted with the permission of Feedpost.  Sep. 21, 2018.

<https://blog.feedspot.com/insurance_law_blogs/>

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Insurance Company Bias in ERISA Cases: Hartford’s History of Bias and Discovery of an Insurer’s Biased Claims Administration Process

Posted in: Abuse of Discretion, Conflict of Interest, Disability Insurance, Discovery, ERISA, Health Insurance, Insurance Litigation Blog, Life Insurance September 26, 2018

The Employee Retirement Income Security Act (“ERISA”), a 1974 federal law, sets minimum standards for many employee benefit plans and serves to provide protection for individuals in these plans.  Discovery in ERISA cases is often limited because the statute’s primary goal is to provide inexpensive and expeditious resolution to employee benefit claims.  District courts are generally limited to the administrative record unless a so-called structural conflict of interest exists.  Considering that insurers make benefit determinations on life, health and disability insurance claims and profit when an adverse decision is made, this scenario creates an inherent conflict of interest whenever an insurer administers a claim.

Courts find that a conflict of interest exists where the “entity that administers the plan, such …

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McKennon Law Group PC’s Trial Victory Included in Los Angeles Daily Journal’s September 21, 2018 List of Top Verdicts & Settlements

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog, Legal Articles, News September 25, 2018

In the September 21, 2018 issue of the Los Angeles Daily Journal, the Daily Journal published a list of its top “Verdicts & Settlements,” which included the McKennon Law Group’s case of Brian Wright v. AON Hewitt Absence Management LLC, et al.  The judgment in Mr. Wright’s favor was rated as the third highest award of damages for a plaintiff for the period of time covered.  The McKennon Law Group PC represented Mr. Wright in a dispute over the payment of short-term and long-term disability benefits.  We won this ERISA case at trial and our client was awarded all of his disability insurance benefits, attorney’s fees, costs and interest.  The list includes a summary of the case and the …

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