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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Breach of Fiduciary Duty under ERISA: Making the Insurer or Plan Administrator Responsible for their actions towards a Plan’s Participants and Beneficiaries

Posted in: Accidental Death or Dismemberment, Equitable Relief, ERISA, Fiduciary Duty, Insurance Litigation Blog, Life Insurance, Waiver & Estoppel November 06, 2018

In a previous blog, we addressed the doctrines of equitable estoppel and waiver when the Employee Retirement Income Security Act of 1974 (“ERISA”) governs their insurance or pension plan.  As we explained, both doctrines provide an insured with methods of forcing an insurance company to honor its word and previous conduct.  However, insureds often have difficulty invoking the doctrines.  ERISA governs a wide variety of plans that provide life insurance, disability insurance, accidental death and dismemberment insurance and pension benefits.  Given the challenges of invoking equitable estoppel and waiver in the ERISA context, do plan participants and their beneficiaries have other ERISA specific tools to force insurers to honor their word and previous conduct?  Luckily, they do.  A lawsuit …

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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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Waiver and Estoppel in the Ninth Circuit Post Salyers v. Metropolitan Life Ins. Co.

Posted in: Equitable Relief, ERISA, Insurance Litigation Blog, Life Insurance, Waiver & Estoppel October 16, 2018

Waiver and equitable estoppel serve as some of the legal systems’ fundamental checks on the fairness of a party’s actions.  Both doctrines serve to prevent an individuals and insurers from performing actions contradictory to what they have previously guaranteed or established via their conduct.  “A waiver occurs when a party intentionally relinquishes a right or when that party’s acts are so inconsistent with an intent to enforce the right as to induce a reasonable belief that such right has been relinquished.”  Salyers v. Metro. Life Ins. Co., 871 F.3d 934, 938 (9th Cir. 2017) (internal quotations omitted).  Equitable estoppel “holds the [individual] to what it had promised and operates to place the person entitled to its benefit in the …

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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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Attending Physician’s Certifications of Disability: How Important Are They for Disability Insurance Claims Under ERISA?

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog, Social Security Administration September 14, 2018

Many employees are covered by group short-term disability insurance and/or group long-term disability insurance.  These plans provide benefits to employees who cannot return to work because of illness or injuries that prevent them from performing their work activities.  The Employee Retirement Income Security Act of 1974 (“ERISA”) governs most of these insurance plans.  Unfortunately, sometimes an insured becomes disabled and must support his claim for disability benefits.  The insured’s attending physician typically has examined the insured and determines that he cannot return to work.  The insured will want to use his physicians’ certification of disability to support his disability by submitting it to his insurer.  A common question is:  Must an insurance company accept the treating physician’s opinion regarding the …

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Do Arbitration Clauses in Employment Contracts Automatically Preclude Employees From Litigating ERISA Claims?

Posted in: Annuities, Beneficiaries, ERISA, Fiduciary Duty, Insurance Litigation Blog, Pensions, Retirement Plans August 29, 2018

Many times, employees must sign written employment contracts before beginning a new position.  These contracts generally set forth the terms of the relationship between the employer and employee.  They also establish both the rights and responsibilities of the two parties.  Employers often include an arbitration clause in their employment contract.  This means that any disputes that arise between the employer and employee must be settled through arbitration, rather than through the courts.

But what happens when an employee sues his employer not on his own behalf, but on behalf of another entity for claims that the employee cannot bring in his individual capacity?  For instance, in the context of ERISA, employees who participate in an employer-sponsored ERISA plan can bring …

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“Sole Cause” Provisions in Accidental Death and Dismemberment Policies: Are ERISA Claimants Getting a Fair Shake?

Posted in: Accidental Death or Dismemberment, ERISA, Insurance Litigation Blog, Policy Interpretation August 22, 2018

According to the Centers for Disease Control, unintentional injury is the leading cause of death among people ages 1 to 44.  For this reason, Accidental Death and Dismemberment (“AD&D”) Insurance should be an essential component of insurance coverage for most families.  As preventative care expands and baby boomers remain active, accidental deaths will likely continue to rise as the leading cause of death among individuals.  While AD&D coverage is important to protect families from unforeseen injuries and death that can have severe financial repercussions, insurance companies do not like to pay these claims as they often attempt to limit the scenarios in which an insured can recover an AD&D benefit by placing “sole cause” provisions in AD&D policies.  These provisions …

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