You already know that the Elimination Period in long term disability cases is a key focus in assessing eligibility for benefits.
This new Sixth Circuit case explains:
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ERISA – 4th Circuit: How Much Weight Do Independent Doctor Paper Reviews Get, and Should Rule 52 Bench Trials Be Used to Resolve De Novo Review Cases
By Mike Reilly
As you know, the federal circuits have varying approaches to resolving ERISA denial-of-benefit cases. Some circuits use Rule 56 summary judgment as a process to resolve these cases, while the trend has been to use Rule 52 bench trials to…
ERISA: Ninth Circuit–Why Denial Letters Must Include All Rationale to be Asserted in Litigation
By Mike Reilly
Can a district court consider new arguments justifying claim denial that were not articulated in the initial claim denial or appeal? NO. In fact this new Ninth Circuit decision indicates for the first time that it is “clear error” for…
ERISA: Ninth Circuit — Why Denial Letters Must Include All Rationale to be Asserted in Litigation
By Mike Reilly
Can a district court consider new arguments justifying claim denial that were not articulated in the initial claim denial or appeal? NO. In fact this new Ninth Circuit decision indicates for the first time that it is “clear error” for…
ERISA: 7th Circuit — Can A Claims Administrator’s Errors, Made During The Initial Claim Denial, Be “Cured” During the Administrative Appeal?
By Mike Reilly
Can the ERISA claims administrator “cure” inadequacies, made during its initial claim denial, during the appeal process? Yes.
Did a claims administrator’s recommendation, that a claimant receive a job-accommodation, constitute sufficient proof of disability? No.
This new case highlights these…
ERISA (5th Circuit)-When the District Court Must Remand the Claim Back to the Administrator
By Mike Reilly
Sometimes an ERISA-governed disability benefit claim is denied on a specific issue that precludes the need for a full development of the record on the merits of the claim. E.g., claimant was not eligible for benefits because he was not…
ERISA (8th Circuit)–Now You Know Why You Should Bring Rule 52 Motions Instead of Rule 56 Summary Judgment Motions
By Mike Reilly
What is the most efficient way to invite the district court to resolve ERISA-benefit claims?
What’s the difference between using Rule 56 motions for summary judgment, versus a Rule 52 Motion for Judgment?
This new case highlights why Rule 52…
ERISA (5th Circuit): Plan Administrators Do Not Waive Exclusions That Develop As A Result Of Court Decisions Affecting The Disability Claim
By Mike Reilly
What happens when an ERISA-governed disability claim is denied solely under the “own occupation” provision, but a reviewing district court concludes the claimant is entitled to “own” occupation benefits?
Does an insurer “waive” an evaluation of the “any occupation” provision…
ERISA – 9th Circuit: Self-Funded ERISA Plans, and Employee-Paid Supplemental Benefits: Can the Abuse of Discretion Standard Apply, Even When State Law Bans It?
By Mike Reilly
You already know that many state laws ban the “abuse of discretion” standard of review in denials of ERISA-governed long term disability benefits.
But self-funded ERISA plans may still apply the discretionary standard of review.
And “incorporating by reference” the…
ERISA: 502(a)(3) Breach of Fiduciary Duty Claim DISMISSED: Repeated Calculation Errors Do NOT Involve “Fiduciary Duties”
By Mike Reilly
We all are seeing more “breach of fiduciary duty claims” asserted in lawsuits seeking ERISA-governed benefits. As you know, ERISA allows participants, beneficiaries, and the Secretary of Labor to obtain relief against ERISA fiduciaries for breaching the fiduciary duties they…