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One by one, additional states are knocking down discretionary clauses in long term disability insurance policies. In Maryland this past week, its bill to outlaw discretionary clauses in their disability policies has passed both houses of their legislative branch. The bill will now move on to a full vote and eventually (presumably)signature by their governor. When that occurs, Maryland will join the list of an ever growing number of states who have passed laws in one form or another banning an insurance company’s use of a discretionary clause. Colorado is one such state. As reported in prior blogs and throughout our website, a discretionary clause can be the biggest hurdle to a successful recovery of a claimant’s denied long term disability benefits, if the claim is governed by the Employee Retirement Income Security Act (“ERISA”). For more on discretionary review, please click here. If you believe your long term disability insurance or life insurance claim has been wrongfully denied, feel free to contact our office at any time to learn more about your rights, the law that applies to your claim and your legal options and remedies. Our initial consultations are typically performed without charge.
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While some people have purchased a life insurance policy on their own, most individuals have coverage in the event of death under a plan established by their employer. Most employer-provided benefit plans which include life insurance, are governed by ERISA (Employee Retirement Income Security Act). While every claim for life insurance benefits should be handled carefully, the impact of the applicability of ERISA should not be taken lightly. Most people are surprised when an unfortunate death of a family member occurs and the insurance company denies (more…)
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Our disability clients are often surprised to hear that their life insurance coverage may continue in full force and effect even if they are disabled and cant work. Most individuals have coverage in the event of disability or death through benefits or policies of insurance provided by their employer. If so, such claims are likely governed by ERISA (Employee Retirement Income Security Act). Most group life insurance policies contain what is often called a “waiver of premium” provision which provides that the life insurance protection continues without having to pay a premium (more…)
The Texas Department of Insurance has adopted a new rule prohibiting discretionary clauses in disability insurance policies. Texas now joins the growing list of a number of states which have undertaken similar action. The ban applies to group life and disability policies and is similar to Colorado’s ban on discretionary clauses as found in C.R.S. § 10-3-1116. For a brief description of Colorado’s ban on discretionary clauses, see our prior blog post by clicking here. (more…)
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The disability insurance attorneys at the Law Office of Shawn E. McDermott prevailed in a recent ERISA appeal filed on behalf of their client when Life Insurance Company of North America (LINA), a subsidiary of CIGNA, wrongfully terminated his long term disability benefits.
In the claim against LINA, Mr B was originally rendered disabled by bladder cancer which had gone into remission. However, at the time of the termination of long term disability benefits, he began suffering from (more…)
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The disability insurance lawyers at the Law Office of Shawn E. McDermott prevailed in a recent ERISA appeal filed on behalf of their client when Hartford Life & Accident Insurance Company wrongfully terminated her long term disability benefits.
In the claim against Hartford Life & Accident Insurance Company Ms. H suffered from the following conditions: (more…)
A Federal Court Magistrate Judge recently ordered Qwest Disability Plan to pay Plaintiff’s attorney’s fees in an action pending in the United States District Court for the District of Colorado.
In Robin Cross v. Qwest Disability Plan, Magistrate Judge Kathleen M. Tafoya awarded attorney’s fees in favor of Plaintiff Cross whose disability benefits had been reinstated during the course of litigation. The Court ordered Defendant to pay for all but a small portion of Plaintiff Cross’s attorney time incurred on the claim. The Court determined that (more…)
As attorneys representing claimants whose disability, health or life benefits have been denied, we have grown accustomed to waging a battle over the ability to engage in discovery of information outside of the so called administrative record in cases governed by the Employee Retirement Income Security Act (“ERISA”). Generally, the law in the 10th Circuit as well as most other Circuits in this country limit a judge’s review of a denied long term disability claim to the ERISA record, a.k.a the insurance company’s claim file. We have often argued that an ERISA claimant is entitled to learn more of the insurance company’s claims handling procedures, the adequacy of those procedures and whether they were adhered to, and information concerning the potential bias of the physician reviewers hired by such insurers to review a claimant’s medical condition and ability to work.
In Murphy v. Deloitte & Touche Group Ins. Plan, 619 F.3d 1151 (10th Cir. 2010), the Tenth Circuit Court of Appeals addressed the scope of discovery permitted when there is a conflict of interest. (more…)
Magistrate Judge Kristen Mix of the U.S. District Court for the District of Colorado recently found in favor of an ERISA long-term disability claimant’s right to conduct discovery. This order can be found in Almedia v. Hartford Life and Accident Insurance Company, No. 09-cv-01556-ZLW-KLM, 2010 WL 743520 (D.Colo. March 2, 2010). In reaching the conclusion that discovery is permitted in ERISA governed LTD case, Judge Mix cited to and partially relied upon a decision in prior case handled by this office, Kohut v. Hartford Life and Accident Insurance Company.
Similar to the issues this office had pursued in the past, the Plaintiff in Almedia sought discovery concerning the scope of the conflict between Hartford Insurance and the third party independent medical reviewers and professionals it utilizes to deny claims. Plaintiff also sought information concerning potential improper incentives paid to Hartford employees who rendered claim decisions, information concerning Hartford’s claims manuals, training and claims guidelines and (more…)
The 10th Circuit Court of Appeals recently issued a decision addressing two ERISA issues: (1) what constitutes a “governmental plan;” and (2) the right to trial by jury. These issues were addressed in the case of Shirley Graham v. Hartford Life and Accident Insurance Company, 589 F.3d 1345 (10th Cir. 2009), decided December 29, 2009. This was an appeal out of the Northern District of Oklahoma.
At issue was Ms. Graham’s claim for long-term disability (LTD) income protection benefits. She was a former employee of the United States Postal Service (USPS). Unlike most LTD plans, Ms. Graham was insured under a plan established by the National Rural Letter Carriers Association (NRLCA), recognized by the USPS as the exclusive bargaining representative for rural letter carriers. The NRLCA procured the group long term disability policy from Hartford. USPS was not involved in those negotiations, nor did it sponsor the plan. Given these facts, the Court concluded that although Ms. Graham was considered a governmental employee of the USPS, the actual plan and policy at issue was obtained by an employee organization, and not the governmental employer. As a result, the plan was not a “governmental plan” and therefore not exempted from ERISA. (more…)
