Court Denies Insurer’s Motion to Dismiss, Finding Plan Language Did Not Clearly Require Administrative Exhaustion Prior to Filing Suit

Ordinarily, a participant or beneficiary of a plan governed by the Employee Retirement Income Security Act of 1974 (“ERISA”) must avail himself or herself of the plan’s internal review procedures before bringing a civil action in federal court for recovery of plan benefits.  This includes group ERISA plans offering long-term disability, life, health or accidental …

Read moreCourt Denies Insurer’s Motion to Dismiss, Finding Plan Language Did Not Clearly Require Administrative Exhaustion Prior to Filing Suit

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

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 …

Read moreTenth 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

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?

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 …

Read moreIf 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?

Court upholds Commissioner’s Contention: A Single Insurance Code Violation Can Constitute Bad Faith Without Evidence of a General Business Practice

Every insurance policy, including disability, life, health or accidental death policies, contains an implied covenant of good faith and fair dealing between the insurance company and the insured. This covenant requires that insurance companies refrain from acting in a way that unreasonably jeopardizes, impairs or interferes with the rights of the insured to receive the …

Read moreCourt upholds Commissioner’s Contention: A Single Insurance Code Violation Can Constitute Bad Faith Without Evidence of a General Business Practice

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

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 …

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

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

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 …

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

Exhaustion of Administrative Remedies in ERISA: The Potential Death Knell of a Disability, Life or Health Insurance Claim

The Employee Retirement Income Security Act of 1974, or ERISA, establishes protections for most employee benefits offered through employer-sponsored benefit plans. ERISA requires that the plan and claims administrators adhere to certain internal procedures, often referred to as “administrative remedies,” when determining a plan participant’s eligibility for benefits. Typically, these administrative remedies include internal appeals …

Read moreExhaustion of Administrative Remedies in ERISA: The Potential Death Knell of a Disability, Life or Health Insurance Claim

Cohorst v. Anthem: When Does Waiver Apply under ERISA?

The Employee Retirement Income Security Act of 1974, or ERISA, governs most employer-sponsored benefit plans.  ERISA establishes protections for employees in the administration of their employer-sponsored benefits, requiring that the administrator adhere to certain requirements when determining a plan participant’s eligibility for benefits.  In ERISA cases, typically the plan’s terms govern.  However, ERISA does recognize …

Read moreCohorst v. Anthem: When Does Waiver Apply under ERISA?

When the Clock is Ticking: The Interplay of the Contractual Limitations Period and the Statute of Limitations in a Disability Insurance Case

The Employee Retirement Income Security Act of 1974, otherwise known as ERISA, governs most employer-sponsored benefit plans, including short and long-term disability benefits, life benefits, accidental death and dismemberment benefits and others.  ERISA was enacted to protect employer-sponsored benefits provided to employees.  As such, ERISA requires that the plan administrator, typically the insurer or employer, …

Read moreWhen the Clock is Ticking: The Interplay of the Contractual Limitations Period and the Statute of Limitations in a Disability Insurance Case

Top 5 Issues to Keep in Mind When Litigating ERISA Claims

The McKennon Law Group PC periodically publishes articles on its California Insurance Litigation Blog and Disability Insurance News that deal with frequently asked questions in the insurance bad faith, life insurance, long-term disability insurance, annuities, accidental death insurance, ERISA and other areas of the law.  To speak to a highly skilled Los Angeles long-term disability …

Read moreTop 5 Issues to Keep in Mind When Litigating ERISA Claims

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