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The Basics of an ERISA Life, Health and Disability Insurance Claim – Part Eight: Impact of Social Security Disability Insurance on an ERISA Disability Insurance Claim

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog, Social Security Administration January 28, 2020

In this several-part blog series titled The Basics of an ERISA Life, Health and Disability Insurance Claim, we discuss the basics of an ERISA life, health, accidental death and dismemberment and disability claim, from navigating a claim, to handling a claim denial and through preparing a case for litigation.  In Part Eight of this series, we discuss the impact of a finding of disability by the Social Security Administration (“SSA”) on a claim for disability benefits that was filed under an insurance policy governed by the Employee Retirement Income Security Act of 1974 (“ERISA”).

Social Security Disability Insurance (“SSDI”) is an important federal program available to many people who pay into the Social Security system.  If a person becomes …

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Withholding Doctor’s Reports Until the Date of Denial Violates an Insured’s Right to a Full and Fair Review

Posted in: Disability Insurance, ERISA, Full & Fair Review, Insurance Litigation Blog January 13, 2020

ERISA requires that an administrator provide a claimant with a “full and fair” review if a denial decision is made.  It has long been held that an administrator must provide a claimant with copies of internal medical reports it generated and relied upon when making its decision to deny a claim, but when do these internal medical reports need to be disclosed?  This question was addressed in the recent decision, Wagenstein v. Cigna Life Insurance Co., 2020 WL 68394 (9th Cir. Jan. 7, 2020) (“Wagenstein”).  The Ninth Circuit held in Wagenstein that when an administrator “has engaged in a procedural irregularity, it must provide the claimant a fair opportunity to submit additional evidence.”

Lea Wagenstein (“Ms. Wagenstein”) filed a …

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Medical Records Are the Key Ingredient to a Durable Administrative Record in ERISA Disability Insurance Cases

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog December 20, 2019

Most ERISA lawsuits proceed in Federal court. ERISA plaintiffs are not entitled to jury trials.  Instead, ERISA lawsuits are resolved in bench trials based upon the administrative record.  The facts contained in the administrative records are gathered during the claim review process and the administrative appeal before the lawsuit is filed.  An extremely important component of any administrative record are the plaintiff’s medical records.

Insurance companies that fund employer provided benefit plans have financial incentives to deny meritorious claims.  In many cases, they will retain experts to closely examine your medical records to find any basis to avoid paying you.  One argument that insurance companies like to make is that your doctor’s treatment records do not document findings that support …

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Life Insurance Policyholders Beware: California’s Statutory Lapse Safeguards Do Not Apply to Policies Issued Prior to January 1, 2013

Posted in: Bad Faith, Beneficiaries, Benefits, Insurance Litigation Blog, Life Insurance November 27, 2019

Life insurance lapse generally refers to coverage ending for insufficient or nonpayment of policy premiums. If premiums are not paid during the grace period to sustain the policy, then the life insurance ends.  The lapse of a life insurance policy at the wrong time could have disastrous consequences for persons or families because policyholders could easily lose their life insurance if a single premium is accidentally missed, even if they have been paying premiums on time for years. On January 1, 2013, California added new sections 10113.71 and 10113.72 to the Insurance Code, as a way of providing consumer safeguards against life insurance policy lapse.

California Insurance Code Sections 10113.71 and 10113.72 primarily do three things: (1) mandate that …

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Exhaustion of Remedies and the Failure to Raise an Argument on an ERISA Appeal: What Happens if an ERISA Claimant Misses a Key Factual or Legal Argument on Appeal?

Posted in: Administrative Record, Disability Insurance, ERISA, Insurance Litigation Blog November 25, 2019

Under insurance policies governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), when an insurer denies a person’s claim for life insurance benefits, short-term-disability benefits or long-term-disability benefits, the beneficiary must request that the insurance company review the denial or termination if they intend to sue the insurer to obtain their benefits.  Courts refer to this review as an “administrative appeal” and the obligation to pursue that appeal as the duty to exhaust administrative remedies.  Courts have universally concluded that they “have the authority to enforce the exhaustion requirement in suits under ERISA, and that as a matter of sound policy they should usually do so.”  Amato v. Bernard, 618 F.2d 559, 568 (9th Cir. 1980).  The …

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McKennon Law Group PC and Robert J. McKennon selected as 2019 Best Insurance Litigation Firm and Best Insurance Lawyer in California and in the United States

Posted in: News Blog November 20, 2019

McKennon Law Group PC is proud to announce that it and its Managing Shareholder Robert J. McKennon have been selected as Best Insurance Litigation Law Firm and Best Insurance Lawyer in California and in the United States for the year 2019 by the following organizations:

Leading Advisor Awards
Worldwide Financial Advisor Awards Magazine
ACQ5 Global Awards
Lawyer International Legal 100
M&A Today Global Awards
Corporate LiveWire Global Awards
Global 100
Corporate Excellence Awards
Lawyer International Legal 100…

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Los Angeles Daily Journal Publishes Article by Robert J. McKennon Entitled “Leveling the Field Between Insurers and Disability Claimants”

Posted in: News Blog November 20, 2019

In the November 19, 2019 issue of the Los Angeles Daily Journal, the Daily Journal published an article written by the McKennon Law Group PC’s Robert J. McKennon.  The article addresses a previous 2009 Daily Journal investigation that revealed insurers’ regular practice of improperly denying claims.  Since 2009, recent regulations promulgated by the Department of Labor and recent court opinions have helped even the playing field for claimants.  A full and fair review of a claim for benefits is required by statute and regulation, and helps prevent insurers from illicit claim denials as detailed in the Daily Journal investigation.  However, it remains to be seen whether these recent regulations and court decisions will ultimately have the effect of evening the …

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Los Angeles Daily Journal Publishes Article on November 19, 2019 by Robert McKennon Entitled “Leveling the Field Between Insurers and Disability Claimants”

Posted in: Disability Insurance, Disability Insurance News, ERISA, Insurance Litigation Blog, Legal Articles, News November 20, 2019

In the November 19, 2019 issue of the Los Angeles Daily Journal, the Daily Journal published an article written by the McKennon Law Group PC’s Robert J. McKennon.  The article addresses a previous 2009 Daily Journal investigation that revealed insurers’ regular practice of improperly denying claims.  Since 2009, recent regulations promulgated by the Department of Labor and recent court opinions have helped even the playing field for claimants.  A full and fair review of a claim for benefits is required by statute and regulation, and helps prevent insurers from illicit claim denials as detailed in the Daily Journal investigation.  However, it remains to be seen whether these recent regulations and court decisions will ultimately have the effect of evening the …

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The Basics of an ERISA Life, Health and Disability Insurance Claim – Part Seven: Wrongful Insurer Practices and Full and Fair Review Requirement

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog November 12, 2019

In this several-part blog series titled The Basics of an ERISA Life, Health and Disability Insurance Claim, we discuss the basics of an ERISA life, health, accidental death and dismemberment and disability claim, from navigating a claim, to handling a claim denial and through preparing a case for litigation.  In Part Seven of this series, we discuss the full and fair review required under the Employee Retirement Income Security Act (“ERISA”), in contrast with the usual practices and power imbalance insurers employ to deny claims.  Our focus in this article will be mostly on disability insurance claim denials.

Every year, millions of Americans seeking to buy a safety net for their middle-class lifestyles enroll in individual or group disability …

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The Basics of an ERISA Life, Health and Disability Insurance Claim – Part Six: Independent Medical Evaluations and Peer Reviews

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog September 26, 2019

In this several-part blog series titled The Basics of an ERISA Life, Health and Disability Insurance Claim, we discuss the basics of an ERISA life, health, accidental death and dismemberment and disability claim, from navigating a claim, to handling a claim denial and through preparing a case for litigation.  In Part Six of this series, we discuss Independent Medical Evaluations and Peer Reviews.  Our focus in this article will be mostly on disability insurance claim denials.

When an insurer examines a disability claim or appeal, it has the medical records examined by medical evaluators, typically a nurse or doctor.  In theory, this allows the insurer to determine whether the claim has merit.  In practice, it is typically a way …

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