ERISA’S ARBITRARY AND CAPRICIOUS STANDARD OF REVIEW IS NOT A RUBBER-STAMP

Under ERISA, if a court determines that a plan contains a proper grant of discretion to the decision-maker, then it reviews the decision under an arbitrary and capricious standard of review. However, while the arbitrary and capricious standard is deferential, “it is not, however, without some teeth.” McDonald v. Western-Southern Life Ins. Co., 347 F.3d 161, 172 (6th Cir. 2003). Continue reading “ERISA’S ARBITRARY AND CAPRICIOUS STANDARD OF REVIEW IS NOT A RUBBER-STAMP”

DISABILITY DEFINED AS THE INABILITY TO BE A RELIABLE EMPLOYEE BECAUSE OF A MEDICAL CONDITION

Most people think about “disability” as defining a state of affairs where an individual cannot provide an income for him or herself; that is, he or she cannot work. Indeed, in most instances, disability does mean an individual is unable to work although in the context of ERISA disability claims there are policies which pay benefits when an individual cannot perform his or her “own occupation” and others which pay benefits for “partial disability.” However, it is best to over-simplify the issue and concede that, Continue reading “DISABILITY DEFINED AS THE INABILITY TO BE A RELIABLE EMPLOYEE BECAUSE OF A MEDICAL CONDITION”

THE IMPORTANCE OF A FAVORABLE SOCIAL SECURITY DISABILITY DECISION IN LONG-TERM DISABILITY LITIGATION

As you might expect, many individuals who have long-term disability (“LTD”) ERISA claims also have claims for Social Security Disability benefits. Indeed, many insurance companies require LTD claimants to file for Social Security disability. This is done because most plans offset the LTD benefit by the Social Security disability benefit and this reduction is considered by the insurers to be one of the most important cost containment features of their LTD contracts (and is usually termed “recovery of an overpayment”).

Continue reading “THE IMPORTANCE OF A FAVORABLE SOCIAL SECURITY DISABILITY DECISION IN LONG-TERM DISABILITY LITIGATION”

UNDER CERTAIN CIRCUMSTANCES, EXHAUSTION OF ADMINISTRATIVE REMEDIES IS NOT REQUIRED IN A LONG-TERM DISABILITY ERISA MATTER

Ordinarily, a long-term disability claimant must exhaust his or her internal review before bringing a claim for judicial review under § 502(a)(1)(B). In other words, a claimant typically has to complete the appeal process as described by the long term disability policy and/or plan. However, the Sixth Circuit has “repeatedly held that exhaustion may be excused if the claimant establishes futility.f Welsh v. Wachovia Corp., 191 F. App’x 345, 356 (6th Cir. 2006) (citing, e.g., Hill v. Blue Cross & Blue Shield of Mich., Continue reading “UNDER CERTAIN CIRCUMSTANCES, EXHAUSTION OF ADMINISTRATIVE REMEDIES IS NOT REQUIRED IN A LONG-TERM DISABILITY ERISA MATTER”