Employee Benefits & Executive Compensation Blog

The View from Proskauer on Developments in the World of Employee Benefits, Executive Compensation & ERISA Litigation

Category Archives: Disability Benefit Claims

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Department of Labor Finalizes 90 Day Delay on New Disability Claims Procedures

On November 24, 2017, the Department of Labor (“DOL”) released regulations finalizing a 90-day delay on the application of new claims procedures for disability claims. The Obama-era regulations providing for the new claims procedures were set to become effective for disability claims filed on or after January 1, 2018. In the absence of additional regulatory … Continue Reading

District Court Applies Texas Ban on Discretionary Clauses in Insurance Contracts

A federal district court in Louisiana upheld a Texas state law prohibiting insurers from granting themselves discretion to interpret benefit plans when deciding benefit claims. These so-called “discretionary clauses” are routinely found in plans governed by ERISA and generally result in courts deferring to the plan administrator’s decisions.  As a practical matter, the current ruling means … Continue Reading

Department of Labor Proposes 90-Day Delay of New Disability Claims Procedures

On October 10, 2017, the Department of Labor (“DOL”) released proposed regulations that would delay for 90 days the effective date of the final disability claims procedures regulations finalized on December 19, 2016. As explained in our August 1, 2017 blog entry, the new disability claims procedures added various participant protections and rights to existing … Continue Reading

Disability Claims Procedures Should be Updated for New Regulations

As open enrollment approaches for many benefit plans, employers and plans sponsors should check to make sure their claims procedures for disability claims are consistent with regulations that become effective for plan years beginning on and after January 1, 2018.  These regulations apply to ERISA-covered short-term and long-term disability plans, as well as retirement plans … Continue Reading

DOL Proposes to Bring ERISA Disability Denials in Line with the Affordable Care Act

On November 18, 2015, the Department of Labor (the “Department”) published a notice of Proposed Rulemaking at 80 Fed. Reg. 222 (the “Proposed Rule”) to amend ERISA’s claims procedures (29 C.F.R. 2560.503-1) as they apply to claims for disability benefits.  One of the purposes of the Proposed Rule is to make ERISA’s claims procedures for … Continue Reading

A Court’s Review of a Disability Benefit Claim May Hinge on the Meaning “Satisfactory to Us”

Twenty-five years ago, the U.S. Supreme Court ruled that courts should review an ERISA participant’s claim for benefits under a de novo standard of review unless the plan gives the plan fiduciary discretionary authority to determine eligibility for benefits or to construe the terms of the plan.  Since then, courts have considered what type of … Continue Reading

No New Statute of Limitations Each Time An Alleged Miscalculated Disability Benefit Is Paid

The First Circuit recently held, in line with other circuits, that the statute of limitations for a claim of underpayment of long-term disability benefits does not accrue with each monthly benefit payment made, but instead accrues at the time the underpayment is made known to the participant when he receives his first “miscalculated” benefit award. … Continue Reading

Supreme Court Affirms Enforceability of Plan Limitations Provision

Resolving a split among the Courts of Appeal, the United States Supreme Court affirmed the Second Circuit in finding enforceable a limitations provision in a long term disability ERISA plan that set forth the length of the limitations period as well as when the period commenced. The plan at issue required participants to file suit for … Continue Reading

Risk of Addiction Relapse May Entitle Plan Participants to Disability Benefits

The First Circuit recently split from the Fourth Circuit in concluding that, absent clear plan language to the contrary, the risk of relapsing into addiction can constitute a current disability under a long-term disability plan. Colby v. Union Sec. Ins. Co., Civ. A. No. 11-2270, 2013 WL 174419 (1st Cir. Jan. 17, 2013). Welfare plan … Continue Reading
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