Eleventh Circuit Rejects Insurer’s Attempt to Treat Early Symptoms as a “Pre-Existing Condition” in ERISA Disability Case

In Johnson v. Reliance Standard Life Insurance Co., No. 23-13443, 2025 WL _ (11th Cir. Nov. 21, 2025), the United States Court of Appeals for the Eleventh Circuit ruled in favor of an insured who was denied long-term disability benefits on the basis of her group policy’s “pre-existing” condition exclusion. The claimant was diagnosed with scleroderma, an autoimmune disorder that …

U.S. Court of Appeals for the Fifth Circuit Rules in Favor of Life Insurance Beneficiary

In a recent decision, Edwards v. Guardian Life Insurance Company of America, No. 24-60381, 2025 WL 1718263 (5th Cir. June 20, 2025), the U.S. Court of Appeals for the Fifth Circuit issued a rare ruling that favors employees and beneficiaries in group life insurance disputes. In this case, the court made clear that an insurance company cannot continue collecting premiums …

ERISA Appeals and Litigation: Understanding The Path Forward After a Denial

When a life insurance, long-term disability, or other ERISA claim is denied upon the first review, it can be tempting to want to run to the courthouse and file a lawsuit. After all, the frustrated ERISA claimant’s degree of trust in the claim review process is at an all-time low. Sure, the denial letter refers to an appeal process, but …

Fifth Circuit Ruling Out of Louisiana Shows Challenges in Long-Term Disability Fights

A recent decision by the U.S. Fifth Circuit Court of Appeals highlights just how tough it can be for people in Louisiana to hold on to their employer-sponsored long-term disability benefits. The case, Stout v. Smith International, Inc., No. 24-30571, 2025 WL 1029503 (5th Cir. Apr. 7, 2025) centers on Charles Stout, a Louisiana resident whose benefits for a heart …

Court Prioritizes Plan Participant’s Last Wishes in Life Insurance Dispute Governed by ERISA

In a recent decision, the New-Orleans based United States Court of Appeals for the Fifth Circuit affirmed a district court’s decision in an ERISA life insurance case where an insured’s formal beneficiary paperwork was incomplete but the insured’s intentions are unmistakably clear. The ruling in Morgan v. Barrera, No. 21-20497, 2025 WL 1234567 (5th Cir. Apr. 21, 2025), confirms that …

Penalties for Failure to Provide ERISA Plan Documents

Pursuant to ERISA, a federal law that governs employee insurance benefits provided by private employers, plan administrators have an obligation to provide plan documents when an employee becomes covered by an insurance plan or upon written request. If the plan administrator – usually the employer – fails to provide these documents, then the plan administrator could be liable for penalties. …

ERISA Claims for Breach of Fiduciary Duty

The Employee Retirement Income Security Act is a federal law that governs claims for benefits under most insurance plans sponsored by private employers. ERISA provides a cause of action for the denial of benefits in 29 U.S.C. § 1132(a)(1)(B). It also provides for a cause of action for breach of fiduciary duty in 29 U.S.C § 1132(a)(3).  The latter provision …

Federal Judge in Baton Rouge, Louisiana Rules for ERISA-Governed Union Pension Fund in Claim Against Individual Who Accepted Payments Not Owed to Her

In a recent decision dated May 25, 2022, Judge Brian A. Jackson of the U.S. District Court for the Middle District of Louisiana entered a default judgment in favor of Plaintiff Baton Rouge Sheet Metal Workers’ Union #21 Pension Fund in a suit against a woman who accepted pension funds not owed to her. Judge Jackson is an appointee of …

Judge Oldham Writes Concurring Decision Questioning the Fifth Circuit’s Deferential Standard of Review for ERISA Cases

Published by The Pellegrin Firm November 1, 2021

Judge Oldham argues that the Fifth Circuit has strayed from the Supreme Court’s instructions, and that law, logic, and history cannot square the legislative purposes of ERISA with the Fifth Circuit’s deferential review of benefit determinations (at least those in which the plan gives discretionary authority to the claim administrator).