U.S. Court of Appeals for the Fifth Circuit Ruling on LTD Calculation Challenge Time Limits

In the recent case of Faciane v. Sun Life Assurance Co. of Canada, No. 18-30918, __F.3d__, 2019 WL 3334654 (5th Cir. July 25, 2019), the New Orleans-based U.S. Court of Appeals for the Fifth Circuit followed other federal courts of appeal and several district courts within the Fifth Circuit in finding that the time limit for challenging an ERISA LTD administrator’s benefit calculations in court begins upon notice of the benefit calculation.

Are There Time Limits for Challenging the Insurance Company’s Long-Term Disability Benefit Calculations?

It seems unfair that an insurance company can underpay a claim and then hide behind time limit defenses when challenged in court. After all, it would seem that the company causes harm to the long-term disability claimant each time it underpays a monthly benefit amount. However, some courts have held that the claimant must challenge the benefit calculation within a …

New Orleans-Based Fifth Circuit Court of Appeals Finds for Insured in Dispute Over Application of Pre-Existing Condition Exclusion in Long-Term Disability Policy

In a brief per curiam decision dated June 11, 2019, and not designated for publication, a panel of the U.S. Court of Appeals for the Fifth Circuit affirmed a decision of the U.S. District Court for the Southern District of Mississippi rejecting United of Omaha Life Insurance Company’s application of a pre-existing condition exclusion to the claim for long-term disability …

U.S. District Court for Eastern District of Louisiana Ruling Shows Importance of Filing for Long-Term Disability at the Same Time You Are Appealing a Short-Term Disability Denial

In a recent case, Civil Action No. 19-1939, a ruling by Judge Feldman of the United States District Court for the Eastern District of Louisiana in New Orleans showed the importance of filing for long-term disability while appealing a short-term disability denial. In this case, the plaintiff filed for short-term disability with the defendant, was denied, and filed suit; however, …

The Importance of Requesting Short-Term Disability (STD) and Long-Term Disability (LTD) Claim Files in Writing Before Appealing an Adverse Determination

Pursuant to Section 104(b) of ERISA and 29 C.F.R. §2560.503-1(h)(2)(iii), a long-term and/or short-term disability insurance company whose policy is governed by ERISA must provide the complete administrative claim file free of charge upon written request. This is important because it gives insight into the reasons the insurance company used to deny the claim and/or terminate disability payments. When a …

New ERISA Regulations Affecting Long-Term Disability (LTD) Claims

From time to time, the Department of Labor promulgates regulations under ERISA (The Employee Retirement Income Security Act of 1974) that affect the review of long-term and short-term disability claims. One such regulation recently went into effect. It allows claimants in disability insurance appeals to reply to evidence as the insurance company obtains it. This allows claimants and their attorneys …