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October 2017 Archives

Aetna is Ordered to Provide Discovery Pertaining to All the Facts Available to It at the Time it Denied Disability Benefits, Regarding its Financial Conflict of Interest, and Its Claims Representative's Communications with Aetna's In-House Counsel

In a recent case out of the Southern District of Florida, Johnston v. Aetna Life Ins. Co., No. 1720996 2017 WL 4654431 (S.D. Fla. Oct. 16, 2017), the court rejected Aetna's argument that discovery was not permitted, beyond the administrative record assembled and proffered by an insurer carrier in claims governed by the Employee Retirement Income Security Act of 1974 ("ERISA"). The case involved a disability insurance claim filed by Dr. Roy Neil Johnson under his ERISA governed Aetna policy.

Aetna is Ordered to Provide Discovery Pertaining to All the Facts Available to It at the Time it Denied Disability Benefits, Regarding its Financial Conflict of Interest, and Its Claims Representative's Communications with Aetna's In-House Counsel

In a recent case out of the Southern District of Florida, Johnston v. Aetna Life Ins. Co., No. 1720996 2017 WL 4654431 (S.D. Fla. Oct. 16, 2017), the court rejected Aetna's argument that discovery was not permitted, beyond the administrative record assembled and proffered by an insurer carrier in claims governed by the Employee Retirement Income Security Act of 1974 ("ERISA"). The case involved a disability insurance claim filed by Dr. Roy Neil Johnson under his ERISA governed Aetna policy.

DI Law Group Successfully Halts Liberty Mutual's Attempt to Terminate Disability Benefits with an IME

Ms. "Jones" contacted DI Law Group after being advised by her representative at Liberty Mutual that her claim was being reviewed under the "any occupation" definition of her Long Term Disability Policy. At the time Ms. Jones became disabled she was a full time Registered Nurse whose primary duties involved the hands-on medical care of her patients. As the result of Fibromyalgia and Chronic Pain Syndrome, Ms. Jones was forced to stop working in 2015 and applied for disability benefits under her employer's Long Term Disability Policy provided to her as a benefit of her employment with the hospital. After a lengthy claim review and several strong statements of support from her physician, Ms. Jones claim for LTD benefits was approved. Specifically, it was determined that as the result of her chronic pain she was unable to perform the duties of her occupation, an RN.

The Southern District of Florida Finds that the PNC Plan Fails to Properly Delegate Discretion to Liberty Life Assurance Company and Finds that the Plan's Denial of Benefits to a Branch Manager Disabled by Degenerative Disc Disease Was Wrong

In a recent case out of the Southern District of Florida, the district court held that while the PNC Plan provided PNC with discretion to determine questions of coverage and eligibility for benefits, there was not a proper grant of discretion to the third-party administrator who actually made the claim decision, The Liberty Life Assurance Company ("Liberty Life"). The court explained that although the Plan permitted PNC to delegate its discretion to another party, the Plan did not contain a clear and unambiguous grant of discretion to Liberty Life. The court rejected PNC's argument that it properly granted Liberty Life discretion in a separate, Administrative Services Agreement ("ASA"), explaining that the ASA was not a plan document and the discretionary language in the ASA was not appropriate to cloak Liberty Life's decisions with full discretionary authority. Accordingly, the court determined that the de novo standard of review applied, rather than the more stringent, arbitrary and capricious standard of review. The court also determined that the denial of disability insurance benefits was de novo wrong and must be overturned.

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