Archive for the ‘2nd’ Category

In MacLeod v. Proctor & Gamble Disability Benefit Plan, 460 F. Supp. 2d 340 (D. Conn. 2006) the administrator denied the participant’s application for benefits on the grounds that the claimed disability resulted from the participant’s prior military service and therefore was excluded from coverage. At oral argument, the administrator admitted that its decision was based on the “categorical military exclusion” and did not entail an individualized consideration of the particular facts of the application. The plan at issue, however, specifically provided that in the event of an “illness, accident or injury occurs while the Participant is working for pay for some person or organization other than the Company, payment of benefits under the Plan shall be made only at the discretion of the [administrator] after their review of the facts of the case.” Although the court did not find that the administrator’s conclusion that the participant’s disability occurred during his time in the military was arbitrary and capricious, it concluded that the manner in which the administrator evaluated the claim was an unreasonable interpretation of the plan language and remanded the matter.

from The Advocate Staff of The Connecticut Post
Updated: 03/07/2009 08:09:09 AM EST

It’s rare for the U.S. Supreme Court to opine on retirement plan beneficiary designations, so when it does, it’s newsworthy. A few weeks ago, the court decided a case, Kennedy v. DuPont Savings and Investment Plan, that involved whether a form as benign as a beneficiary designation overpowers a divorce decree. Read more

Champion v. Black & Decker Inc., 2008 WL 5377692 (4th Cir. 2008)

McCauley v. First Unum Life Ins. Co., 2008 WL 5377680 (2nd Cir. 2008) Read more

McCauley v. First Unum Life Ins. Co., 2008 U.S. App. LEXIS 26094 (2nd Cir.) (December 24, 2008) is an important post MetLife v. Glenn decision in the Second Circuit. The Court found First Unum’s past history as being a factor in evaluating a conflict of interest.

The Court mentioned the fact that First Unum had a history of biased claims administration and how First Unum has a disturbing pattern of erroneous and arbitrary benefits denials, bad faith contract misinterpretations, and other unscrupulous tactics.  The court listed more than thirty cases in which First Unum’s denials were found to be unlawful, including one decision in which First Unum’s behavior was “culpably abusive. Read more

U.S. District court Judge Harold Baer has ruled that Allianz S.E. is primarily entitled to recoveries from third parties found liable for damages from the Sept.11, 2001 terrorist attacks.  World Trade Center leaseholder Silverstein Properties Inc. challenged the ruling claiming that the $433 million settlement of the $3.55 billion property limit from Allianz S.E. last year was insufficient.  Read more

The fact that an individual had medical treatment for a condition before an accident and subsequently suffered an injury that required additional treatment should not defeat a plan’s right to reimbursement for benefits paid on account of the treatment resulting from the accident. A U.S. District Court reached that conclusion in Schaffer v. Mancini, 2007 WL 2725569 (N.D. N.Y., Sept. 13, 2007). Read more