Ordorf v. Paul Revere Life Insurance Company, 404 F.3d 510 (1st Cir. 2005) When the Plaintiff Has the Burden To Present Proof in Support of Their Claim Plaintiff appealed the district court’s denial of benefits on de novo review of an ‘own occupation’ disability policy.  He started benefits in 1995…

FMC Corporation v. Holliday, 498 U.S. 52 (1990) The issue before the Court was whether a state law precluding subrogation (reimbursement) of health care benefits paid by health insurers of ERISA health benefit plans out of third party settlements applied to a self-insured plan.  The Court held that ERISA preempted…

Why ERISA Insurers Are Working Against You The Insurance Industry System Is Never in Your Favor Individuals who become disabled and then run into insurance company resistance to paying benefits under their group plans often feel shock and disbelief. They may ask: “Why have I been paying premiums all this time only…

Reimbursement Rights in ERISA Plans Expanding on When ERISA Plans Offset Other Benefits In “ERISA Plans Offset Other Benefits” we explained how a claimant suing for disability benefits can end up losing and then owing money back to the insurer. In that example, the plaintiff sues seeking payment of their disability benefits…

There is No Ordinary Discovery in ERISA Litigation The Upside-Down World of ERISA Disability Benefits The first thing to understand about the topsy-turvy world of ERISA disability benefits litigation is that the plaintiff has no right to take ordinary discovery after filing a complaint in federal district court. On its face, an…

ERISA Plans Offset Other Benefits When a Claimant May Unknowingly Cost Themselves More Than Anticipated Notice to Unweary Claimants ERISA plans offset other benefits, like SSDI benefits and workers’ compensation benefits, which can cause very unfortunate results for unweary claimants. An ERISA disability benefit plan is a contract, written by an insurer and chosen…

ERISA Preempts State Law Understanding Why ERISA Preempts State Law An Embarrassing Situation for a Lawyer There are very few things as embarrassing for a lawyer as being at the wrong court. This is certainly true if it is 8:50 a.m. and you are wondering why your case is not on the list at the courthouse…

Courts Typically on Review ERISA Denials for an Abuse of Discretion A Hypothetical Scenario… A potential client comes to your office and she says, “I was working for a large corporation that offered me a disability benefit plan. I have been paying for that plan for 15 years, and a few…

Submit or Die: ERISA Appeals Must Be Submitted within 180 Days The Unforgiving Nature of ERISA Appeals The Clock Starts… Now! The ERISA claims process is about as forgiving as a cement floor. A person who is denied benefits after an initial application will receive a notice of denial explaining…

ERISA and Social Security What You’ll Need To Know When It Comes to Social Security Benefits & ERISA Benefits Administrators Must Consider Most group long term disability plans require claimants to apply for social security disability benefits. In fact, administrators often offer to assist claimants by referring them to a…