In Ryan S. v. UnitedHealth Grp., Inc., No. 22-55761, __F.4th__, 2024 WL 1561668 (9th Cir. Apr. 11, 2024), Plaintiff-Appellant Ryan S. brought a putative class action against Defendant-Appellee UnitedHealth Group, Inc. and its subsidiaries alleging that the Defendants violated the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (“Parity Act”), 29 U.S.C. § 1185a, and their ERISA fiduciary duties by applying a more stringent review process for outpatient, out-of-network mental health and substance use disorder (MH/SUD) treatment than to comparable medical/su ..read more

In Rogers v. Unum Life Insurance Company of America, et al., No. 22-CV-11399-AK, 2024 WL 1466728 (D. Mass. Mar. 31, 2024), Massachusetts District Judge Angel Kelley denied both Plaintiff and Defendant Unum’s Motions for Summary Judgment, finding that the court required more information to determine whether Unum’s decision to deny Plaintiff’s long-term disability (LTD) claim was arbitrary and capricious, and directing Unum to prepare an amended final determination letter. Plaintiff first sought and Unum awarded short-term disability (STD) benefits through the 26-week maximum benefit period for ..read more

In E.L. v. Hartford Life and Accident Insurance Company, No. 22-CV-00050-PCP, 2024 WL 1336463 (N.D. Cal. Mar. 27, 2024), California Northern District Judge P. Casey Pitts granted Plaintiff’s Motion for Judgment in part finding that Plaintiff demonstrated total disability from her own occupation. The Court denied Plaintiff’s request to submit extrinsic evidence from her Social Security disability claim, finding that the circumstances did not clearly establish that additional evidence was necessary to conduct an adequate de novo review. Plaintiff was a resident of Campbell, California and employ ..read more

In Khesin v. Hartford Life & Accident Insurance Company, No. 22-1766, 2024 WL 1404576 (2d Cir. Apr. 2, 2024), Plaintiff-Appellant Daniel Khesin appealed the district court’s judgment in favor of Hartford Life & Accident Insurance Company on his claims for long-term disability (“LTD”) and life-waiver-of-premium (“LWOP”) benefits. Khesin sought LTD and LWOP benefits after his condition of neuromyelitis optica rendered him unable to work. Hartford paid Khesin two years of LTD benefits and denied benefits thereafter. Hartford never approved Khesin’s LWOP claim. Reviewing de novo Khesin’s c ..read more

In Bulk Transp. Corp. v. Teamsters Union No. 142 Pension Fund, No. 23-1563, __F.4th__, 2024 WL 1230236 (7th Cir. Mar. 22, 2024), Bulk Transport challenged the district court’s grant of summary judgment to the Teamsters Union No. 142 Pension Fund in this dispute over $2.3 million in withdrawal liability. The Fund assessed withdrawal liability after Bulk Transport stopped making pension contributions for employees whose work was not covered by the governing collective-bargaining agreement (CBA). There was a main agreement called the Construction Agreement and a Steel Mill Addendum which applied ..read more

In Whitehouse v. Unum Life Ins. Co. of Am., No. CV 22-1736 (JWB/ECW), 2024 WL 1209230 (D. Minn. Mar. 21, 2024), Minnesota District Judge Jerry W. Blackwell granted Plaintiff’s Motion for Judgment on the Administrative Record finding that Plaintiff remained partially disabled under the Unum long-term disability policy, and retroactively reinstating benefits. Plaintiff was a licensed physician employed as an addiction specialist. In March 2020, Plaintiff was working full-time at St. Joseph’s Hospital, which had been designated as a COVID-19 patient deployment center. On March 31, 2020, Plaintiff ..read more

In Cloud v. The Bert Bell/Pete Rozelle NFL Player Retirement Plan, No. 22-10710, __F.4th__, 2024 WL 1130511 (5th Cir. Mar. 15, 2024), the Fifth Circuit panel withdrew its opinion in Cloud v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, 83 F.4th 423 (5th Cir. 2023), which we wrote about here, and substituted it with a new opinion. The new opinion includes the following changes: The new opinion clarifies that when Cloud sought a higher tier of benefits in 2014 that he sought “reclassification to” totally and permanently disabled benefits (instead of “line of duty” benefits). The original ..read more

In Osborn v. The Paul Revere Life Insurance Company, No. 1:21-CV-00842-CDB, 2024 WL 1020486 (E.D. Cal. Mar. 8, 2024), a California Eastern District Magistrate Judge (assigned for all purposes) granted summary judgment to The Paul Revere Life Insurance Company, finding that Paul Revere did not breach the terms of Plaintiff’s individual disability or business overhead expenses policies when it concluded that Plaintiff was not disabled due to an illness or injury. Plaintiff was an oral and maxillofacial surgeon who opened and owned a business in Bakersfield, California. In addition to an individu ..read more

In Harmon v. Unum Life Insurance Company of America, et al., No. 23-5619, 2024 WL 1075068 (6th Cir. Mar. 12, 2024), Plaintiff-Appellant Joey Harmon appealed the district court’s judgment in favor of Unum Life Insurance Company of America in his lawsuit challenging Unum’s termination of his long-term disability benefit claim. The Sixth Circuit found that Unum’s decision to terminate Plaintiff’s LTD benefits was not arbitrary and capricious where Unum relied on its in-house file-reviewing physician, interpreted Plaintiff’s doctor’s opinion as supporting Plaintiff’s ability to work, and conducted ..read more

In Krishna v. National Union Fire Insurance Company of Pittsburgh, Pennsylvania, No. 23-20289, 2024 WL 1049474 (5th Cir. Mar. 11, 2024), the Fifth Circuit affirmed the district court’s grant of summary judgment in favor of Defendant National Union Fire Insurance Company of Pittsburgh, Pennsylvania, in this action seeking payment of Business Travel Accident (“BTA”) insurance under the Honeywell International, Inc. Benefit Plan (“Plan”). The court held that (1) the district court did not err in applying the abuse of discretion standard of review to the administrator’s decision; (2) the terms of ..read more