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Case Summary Blog

Tash v. MetLife – Court Holds That MetLife Undermined The ERISA Process

The Court held that MetLife undermined the ERISA process by failing to issue a proper denial and, further, by failing to notify the insured about the issues in dispute. The Court ordered MetLife to pay past-due benefits, with interest, and to continue paying benefits so long as they continue to remain due under the provisions of the Plan, unless and until MetLife issues a denial that is in full compliance with the requirements contained in ERISA.

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Slaton v. Standard – Claimant’s Failure To Report Symptoms Led To Claim Denial

The Court concluded that Defendant did not act in an arbitrary and capricious manner in denying Plaintiff’s claim for long-term disability benefits. Accordingly, the Court overruled Plaintiff’s Motion for Judgment on the Administrative Record, and sustained Defendant’s Motion for Entry of Judgment on the Administrative Record.

Slaton v. Standard – Claimant’s Failure To Report Symptoms Led To Claim DenialRead More

Sapp v. AT&T – Court Rules Sedgwick’s “Improper” Decision Was Reasonably Supported

In this case, Shenita Sapp (“Sapp”) sought to recover long term disability benefits that were denied by the administrator of her plan. Sapp argued that the claims administrator, Sedgwick Claims Management Services (“Sedgwick”) was acting in an arbitrary and capricious manner when it made its decision. However, the Administrator of the Plan, AT&T Services, Inc. (“AT&T”) argued that Sapp …

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Seese v. Prudential – Court Rules ADA Lawsuit Against Prudential Must Be Dismissed

The plaintiff filed a civil action in federal court, asserting four claims under ERISA, a state law breach of contract claim, and an ADA claim. Prudential moved to dismiss the breach of contract claim, as ERISA preempts such a claim. Prudential also moved to dismiss the ADA claim because Prudential is not a proper defendant under that statute.

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Seeman v. MetLife – Vice President Wins Long-Term Disability Claim

In this case, Teresa A. Seeman (“Seeman”) was an employee of Bank of America and served as a Vice President, Unit Manager from May of 1990 to December of 2007. Through her employment, she was part of a long term disability plan that was administered by Metropolitan Life Insurance Company (“MetLife”). The plan defined “disability” as follows: By June …

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Sapp v. Liberty Life – Liberty Failed To Consider Plaintiff’s Job Description

Because Liberty failed to consider the evidence of Plaintiff’s job description in its determination of Plaintiff’s occupation, ultimately leading to their denial of Plaintiff’s claim, Liberty abused its discretion under the policy and incorrectly denied Plaintiff’s claim. In assessing the appropriate remedy for the case, the Court saw no need to remand the case back to the administrator.

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Rowe v. United of Omaha – Claimant’s Failure To Apply For Social Security Disability Should Not Be Considered

The Magistrate Judge found that the defendant’s decision to deny benefits does not withstand the arbitrary and capricious standard of review and recommended that the case be remanded for further consideration. Defendant raises four objections to the R&R. The two most interesting objections were those where the defendant objected to (1) the application of the arbitrary and capricious standard of review and (2) the determination that the plaintiff’s failure to apply for Social Security benefits is irrelevant.

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Randall v. MetLife – Doctor’s Conclusion Outweighs Subjective Complaints

Case Name: Randall v. Metropolitan Life Insurance Company Court: United States District Court for the Northern District of California Date of Decision: February 6, 2017 Type of Claims: Short-term disability, long-term disability, and related health, dental, vision, and life insurance benefits. Insurance Company: Metropolitan Life Insurance Company, aka MetLife. Claimant’s Employer: Verizon Wireless Claimant’s Occupation / Job Position: Facilities Network Engineer Disabilities: Randall …

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Kavanay v. Liberty Life – Court Rules Insurer Cannot Ignore Work Obligations During Own Occupation Period

In Kavanay v. Liberty Life Assurance Company of Boston, the plaintiff sought long-term disability benefits from Liberty Life, the insurer of his ERISA governed disability plan. The court held that Liberty abused its discretion, granted plaintiff summary judgment, and awarded disability benefits. The plaintiff worked as an insurance adjuster for Allstate; he was an “outside claims …

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Puccio v. Standard – Plaintiff Entitled To Description Of Material Needed To Perfect Claim

There is no dispute that Puccio is disabled. She has multiple medical conditions that limit her ability to work. The only dispute is whether her disabilities are covered by the LTD policy or whether she has exhausted the maximum benefits allowed under the policy for her particular conditions.

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