Disability Benefits


These executive summaries were compiled from EMPLOYEE BENEFITS INFOSOURCE database, a source for information on employee benefits and human resources.

The Next Chapter for Return to Work.
Kuehner-Hebert, Katie; Risk & Insurance; v25 no7 pp 42-43 Sep 1, 2014; journal article

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Abstract : The improving economy and requirements of the Americans with Disabilities Act Amendments Act (ADAAA) are stimulating a resurgence in return to work programs, often geared toward reasonable accommodations for obese workers classified as disabled under the ADAAA. But a conflict exists between the ADAAA and workers compensation. Workers comp incentivizes employers to get workers back on temporary light duty, while an employee disabled by a nonwork condition may need long-term light duty as a reasonable accommodation. Employers should consider limiting light duty assignments to a specific time period and evaluate accommodation options on a case-by-case basis. In some cases nonoccupational accommodations, such as transitional placement in volunteer positions, may be useful. Inconsistent treatment of work-related and non-work-related injuries and conditions may open them to litigation.

Varied Response to EEOC's New Pregnancy Guidance.
Employee Benefit News; v28 no11 pp 10-11 Sep 1, 2014; journal article

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Abstract : Updated enforcement guidelines from the Equal Employment Opportunity Commission (EEOC) blend aspects of the Pregnancy Discrimination Act of 1978 and the Americans with Disabilities Act regarding pregnant employees. President Barack Obama has recognized the prevalence of women in the workforce and stressed the need to accommodate pregnant workers. The EEOC has prioritized eliminating pregnancy-related discrimination. The guidance clarifies that the EEOC does not permit an employer to distinguish those with work-related injuries from those limited by a nonwork related condition when considering accommodations, protecting pregnant workers.

Supporting Employee Success When Mental Health Is a Factor.
Baynton, Mary Ann; Plans & Trusts; v32 no5 pp 6-11 Sep-Oct 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : According to the Mental Health Commission of Canada, as many as 500,000 Canadians will not go to work in any given week because of mental illness. The unseen nature of mental healing may mean that employers do not know how to accommodate a worker returning from a mental health issue. Support should begin as soon as an employee takes mental health leave, with employers making regular contact with the employee. Employees' issues often can be addressed by reducing or eliminating one or two key stressors in the workplace. Increasing an employee's involvement in the most comfortable elements of the job can also help. A group of top Canadian occupational health and safety professionals have created Supporting Employee Success, a free online tool to help managers create back-to-work programs for employees with mental health issues.

Benefits Integration Picks up Steam.
Goldberg, Stephanie; Business Insurance; v48 no18 pp 13-14 Aug 18, 2014; journal article

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Abstract : While the financial benefits of integrating short and long term disability, workers compensation leave, family and medical leave and other absences are well recognized, the demand for compliance is adding impetus to the drive toward integration. The Family and Medical Leave Act, Americans with Disabilities Act and the Rehabilitation Act, as well as state laws and company policies impose complex and intertwined rules, prompting many employers to outsource leave management. Aon Hewitt reports that 36 percent of employers tie worker absence to corporate financial status and 22 percent connect health and absence management with workers comp in 2014, though over half may start by 2019. Though compliance and penalty concerns may spur integration, managing absence holistically through a total absence management program yields substantial opportunities for human resource management.

Court Affirms Denial of Benefits and Awards Attorney Fees.
Benefits Magazine; v51 no8 p 53 Aug 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The employee plaintiff in Spenrath v. Guardian Life Insurance Co. of America had seizurelike episodes that were not definitively diagnosed by her primary physician and two neurologists. She failed to undergo additional recommended testing. Inability to focus and poor performance reviews led her to stop work three years later and seek long-term disability benefits. The defendant plan administrator denied the claim, lacking medical evidence of any condition causing the functional impairment. The district court found the administrator properly considered all evidence provided and granted attorney fees for the defendant. The Fifth Circuit Appeals Court found no substantial evidence of disability, upheld the lower court, affirmed the attorney fee award and granted the defendant an additional $6,000 for attorney fees for the prolonged litigation of the plaintiff's weak case.

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Court Upholds Disability Plan's Discretion and Full and Fair Review Process.
Benefits Magazine; v51 no8 p 57 Aug 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The plaintiff in Prezioso v. Prudential Insurance Company of America was injured at work and fired the next day for failing to meet sales targets. He applied for but was denied short- and long-term disability benefits. The plan administrator stated the injury did not prevent the plaintiff from performing his job during the plan elimination period. The district court granted summary judgment for the defendant. The plaintiff appealed contending the court wrongly used the abuse of discretion standard of review since the plan language did not specify discretion for the defendant. The Eighth Circuit Appeals Court disagreed, finding wording regarding proof of disability satisfactory to the plan to clearly indicate discretion.

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Employers, Employees Increasingly at Odds Over Wellness Incentives.
Employer's Guide to Fringe Benefit Rules; v21 no2 pp 7-8 Aug 2014; journal article

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Abstract : A Kaiser Family Foundation survey found 76 percent of general public respondents support wellness programs, but 62 percent oppose mandatory employee participation, with similar results found among adults with employer-sponsored health insurance. Women are more likely to participate at 73 percent compared to 54 percent of men. The Society for Human Resource Management shows shifts in prevalence of wellness programs to contain long-term health care costs, used by 36 percent of respondents in 2014, 43 percent in 2013 and 28 percent in 2012. Incentives were most widely used for getting yearly health risk assessments, refraining from tobacco use and wellness program participation. Aon Hewitt reports one in five employers use tiered incentives, richer for those carrying out specific wellness activities and basic for others.

Worksite Education Key to Voluntary Disability Plan Success.
Lundquist, Barry; Broker World; v34 no8 pp 28-30, 32 Aug 2014; journal article

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Abstract : Health care reform has contributed to unprecedented change in the employee health benefit and disability insurance industries, for better or worse. Slightly more employers offered long term disability plans in 2013 than previously, but fewer employees took up the offer, according to the Council for Disability Awareness (CDA). The CDA's 2014 report also showed the average age of new disability claimants to be rising, though 41 percent of those approved were in their 40s or younger, women claim more but men are catching up, and the number of new claimants fell in 2013 but the payments increased. Most employees and brokers mistakenly see disability rising from accidents, failing to realize how often common disorders and illnesses interrupt the ability to work. These facts point to the need for stronger education on disability preparedness and rising opportunities for voluntary product sales.

Court Affirms VEBA's Denial of Disability Benefits.
Benefits Magazine; v51 no7 p 60 Jul 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Second Circuit Appeals Court ruled in St. Onge v. Unum Life Insurance Company of America that the defendant's benefit denial did not amount to abuse of discretion. The voluntary employee benefits association (VEBA) plan administrator found the plaintiff not disabled and denied disability benefits. The plaintiff asserted the defendant ignored evidence and misconstrued the record, applied the wrong criteria to assess the demands of the job and had a conflict of interest. The administrator consulted independent physicians, arranged a functional capacity exam and reviewed the plaintiff's physician's opinion. The Appeals Court found the medical review sufficient, the job task analysis unpersuasive and any conflict of interest to be absent, upholding summary judgment for the defendant.

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Court Awards Attorney Fees to Successful Plaintiff in Claim for Disability Benefits.
Benefits Magazine; v51 no7 p 62 Jul 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : After an employee suffered debilitating anxiety and depression following heart surgery, he applied for but was denied long-term benefits, despite his psychiatrist's recommendation. In Donachie v. Liberty Life Assurance Company of Boston the district court granted summary judgment for the plaintiff but denied the requested attorney fees. The Second Circuit Court of Appeals ruled the defendant's denial of disability benefits was arbitrary and capricious for ignoring substantial medical evidence. Considering the issue of attorney fees, the court noted fees should be granted to a prevailing party unless there is particular justification for not doing so. Finding no such justification, the appeals court vacated that portion of the lower court's decision and remanded the case to determine reasonable attorney fees for the plaintiff.

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