Disability Benefits


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

Insurer Did Not Abuse Discretion in Denying Long-Term Benefits.
Benefits Magazine; v52 no5 p 55 May 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Fifth Circuit Appeals Court upheld the lower court's grant of summary judgment for the defendant in Killen v. Reliance Standard Life Insurance Company. The defendant did not extend the two years of disability benefits for the plaintiff's rotator cuff injury because she did not meet the definition of totally disabled, being unable to perform any job for which she was qualified. The plaintiff's primary physician said she was incapable of holding down a job, but her orthopedist and a rehabilitation specialist found her able to perform sedentary work. The district court found no abuse of the plan administrator's discretion in denying the claim, and the Appeals Court concurred, finding the defendant attended to the abundant evidence, provided full and fair review and had no significant conflict of interest in its decision.

Link To Full Article
Plan Participant Ineligible for Increased Disability Benefits.
Benefits Magazine; v52 no5 pp 57-58 May 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Eighth Circuit Court of Appeals upheld a lower court's finding that a disability plan administrator correctly followed plan terms in denying benefits for a plan participant. The plaintiff in Brake v. The Hutchinson Technology Incorporated Group Disability Income Insurance Plan bought disability insurance in 1988 and was diagnosed with multiple sclerosis in 2000. When the plan changed insurers in 2005, she opted for extra coverage for her preexisting condition, but the buy up blocked coverage for a disability treated within the prior 12 months. The plaintiff filed for disability benefits in 2008 but was granted only core benefits since she had been treated within the previous 12 months. The courts rejected plaintiff assertions about South Dakota and Minnesota state statutes, noted the buy up option did not change the insurer or replace the previous policy and ultimately affirmed the defendant's interpretation of the policy.

Link To Full Article
ERISA Fiduciaries Have Duty to Seek Out Readily Available Information.
Benefits Magazine; v52 no4 p 57 Apr 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : After an initial thoracic surgery the plaintiff in Harrison v. Wells Fargo Bank N.A. et al. required additional, more complicated surgery and, in the same time frame, lost her husband to death, causing severe depression. The defendant employer and health plan rejected her claim for disability benefits. Through two internal appeals, the plaintiff provided documentation from her primary care physician, surgeon and psychologist. The defendant's independent reviewing physician failed to contact the psychologist and recommended denial without supporting records. The plaintiff sued for failure to consider all relevant records and to explain what was needed to complete her claim. The Fourth Circuit Court of Appeals found the defendant violated ERISA Section 503 by falling short of a full and fair review, ignoring medical information and basing its decision on an incomplete record. The case was remanded to the district court for reconsideration.

Link To Full Article
FMLA v. ADA: The Stark Legal Differences Are in the Details.
Susser, Peter A.; Thompson's ADA Compliance Guide; v26 no4 pp 1, 6-7 Apr 2015; journal article

Availability :
Abstract : The Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA) both address serious health conditions and protected disabilities, but their protections differ in coverage scope and in applicability based on employer size. The FMLA applies to employers with 50 or more employees, requires a certain work history and protects up to 12 weeks of leave, while the ADA affects private employers with 15 or more workers and can apply at any time. The FMLA's protection can be triggered by an employee's own medical issue or that of close relatives, by a new baby or adopted child. The ADA focuses on the employee but bans discrimination stemming from a disabled relative. The ADA requires reasonable accommodations that are not an undue hardship for the employer. The FMLA has strict provisions around an employee's return to work. State rules may be tighter than the federal laws, and workers compensation, collective bargaining agreements and internal policies must be considered.

Strategies to Keep Aging Workers Young.
Brown, Susan; Benefits and Pensions Monitor; v25 no2 pp 40-42 Apr 2015; journal article

Availability :
Abstract : As the Canadian workforce ages, employers should support older workers to maintain their health, engagement and ongoing contributions to the organization. A proactive approach toward comprehensive wellness that addresses health risks and work environment issues geared to older people is needed. The program should include wellness, disease management, accommodations for disabilities, flexible work arrangements and assessment of psychosocial and multigenerational dynamics. Negative stereotypes should not confuse facts about productivity. Losing aging workers' expertise and dealing with employee turnover create significant expenses for the employer. Focusing early on preventing or minimizing the six costliest diseases by addressing risk factors and providing health screenings, affordable drugs to manage chronic disease and practical support programs contribute to older workers' ongoing productivity.

UK Workplace Update.
Beeby, Sarah; Higginbottom, Karen; Mackay, Annabel; Williams, Andy; Chalkley, Emily; International HR Journal; v24 no2 pp 24-33 Spring 2015; journal article

Availability :
Abstract : Employment law in the United Kingdom is being shaped in 2015 by elections, legal changes and court judgments. Collective redundancy consultation is key in two legal cases, rules on shared parental leave are changing, firms must be able to claw back bonuses in certain circumstances, caste discrimination will become illegal and exclusivity clauses in zero hour contracts will be banned. More than one in three U.K. workers anticipate changing jobs in 2015, signaling strong confidence in the job market while highlighting the need to focus on engagement, motivation and retention. High rates of absence due to sickness for minor illnesses demand an effective absence management policy, while legal cases reinforce the need for employers to make reasonable accommodations for chronic conditions and disability. With social media a growing and pervasive influence in business and networking, employers must consider data ownership and security issues and appropriate restrictive covenants.

Do EAPs Really Make a Difference?
Alderson, Patricia; Canadian HR Reporter; v28 no5 p 13 Mar 23, 2015; journal article

Availability :
Abstract : A study by Arete Human Services on the mental health status of Canadian workers before and three months after utilizing employee assistance program (EAP) services shows significant mental health improvements. Two-thirds of EAP users in the study reported moderate or worse depression, anxiety or stress and had performance and productivity issues. After EAP counseling the number dropped to 32 percent, and visits to public health care specialists fell. EAPs' counseling and referral services help employees cope with mental health issues and indirectly reduce short- and long-term disability costs, work conflicts and absenteeism. Statistics Canada reports that one fourth of Canadian employees feel chronic work stress, and the Mental Health Commission of Canada reports 70 percent of disability costs are tied to mental health concerns.

Cause of Action Accrues When Plan Participant Has Reason to Know of Claim's Clear Repudiation.
Benefits Magazine; v52 no3 pp 56, 58 Mar 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Eleventh Circuit Court of Appeals upheld the lower court in Witt v. Metropolitan Life Insurance Co. et al., finding the plaintiff's actions seeking to reinstate disability benefits exceeded ERISA's time limitations. Two years after being granted disability benefits for life, the plaintiff failed to provide medical records to support his status, resulting in termination of benefits. He challenged the termination 12 years later and claimed he did not receive the defendants' request for supportive information. The dispute centered on the start of the six-year limitations period, whether originating shortly after the 1997 termination of benefits or with the 2012 final decision. The court ruled that, whether the plaintiff received the original denial letter or not, nonreceipt of benefits for 12 years gave a clear signal of denial, well before the later rejection stemming from the courtesy review of the claim.

Link To Full Article
Claim for Equitable Surcharge to Remedy Breach of Fiduciary Duty Can Proceed.
Benefits Magazine; v52 no3 p 59 Mar 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The District Court for the Northern District of California permitted the plaintiff in Zisk v. Gannette Company Income Protection Plan et al. to pursue his claim seeking equitable relief after the defendant allegedly mismanaged his disability claim. The plaintiff was awarded disability benefits after cancer treatment in 2000, but the defendant terminated benefits in 2012 for failure to provide updated medical records. The plaintiff appealed, asserting the defendant had provider contact information, then delivered the information himself. The defendant did not reinstate benefits, prompting the suit. The plaintiff sought other appropriate equitable relief under ERISA Section 502(a)(3). The court supported the plaintiff, stating such relief is available to individuals and that, with the decision in Cigna v. Amara opening the possibility of an equitable surcharge and another relevant case pending, the case would not be dismissed but allowed to proceed.

Link To Full Article
Out of the Darkness.
Patton, Carol; Human Resource Executive; v29 no2 pp 46-48 Mar 2015; journal article

Availability :
Abstract : Depression is a common but overlooked condition affecting one in ten adults, according to the Centers for Disease Control and Prevention, and the top disabling condition in the U.S. and Canada. Employers see absenteeism and presenteeism cutting into productivity. Some human resource professionals are tackling the issue directly to overcome the stigma and encourage those affected to seek help. Nearly one in four of 1,000 employees surveyed in 2014 reported being diagnosed with depression at some point in their lives. Antianxiety and antidepressant drugs top lists for medication costs and disability claims soar, while employee assistance program utilization is meager. Efforts to bring depression into the open through manager training and employee education have helped raise awareness and resource development. The recognition process should include a critical look at potential contributing factors in the workplace.

The Return of Integrated Disability Management.
Rousmaniere, Peter; Risk Management; 5 pp Feb 2, 2015; journal article

Availability :
Abstract : The concept of integrated disability management emerged in the 1990s but gained little traction, due to bureaucratic siloes separating insurers and service providers and inadequate information systems. In the 2010s the idea has reemerged as total absence management. The change has been driven by mandated absence benefits, risk of litigation for noncompliance, improved technology and engaged service providers. Employers are showing significantly more interest in the approach, prompting expansion in services offered. The case of Sutter Health, a California healthcare system, illustrates the value of managing employee absence proactively and consistently through integrated disability management, using a single, master, self-service platform to handle nearly all absences. The successful transition required coordination of human resource professionals, payroll, metrics and technology.

2014 Benefits Benchmarking.
Mrkvicka, Neil; Benefits Magazine; v52 no1 pp 12-14 Jan 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The fourth annual Employee Benefits Survey by the International Foundation of Employee Benefit Plans, reflects responses from 571 organizations, almost 20 industries and small to very large firms. Two-thirds offer defined benefit pension plans and 61 percent offer defined contribution plans, primarily 401(k) plans in corporations and 457 plans for public employees. Automatic enrollment with three percent default deferral and target date investment funds have become common. Virtually all offer health care benefits, 73.1 percent through preferred provider organizations while 46.1 percent of corporations offer high-deductible health plans. Short-term disability benefits are offered by 77.9 percent and long-term benefits by 60.7 percent. Vacation is widely tied to years of service, and the average organization offers nine paid holidays annually. About two in five use paid-time-off banks. Extra and innovative benefits include on-site fitness centers, paid day off for birthdays, pets at work and subsidies for hybrid vehicles.

Link To Full Article
Court of Appeals Lacks Jurisdiction Where District Court Does Not Issue Final Order.
Benefits Magazine; v52 no1 p 50 Jan 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The plaintiff in Mead v. Reliastar Life Insurance Company sought long-term disability benefits for cervical disc disease that prevented her carrying on her own or any other occupation. When denied benefits for inability to perform her own occupation, the plaintiff filed the case. The district court remanded it to the administrator for consideration under the any occupation standard and closed the case, prompting the defendant to appeal. The defendant calculated benefits under the own occupation definition as required but denied benefits under the any occupation definition. The plaintiff was blocked from reopening the case in district court pending the appeal and sought to dismiss the appeal for lack of jurisdiction without a final district court decision. The Second Circuit Appeals Court ruled that the district court's remand order did not close the case and prevented the appeals court from assuming jurisdiction.

Link To Full Article
Other Recent Decisions.
Benefits Magazine; v52 no1 pp 62-64 Jan 2015; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : In Barrett v. Citigroup, Inc. et al. the District Court for the Southern District of New York found the defendant employer did not abuse discretion by calculating employee benefits on the basis of Social Security Administration documentation when original payroll records could not be found. Coworker corroboration of salary would not provide objective proof. In Kosloff et al. v. Smith et al. the District Court for Kansas dismissed the plaintiffs' claims of fiduciary breach and embezzlement as time barred and/or preempted by ERISA. The plaintiffs asserted the defendants failed to provide annual funding notices and improperly shifted funds to another plan. The plaintiffs stated they had no access to supportive documents until after the statute of limitations expired, but the court found no information was actively concealed. In McCandless v. Standard Insurance Company the plaintiff sought review of a second denial of disability benefits after a previous denial based on an independent medical evaluation. The defendant failed to convey the plaintiff's additional documentation for review and had the same review specialist generate both denials. The Eastern Michigan District Court found the decision making procedures to be defective and remanded the case for further consideration. In Preville v. Pepsico Hourly Employees Retirement Plan the Southern District of New York granted summary judgment for the defendant denying long-term disability benefits, finding the plaintiff did not meet the plan's requirement to file for benefits within 30 days of notification of eligibility. The Southern District of New York found In Re UBS ERISA Litigation, a stock drop case, that the plaintiff lacked standing since she did not demonstrate personal financial injury, and she was not permitted to amend her complaint.

Link To Full Article
Front-Line Managers Often Cause ADA Violations, EEOC Says.
Leave and Disability Coordination Handbook; v18 no2 pp 5, 9 Dec 2014; journal article

Availability :
Abstract : Chai Feldblum of the Equal Employment Opportunity Commission (EEOC) explained the critical role of front line managers in avoiding violations of the Americans with Disabilities Act (ADA). To lower the risk of ADA claims, managers must let employees know qualitative and quantitative measures of job performance and inform employees in a timely manner of any shortcomings, setting clear goals for improvement. A distinction must be made between essential job functions and the job-related qualification standards for a person to carry out those functions. Regular physical attendance may be a qualification standard but not a job function. Managers should recognize even if subtle or unexpressed requests for accommodation. With an employee having an obvious disability, managers can initiate the interactive process toward accommodation. Employers may request medical documentation and start a trial period of accommodation to test its effect and potential undue hardship.

Review Benefit Denial Letters.
Murtos, Alice;O'Leary, Meredith L.; Employee Benefit News; v28 no15 p 36 Dec 2014; journal article

Availability :
Abstract : A participant in an ERISA-governed disability plan applied for benefits but was issued a denial that did not specify that any request for judicial review must be initiated within three years of the denial. The plaintiff's claim, made four years after the denial, was rejected for exceeding the time limit. In Moyer v. Metropolitan Life Insurance Co. the district court found the case time-barred and ruled for the administrator. The Sixth Circuit Court of Appeals reversed, noting that ERISA Section 503-1(g)(1)(iv) requires the review procedures, applicable time limits and a statement of the right to civil action to be included with the denial letter, but that the administrator had failed to state the contractual three-year time limit. The Fourth and Fifth Circuits apply a substantial compliance test relying on the content of aggregated communications. Plan administrators should protect themselves by providing time limits and summary plan description with any denial of benefits.

Telecommuting as a Reasonable Accommodation: A Remote Possibility?
Rocco, Dean A.; Employee Relations Law Journal; v40 no3 pp 48-52 Winter 2014; journal article

Availability :
Abstract : The Americans with Disabilities Act requires employers to provide reasonable accommodations for disabled workers that would not amount to undue hardship for the employer. The Equal Employment Opportunity Commission (EEOC) has issued guidance on whether work can be performed at home, while recognizing a range of considerations such as adequate supervision, access to materials and resources and the need for face-to-face interaction. The EEOC notes that partial telecommuting may serve as an accommodation, and can be limited in time or on an as needed basis. While telecommuting can boost productivity and morale, many employers are disinclined to support it. Courts have respected their denial of telecommuting, though situations must be reviewed case by case. Employers choosing to limit telecommuting should address the issue in employee handbooks, policies and job descriptions, and ensure policies and past practices are consistent with their position.

The Social Security Disability Insurance Program.
Kilgour, John G.; Compensation and Benefits Review; v46 no4 pp 239-246 Jul-Aug 2014; journal article

Availability :
Abstract : In 1955 the Social Security Act was amended to provide benefits to fully disabled workers, with a Disability Insurance (DI) trust fund financed through a payroll tax. Amendments over the years have altered definitions and broadened eligibility, making Social Security Disability Insurance an important safety net, commonly bridging unemployment and Social Security retirement benefits. Disabled workers must have accumulated sufficient work credits and be unable to engage in substantial gainful activity. Benefits are based on covered earnings through the individual's work history. At full retirement age, coverage shifts from the DI trust fund to Social Security. At the existing rate of funding and usage, the trust fund will run dry in 2016. A proposed shift of money from the Old Age and Survivors Insurance to the DI trust would postpone depletion until 2033, but delaying action will make any solutions more complex and costly.

7 Questions Toward More Effective Workers' Comp Programs.
Skrocki, Ron; Benefits Magazine; v51 no11 pp 48-52 Nov 2014; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : A workers compensation program works most effectively for both employers and employees if certain critical issues are considered. The program can be customized to reflect the organization's commitment to accident prevention, wellness and return to work goals. An ergonomic evaluation can help uncover causes of injuries, and a qualified nurse case manager can serve as liaison between patient and employer. A medication safety program can help circumvent opioid abuse and balance drug utilization with price. Catastrophic claims are rare but costly and require early intervention and medical management. Employers should be alert to possible effects of the Affordable Care Act, such as claims shifting from group health plans to workers compensation. Data from the workers comp program should be integrated with other claims data and analyzed as a whole to drive improvements across the program.

Link To Full Article
EEOC Adopts Controversial Positions in Recently Issued Enforcement Guidance on Pregnancy and Related Issues.
Ennis, Peter J.; Employee Benefit Plan Review; v69 no5 pp 5-7 Nov 2014; journal article

Availability :
Abstract : The Equal Employment Opportunity Commission (EEOC) put out guidance based on a broad view of the Pregnancy Discrimination Act regarding accommodations for employees who are pregnant, have been pregnant or hope to become pregnant. The guidance addresses discrimination and decisions based on assumptions about an employee. The EEOC discusses accommodations such as leaves of absence and light duty, a matter to be resolved by the Supreme Court in Young v. United Parcel Service, Inc. It also addresses health insurance coverage of pregnancy and related conditions as well as contraceptive coverage, parental leave, and pregnancy-related conditions under the Americans with Disabilities Act Amendments Act (ADAAA). The EEOC allows exceptions to eligibility rules in leave policies for pregnant women. The agency recommends that pregnant women be treated like others with a medical condition but that circumstances be considered under the ADAAA, Family and Medical Leave Act and other federal and state laws.

EEOC Targets Wellness Incentives.
Dunning, Matt; Business Insurance; v48 no21 pp 1, 41 Oct 13, 2014; journal article

Availability :
Abstract : Lawsuits brought by the Equal Employment Opportunity Commission (EEOC) against two firms demonstrate the agency's requirement of strict compliance with the Americans with Disabilities Act (ADA) in connection with wellness programs. Flambeau Inc. and Orion Energy Systems Inc. penalized employees who did not complete health risk assessments and biometric screenings, in violation of the Affordable Care Act's (ACA) requirement that wellness program participation be voluntary. The two lawsuits contradict the Eleventh Circuit Appeals Court's ruling that allowed Broward County, Florida, to penalize employees who did not complete a health risk assessment. Some efforts to promote employee wellness are backfiring and creating uncertainty and tension between the ADA and ACA, and the EEOC has not produced formal nondiscrimination guidance as of late 2014. Many of the chronic diseases that wellness programs target qualify as disabilities under the ADA, blocking employers from applying standard incentives and conditions to those individuals and requiring reasonable accommodations to get a reward.

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

Availability :
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

Availability :
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.

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

Availability :
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.