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.

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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.

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So Your Employee Has TRD...
Sullivan, Mike; von Heymann, Chris; Benefits Canada; v39 no5 pp 51-53 May 2015; journal article

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Abstract : Treatment resistant depression (TRD) is a major depressive disorder that does not respond well to two or more courses of antidepressant therapy. Afflicting at least half of adults with major depression, it calls for special treatment, often a third course of treatment, an alternative antidepressant or combination with a second antidepressant therapy, along with counseling, psychotherapy or lifestyle changes. To support affected workers, employers should ensure their health and short- and long-term disability coverage provides the necessary benefits, avoids contradictory limits and facilitates return to work as appropriate. Analysis of claims data can reveal TRD and gauge severity. Research by Janssen, Great-West Life and Cubic Health provides incidence data and financial and health metrics that can guide decision making on benefit plan design.

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.

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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

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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

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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

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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

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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.

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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.

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