Exhausting Administrative Remedies Disability

The decision reached in the United States District Court, Eastern District of Arkansas on July 27, 2010 highlights how important it is to exhaust the entire appeals process available when long-term disability benefits have been denied or terminated. Unless a claimants goes through the entire appeals process with the disability insurance company, the Court will honor any motion made by the disability insurance company to not hear the case.

These two pieces of information would contribute to the proof, under the arbitrary and capricious standard of review, that Unum had taken its time to do a thorough investigation into Blackwell's claim. Unum had reviewed the initial claim, and when it failed to supply all the information needed, the claims handler had requested the necessary medical records from Blackwell's healthcare providers. Only then was an in-house clinical review ordered.ed.


If ERISA were human, she'd be an ex-girlfriend of death. In fact, the Employee Retirement Income Security Act and the cases interpreting it introduce a dust storm of arcane legal doctrine and ambiguity to the question of what liens must be paid back. Legal questions dot the fur like fleas on your pet. Which health plans and disability plans are promulgated pursuant to ERISA? Which of those ERISA plans are self-funded and thus entitled to federal preemption of state anti-subrogation statutes? Does the request for reimbursement meet the requirements of equitable restitution or is it merely a claim for money damages? What is the lawyer's obligation under rules of ethics?

Adequate communication with your treating physician can be the difference between a disability insurance claim that is accepted and one that is denied. It's important for doctors to speak with an attorney experienced in disability insurance matters in order to formulate the best plan for giving the correct information to the physician and enlisting the physician's cooperation in documenting the facts.

However, courts have extensively broadened the parameters of ERISA to include even individual policies if insurance premiums are paid by the business. Although courts have not been entirely consistent, there are rulings holding that disability claims brought by business partners or even sole shareholder organizations purchasing individual insurance coverage for the owner of the business are covered by ERISA. Thus, it is critical for professionals to determine at the time they apply for an insurance policy whether they are more interested in tax savings (by purchasing benefits through the business) or in significantly expanded coverage (by making sure the policy is not covered by ERISA).

Though incredibly vast and complex, the determination of whether or not a plan falls under ERISA boils down to a few simple tests; however, application of these tests proves to be less than simple. Courts have used different standards and definitions when interpreting the governing regulations, and the use of these contrary definitions has caused confusion among the courts and created a pool of law that often has completely opposite holdings on similar fact patterns. The only surefire way to avoid ERISA applying to a professional's disability insurance policy is to purchase the policy individually, not through the business. However, if a professional is unsure about whether or not his or her policy is ERISA-governed or needs help trying to avoid ERISA, the best course of action is consult an attorney.

A precedent established regarding Section 28 U.S.C. 1961 states that post judgment interest is calculated at the interest which equals the weekly average 1-year constant maturity Treasury yield. "The Court uses the rate published by the Board of Governors of the Federal Reserve System during the calendar week that proceeds the date of the judgment."

As a general rule, funds in plans which are exempt from income taxes are also protected in bankruptcy cases. These instances fall under the tax code of the United States Code in sections 401, 408 A, 414, 457, and 501 (a). This includes 401(k)s, 403(b)s, IRAs, Roth IRAs, government retirement plans, and tax-exempt organization plans.

Under California law, the System One option provides for a homestead exemption of up to $50,000 for a single person who is not disabled, up to $75,000 for families, and up to $125,000 for those who are senior citizens. System One also allows for the following personal property exemptions: cash in the bank up to $2,000; building materials of up to $2,000; jewelry and heirlooms up to a value of $5,000; motor vehicles up to a value of $1,900; burial plots; appliances; home furnishings; personal clothing; health related aids; food; and any money that comes from personal injury or wrongful death claims.

ERISA Reporting and Disclosure Requirements. Visit somekeyword. Making ERISA and DOL Appeals Easier and More Cost Effective. Visit somekeyword.

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