Tag Archives: Seventh Circuit

It May Be Time to Start Thinking About Equitable Claims Again

A recent decision by the Eighth  Circuit Court of Appeals, Jones v. Aetna Life Ins. Co., No. 16-1714, 2017 U.S. App. LEXIS 8112 (8th Cir. May 8, 2017), provides another signal that those of us defending against benefit claims increasingly may have to contend with simultaneous equitable claims for breach of fiduciary duty. Though the law … Continue Reading

Disability Plan Administrator Can Reasonably Change its Mind About Sufficiency of Evidence

In Geiger v. Aetna Life Ins. Co., 845 F.3d 357 (7th Cir. 2017), Aetna initially determined that plaintiff qualified for disability benefits due to bilateral avascular necrosis in her ankles, which prevented walking and driving. When the definition of disability was about to change, Aetna conducted an Independent Medical Exam, which found her capable of … Continue Reading

ERISA governs plans established by church-related organizations

It is well-established that ERISA contains what is commonly referred to as a “church-plan exemption” which provides that plans established by churches are not required to abide by ERISA’s many rules and regulations. For many years, a number of courts have held that this exemption also applied to plans that were established by organizations that … Continue Reading

Preferred provider agreements do not support ERISA claim

In Penn. Chiro. Assoc. v. Independence Hosp. Indem. Plan, Inc., — F.3d –, 2015 WL 5853690 (7th Cir., Oct. 1, 2015), two chiropractors who had signed preferred provider agreements with an insurer claimed that the insurer violated ERISA in determining payments to them. In particular, plaintiffs claimed that the insurer had improperly recouped overpayments without … Continue Reading

Failure to Understand Exhaustion Requirement Does Not Excuse Compliance

Orr v. Assurant Employee Benefits, 786 F.3d 596 (7th Cir. 2015), concerned the failure to exhaust administrative remedies following the denial of a claim for AD&D benefits. The plan in question required two administrative appeals; the administrator advised plaintiffs of these two appeals, and specifically stated that the failure to complete both reviews could result … Continue Reading

Second Circuit Evaluates Split in Circuits, and Rules That Order Remanding Claim to Administrator Is Generally Not Appealable

In Mead v. Reliastar Life Ins. Co., — F.3d –,  2014 WL 4548868 (2d Cir. Sept. 16, 2014), the district court determined that Reliastar’s decision on plaintiff’s disability claim was arbitrary and capricious, and remanded the matter to Reliastar to calculate the benefits owed for plaintiff’s own-occupation disability, and to determine whether she was disabled … Continue Reading

Effect of Requiring “Satisfactory” Proof Is A Popular Issue in the Circuits This Year

Every so often a bit of legal synchronicity seems to occur. Sometimes its personal, like when you have several cases with the same uncommon issue, or multiple cases in the same rarely visited court. In 2013, there appears to be a larger force at work that has caused three circuits to address the question whether … Continue Reading

Presumption that Plan Administrator Acted Prudently Does Not Apply in Stock-Drop Case

ERISA requires fiduciaries to follow a prudent person standard regarding investment decisions. For plans requiring investment in the employer’s stock, often called Employee Stock Ownership Plans, or ESOPs, courts have developed a presumption that the investment in employer stock is prudent. A recent 9th Circuit case has addressed the limits of that presumption. Harris v. … Continue Reading

Revenue Sharing in 401(k) Plans is OK, According to the Seventh Circuit

Revenue sharing is an arrangement under which a mutual fund in which pension assets are invested pays a portion of its fees to the entity that services the pension plan. In Leimkuehler v. American United Life Ins. Co., 713 F.3d 905 (7th Cir. 2013), the Seventh Circuit held that the arrangement did not violate ERISA … Continue Reading

Examining the Treating Physician

Often the most common divide between a participant claiming disability benefits and the claim administrator evaluating the claim is the weight to be given the opinion of a treating physician. Time was that a claimant argued that the administrator must defer to the treating physician, like the Social Security Administration does. That argument, at least … Continue Reading

Failure to Exhaust Administrative Remedies Not Excused Even When Termination Notice Is Defective

In Schorsch v. Reliance Standard Life Ins. Co., — F.3d — ,  2012 WL 3667977 (7th Cir. Aug. 28, 2012), the court “considered here whether the content of a termination notice, specifically the absence of particular information, caused the beneficiary’s failure to exhaust and whether [he is]  estopped from taking advantage of that failure.” The … Continue Reading

Statute of Limitations Can Start Running Before Claim Accrues

ERISA claim practitioners generally have the concept of exhaustion of administrative remedies engrained in our thought process. They know well that claimants are required to exhaust their administrative remedies before they can sue over a benefit determination. Given the focus on this exhaustion requirement, it may surprise some to know that, in many circuits, the … Continue Reading

Seventh Circuit Holds that Claim Administrator Has Inherent Power to Delegate Discretionary Authority, Unless Plan Prohibits It

In Aschermann v. Aetna Life Ins. Co., — F.3d. –, 2012 WL 3090291 (7th Cir. Jul. 31, 2012), the Seventh Circuit gave a clear ruling that an ERISA claim administrator can delegate its discretionary authority to a substitute, as long as the plan does not expressly prohibit delegation. The plan at issue was funded by … Continue Reading

Looking in on Surveillance

The Seventh Circuit has recently considered whether surveillance evidence can be relied upon in deciding ERISA-governed disability claims. Marantz v. Permanente Med. Group, Inc. Long Term Disability Plan, 2012 WL 2764792 (7th Cir. July 10, 2012), involved a de novo review of the claim determination. The claimant was a pulmonologist who developed back pain. After … Continue Reading
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