This month’s Friday Five covers cases relating to a claimant’s second chance when a lawyer misses a court deadline, whether certain voluntary benefits fall within a broader ERISA plan, a court deciding that an insurer was “probably not wrong,” judicial reconsideration to mold the time period for benefits awarded, and an insurer’s duty to consider particular hazards of a claimant’s occupation.
- Claimant Granted Another Chance After Attorney Misses Filing Deadline. In a recent life insurance dispute, the court granted the insurer’s motion for judgment on the pleadings uncontested after the claimant failed to file a timely response. But, a few days after dismissing the case, the claimant asked for a second chance, which the court allowed. Apparently, the claimant’s counsel marked the incorrect response deadline on the calendar, which resulted in the missed filing. The court, in a rather colorful opinion, noted that “[m]istakes happen. That’s true in life, and it’s true in the practice of law (to the extent that’s not real life).” As such, the court refused to detriment the client for counsel’s inadvertent mistake and reopened the case to allow a decision on the merits. Fuhrer v. The Hartford Life & Accid. Ins. Co., No. 21-5040, 2022 WL 970848 (E.D. Pa. Mar. 31, 2022).
- Court Determines Separate and Voluntary AD&D Policy Falls Within Larger ERISA Plan After Initially Triggering Safe Harbor. In an accident death and dismemberment (AD&D) benefits case, the insurer denied a claim for AD&D benefits under a provision excluding coverage for death while intoxicated. The parties first sparred over a motion to dismiss state court claims related to the AD&D policy, which was a voluntary add-on benefit for employees to choose (and pay for). The court first decided, in favor of the plaintiff, that the AD&D policy fell under an ERISA safe harbor exempting benefits that are paid for solely by the employee, among other requirements. Later in the opinion, the court backtracked in favor of the insurer and decided that the AD&D policy was still part of the overall ERISA plan offered by the employer, which brought the AD&D policy back within ERISA’s governance. According to the court, because the voluntary AD&D plan was so closely related to, and integrated in, the overall employer plan, it was part of the larger benefits scheme. As such, the court determined that ERISA preempted the state court claims and granted the insurer’s motion to dismiss. Garrity v. Sun Life & Health Ins. Co., No. 20-1334, 2022 WL 972290 (N.D. Ill. Mar. 21, 2022).
- Court Decides that Insurer was “Probably Not Wrong,” Which was Enough to Win Summary Judgment. In a long-term disability benefits case, the claimant was approved and received benefits for approximately six years, when the insurer terminated benefits due to lack of support for continued disability. The insurer relied on a lack of support from treating physicians, independent medical reviews, surveillance footage and other sources to terminate the claim. Even though the plaintiff continued to receive Social Security Disability Benefits and had some support in the record, the court decided that “[t]he challenged benefits decision was probably not wrong, and it was certainly not ‘arbitrary and capricious.’” While the court did not provide an exceedingly glowing endorsement of the correctness of the insurer’s decision, it still granted summary judgment in the insurer’s favor. Boatwright v. Aetna Life Ins. Co., No. 20-2165, 2022 WL 1015785 (M.D. Fla. Apr. 4, 2022).
- Court Grants Remand to Determine Whether Benefits Should Extend to Time of Judgment. The plaintiff in a long-term disability benefits case won summary judgment in March 2022, where the court determined that she was due benefits. The court, however, did not delineate whether the insurer erred in its determination that the plaintiff was not disabled up to the time of judgment in March 2022, or whether the determination only extended through August 2020, when the administrative record closed. Despite the plaintiff’s attempts to block the remand, including various procedural challenges, the court agreed with the insurer that there was a lack of evidence to evaluate the plaintiff’s disability between the close of the administrative record and date of judgment. Therefore, the court ordered a remand for the insurer to evaluate disability during the intervening period. Chicco v. First Unum Life Ins. Co., No. 20-10593, 2022 WL 973733 (S.D.N.Y. Mar. 30, 2022).
- Insurer Must Consider Specific Occupational Duties in Deciding Disability Claim. In a recent long-term disability dispute, the plaintiff worked for a logistics company and drove large, eighteen-wheel tractor trailers containing heavy materials around the country. The plaintiff relied on strict federal regulations and company safety standards, and the inherent stressors of the job, to argue that his anxiety, which worsened after an on-the-job collision with a bus on the highway, prevented him from performing his own occupation. The court agreed with the plaintiff and found that it was irrational of the insurer to ignore the mental capacity necessary for truck drivers to safely perform their jobs, and, in particular, federal regulations that set forth the emotional requirements of a driver to handle commercial driving responsibilities. The court ultimately capped long-term disability benefits based on the 24-month mental disorder limitation in the policy. Whetstone v. United of Omaha Life Ins. Co., No. 20-3756, 2022 WL 896784 (S.D. Ohio Mar. 28, 2022).