The Standard Insurance Company Loses Court Battle To Enforce Discretionary Clauses In Long-Term Disability Insurance Policies

Once again the Ninth Circuit U.S. Court of Appeals has upheld a state’s rights to protect employees that have long-term disability insurance policies issued by their employers. In an opinion filed on October 27, 2009, three circuit judges on the ninth circuit reached a unanimous decision that a state’s practice of disapproving insurance policies that contain clauses that vest insurers with discretion in how they process long-term disability claims and who they issue these claims to is legal and does not conflict with Federal law. The court agreed that a discretionary clause in a long-term disability plans is not valid. This is a major victory for disability claimants; however this ruling is only binding in the following states: Washington, Oregon, Montana, California, Arizona, Idaho and Nevada.

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Court Rules That An Undiagnosed Pre-Existing Condition Will Not Result In Denial Of Long-Term Disability Benefits

On November 4, 2009, a ruling was handed down in the Sixth Circuit Court of Appeals that will surely have insurance companies looking at how they define ”pre-existing condition”. Ruth Mitzel is certainly happy that the court affirmed the lower court’s decision that Anthem Life Insurance Company, her employer and insurer, had wrongfully denied her long-term life insurance benefits.

When Mitzel was diagnosed on June 18, 2004 with Wegener’s granulomatosis (WG), an auto-immune disease that is life-threatening. Her diagnosis came just five days after she qualified for her employer’s long-term disability plan. She continued working until her condition required hospitalization on June 3, 2005, just shy of a year later.

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