Posted on December 10, 2009 by Gregory Dell

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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Posted on April 30, 2009 by Gregory Dell

Insurance Industry Loses Lawsuit Challenging the Abolishment of Discretionary Clauses In ERISA Long-Term Disability Policies

In 1989, The US Supreme Court declared that if ERISA plans contain language giving plan fiduciaries discretion to interpret the terms of the plans and to make benefit determinations, courts will generally yield to that discretion. As a result of this discretion, insurance companies were able to deny claims and there was very little that courts could do to reverse the decision of an insurance company. Throughout the past several years, many states have passed laws to ban discretionary clauses and the insurance industry has been fighting to keep the discretionary clauses.

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