Jim Plummer's blog

Documents not submitted during the administrative review are not part of the adminstrative record

In Kearney v. Aetna Life Insurance Company, Civil Action No. 13-548-SDD-RLB (M.D. La. Apr. 22, 2014) Aetna provided what it claims was the complete administrative record to the Plaintiff. Plaintiff responded by filing a motion and attaching to the administrative record medical records it claims should be part of the administrative record. Aetna's appeal personnel attached an affidavit to Aetna's response in opposition to Plaintiff's motion to supplement the administrative record.

Delay in providing denial letter does not alter standard of review

Steward v. Prudential Insurance Company of America, Civil Action No. 3: 12-CV-3844-B (N.D. Tex. Jan. 10, 2014) involved a claim for disability benefits. The Court first addressed Plaintiff's argument that Prudential's failure to provide the denial letter within 45 days of Plaintiff's appeal changed the standard of review from abuse of discretion to de novo. The Court noted that neither party informed the court of the date Prudential received the appeal. The Court found that Prudential was anywhere from 62 to 86 days late.

Fifth Circuit Awards Attorney's Fees to Insurer

SPENRATH v. THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, C.A. No. 13-20196. (5th Cir. Apr. 18, 2014) (per curiam) involved a claim for disability benefits under ERISA. Although this case cannot be cited as a precedent it is important for the appellate trap. Here the district court affirmed Guardian's denial of Ms. Spenrath's claim for disability benefits and awarded attorney's fees to Guardian. Spenrath appealed arguing there was substantial evidence in the record to support her claim for disability benefits.

Nugent v. Aetna Life Ins. Co., C.A. No. 13-30795 (5th Cir. Jan 3, 2014)

This is a case for long-term disability benefits. Court reiterated its earlier position that where there is an existing SSA determination finding that a claimant is disabled, the plan administrator must address the SSA's decision in its determination; failure to do so renders a determination procedurally unreasonable. evidence, structural conflicts of interest, and whether the SSA has awarded benefits. Schexnayder v. Hartford Life & Accident Ins. Co., 600 F.3d 465, 471 (5th Cir. 2010).

SCHIRO v. OFFICE DEPOT, C.A. No. 13-1156 (E.D. La. Jan. 27, 2014)

This is a claim for short-term disability benefits. AETNA LIFE INSURANCE COMPANY was the insurance company and SEDGWICK CLAIMS MANAGEMENT SERVICES, INC. was the claims administrator. Sedgwick denied the claim because it claimed the file lacked "objective medical evidence" of his inability to work.

Parker v. Cooper Tire & Rubber Company, 12-60503 (5th Cir. Feb. 21, 2014) (unpublished)

In an unpublished decision the Fifth Circuit limited the anti-retaliation provisions of ERISA. ERISA section 510 makes it illegal for an employer to terminate an employee with the specific intent of preventing the employee from obtaining an ERISA benefit.

Blair Brininger will soon take ERISA disability cases in New Mexico

Blair Brininger passed the Full New Mexico bar. No reciprocity or any short test. Here is a plug for http://www.BarBri.com. (Thanks to Whitney, my coach, I am one of the oldest people to pass-based on looking around the room).


Judge Sparks invites lawyers to kindergarten class-only lawyers need attend

Judge Sparks appears fed up with technical objections to subpoenas when those technical objections serve only to waste time. He invited the lawyers to school in his courtroom. Told the lawyers to bring a sack lunch and their toothbrush so they could stay with the US Marshall if the session went past the lawyers' bedtime.

Unhappy litigant with an unusual pleading style

This is not an ERISA case and the pleadings contain (to put it mildly) salty language. I have left the pleading in its original state except that I redacted Mr. Hupp's personal information. I think Wyatt Cenac of the Daily Show should interview Mr. Hupp. I downloaded the pleading from the website for the Ninth Circuit.

The Ninth Circuit denied Mr. Hupp's petition. Thus, this pleading style is ineffective.

Has CIGNA denied your ERISA disability claim on a Thursday?

While testing a new research tool for my firm, I decided to look for cases in which CIGNA’s Book of Knowledge (Cigna’s claim manual) was quoted. (CIGNA and Life Insurance Company of North America are the same company). In one of my cases I wanted to see what court’s thought of Cigna’s failure to comply with its claim manual. This firm reviews its copy of the CIGNA’s Book of Knowledge and compares the actions in my Cigna case with the BOK.


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