Many life insurance policies contain exclusions that prevent the recovery of any benefits if the insured commits suicide. (In many policies, the suicide exclusion is only effective for two years from the date of issuance of the policy.) Under Tennessee law, if there is inadequate proof to determine if the…
In an ERISA case, at the center of any dispute over a claimant’s eligibility for long-term disability benefits is the administrative record. The administrative record is legalese for all the medical records, documents and other information obtained by, and submitted to, the plan administrator during the initial stages of the…
For claimants, it is not easy to challenge an insurer’s denial of long-term disability benefits in court, particularly in an ERISA case. Courts review the insurer’s or administrator’s decision under an “arbitrary and capricious” standard meaning that they will uphold the decision as long as it was the result of…
If you’re applying for long-term disability benefits, not much of your private life is off limits. Whether you’re mowing your lawn or posting on your Facebook page, your disability insurer can monitor your activities in search of any reason to deny your claim for benefits. And, it may well do…
In our last post, we discussed the insurable interest requirement in Tennessee. Under that requirement, the prospective owner of the policy must prove that he or she would suffer some type of loss if the insured were to die while the policy was in effect. This requirement prevents speculators from…
The law which requires a policy owner to have an insurable interest in whatever is being insured seems fairly straightforward. Under Tenn. Code Ann. § 56–7–101, a person who buys an insurance policy must have an insurable interest in what is being insured. For example, you can only take out…
In lawsuits challenging an ERISA plan’s denial of long-term disability benefits, can claimants who have qualified for Social Security disability benefits use that as evidence in their case? Or, to put it another way, can a decision from the Social Security Administration (SSA) on a claimant’s disability status be a…
Under what circumstances will a court rule that the named beneficiary under a life insurance policy is not entitled to receive the proceeds of the policy? In Estate of Lane v. Courteaux (2017), the Court of Appeals of Tennessee wrestled with that issue, before ruling against the party who…
Even when plaintiffs win ERISA disability lawsuits, their attorney’s fees can cut into their awards. In some ERISA disability cases, however, plaintiffs can recover their attorney’s fees (and costs) under federal law. What do plaintiffs need to show in order to be awarded their attorney’s fees in an ERISA disability…
In an ERISA disability case, a court will not overturn an insurer’s decision to deny a claimant benefits unless it is clear from the administrative record that the decision was “arbitrary and capricious.” This can be a tough bar for someone covered by a disability policy. In fact, courts in…