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Category Archives: Life/AD&D Claims

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Does the Insurance Company or the Employer Pay Penalties for Failure to Produce Group Plan Documents?

Picture of Disability Insurance Policy

A Federal Law Called ERISA Gives an Employer Plan 30 Days to Produce a Copy of the “Summary Plan Description” The majority of people under age 65 in the USA have their disability, health, and life insurance through group plans sponsored by their employers.  For people that work for a company other than the government […]

New York Court Upholds Aetna Life Insurance Denial in DUI Death Based on Self-Inflicted Injury

Picture of alcoholic drink next to car keys

Intoxication Exclusions in Life Insurance Policies Can Often Result in Claim Denials When a motorcyclist died in a crash while driving 124 miles per hour, Aetna Life Insurance Company denied the claim, asserting that the driver was intoxicated and that made the crash an “intentionally self-inflicted injury,” something excluded from payment under his employer’s Accidental […]

VIDEO: Why Life Insurers Deny Accidental Death Claim

Picture of Insurance Claim Form with Denied stamped on it

When a life insurance company refuses to pay an accidental death claim, it adds insult to injury.  Accidental Death and Dismemberment Insurance (often called “AD&D Insurance”) exists to pay a benefit when someone dies in a way that you cannot plan for – as a result of an accident.  AD&D Insurance companies find creative ways […]

Group Plan Can Still be an ERISA Plan Even When Employees Pay the Full Premium for Insurance

picture of Statute Book - Pages from ERISA, the Employee Retirement Income Security Act

A common question our clients often ask is whether the Employee Retirement Income Security Act – ERISA – applies to employer group insurance plans where the employees pay 100% of the premium.  ERISA is the federal employee benefit law that applies to pension and insurance benefits offered by private (non-government or church) employers.  It governs […]

ERISA Preemption: What is it?

picutre of statute book showing the Employee Retirement Income Security Act

ERISA – The Employee Retirement Income Security Act When someone files a lawsuit on a Disability Insurance or Life insurance claim that was denied, the law that governs their case depends on how they bought their insurance.  If they bought the insurance on their own from a private insurance agent, state insurance law applies to […]

SCOTUS to Decide Whether Hospitals Affiliated with Religions Exempt from ERISA

Picture of Christian Hospital

Are benefit plans offered to employees of hospitals affiliated with churches exempt from ERISA? The federal law that governs employee benefits – the Employee Retirement Income Security Act (“ERISA” for short) does not apply to employers that are religions.  So, are benefits offered by Christian-affiliated hospitals offered to their administrative and medical staff covered?  Using […]

Lower Court Uses Wrong ERISA Standard – Appeals Court Reverses and Orders De Novo Review

Picture of rose colored glasses changing image

Think of ERISA Standards of Review like colored lenses – which color the Judge has to use changes how the court must view the facts. When someone is denied benefits under an employer’s group insurance plan, a court that reviews that decision has to decide which standard of review it has to apply to the […]

Stranger-Originated Life Insurance (STOLI) Policies in Florida

Picture of Stoli vodka bottle

STOLI…No, not this kind of Stoli…We are talking about Stranger-Originated Life Insurance Policies in Florida! What is stranger-originated life insurance (STOLI) in Florida? In Florida, people are allowed to sell their life insurance policies on the secondary market.  A Florida statute, § 627.422, permits a person to assign a life insurance policy to someone else, […]

Florida Life Insurance Policies: Insurable Interests Under Florida Law

copy of Life Insurance Policy with calculator and glasses

This week, we are talking about the concept of insurable interests in life insurance.  On Monday, I explained what an insurable interest is.  Today, we are going to talk about Florida’s insurable interest law. This applies to life insurance policies that were issued in the State of Florida, and regulates who may take out a […]

Life Insurance: What is an Insurable Interest?

copy of Life Insurance Policy with calculator and glasses

When someone buys a life insurance policy, they must have some significant interest in the life they want to have insured by the policy.  Obviously, they can buy their own policy.  However, a spouse, a parent, or a business party also have legitimate legal interest to buy a life insurance policy on someone else.  This […]

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