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arbitrary and capricious
Deference Ploy Is Defeated
As readers of this column are well aware, insurance companies are “stodgy” and “old-fashioned” only when it comes to paying claims. When it comes to defending against claims, insurers are swift, inventive and show very little, if any, conscience. Even experienced disability...
Committee's Interpretation Of Plan's Ambiguous Term Was Reasonable
FRYE v. THOMPSON STEEL COMPANY (September 2, 2011) During Basil Frye's long employment with Thompson Steel Company in Franklin Park Illinois, he suffered two work-related injuries. He received over $80,000 in workers’ compensation settlements for permanent partial disabilities. In 2007,...
Court Must Defer To Plan Administrator, Even If Not An ERISA Fiduciary
COMRIE v. IPSCO, INC. (February 18, 2011) Ipsco, Inc. had an unfunded, supplemental pension plan for its top executives. The plan had a golden parachute provision under which an executive was eligible for benefits if he left the company's employ within two years of a change of control. John Comrie...
Injury Resulting From Medical Treatment Is Not An "Accident" Under AD&D Policy
SELLERS v. ZURICH AMERICAN INSURANCE CO. (December 3, 2010) On September 15, 2005, Time Warner Cable employee Anthony Sellers suffered a torn tendon in his knee while at work. His surgeon, Dr. Schultz, repaired the tear and inserted a metal wire in the knee to facilitate Sellers' recovery. The wire...
The "Sole" Of Discretion
Lawyers sometimes have a habit of using more words than necessary. Many times this just bores the audience. Sometimes, it really, really hurts. A case in point is the rule banning the use of the discretionary clause in health insurance policies in New Jersey. Discretionary clauses have been used by...