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Court Decisions


Laventure v. Prudential Insurance Company of America, 237 F.3d 1042 (9th Cir. 2001)   The Ninth Circuit Court of Appeals held that a disability insurance policy purchased by a family-owned company to cover only the owners of the company but none of the other employees is not an “employee benefit plan” under ERISA, such that a lawsuit for benefits was not preempted by ERISA, but instead was governed under state law.

The Ninth Circuit Court of Appeals held “notice-prejudice” rule of insurance law, requiring an insurance company to prove that it was actually prejudiced by the insured’s submitting a claim beyond the time set forth in the policy is a law “regulating insurance,” saved from preemption, and thus, applicable to claims brought under ERISA. This decision was essentially upheld by the United States Supreme Court in the sister case of Unum Life Insurance Company v. Ward, 526 U.S. 358 (1999).
The Ninth Circuit Court of Appeals held that language in our client’s long-term disability insurance policy requiring “satisfactory proof” of her disability did not unequivocally delegate discretion to determine eligibility for benefits to the insurance company, such that the applicable standard of review was de novo.  
Lacy v. Met Life Insurance Company, U.S. Dist. Ct., So. Dist. CA, #10-0830 (July 3, 2012) The Court held that Met Life abused its discretion in terminating our client's benefits for, first, failing to consider "the well-documented and considerable evidence by Lacy's treating physicians that he suffered, both subjectively and objectively, significant and debilitating pain," and second, for failing to consider Lacy's occupational duties as a territory sales manager, though "there is not a scintilla of evidence in the adminsitrative record that Lacy is capable of performing at the high functional level demanded of a territory sales manager position."  Benefits were awarded "at least" through the date of the judgment.