Recently, the United States District Court for the Central District of California ruled that an employee who has dependent spouse life insurance is entitled to the full benefits for which she had been paying premiums for over a year. First Reliance argued that no “evidence of good health form” had been completed by the insured and that the First Reliance did request that it be completed shortly before the Plaintiff’s husband died. Nevertheless, the Court ruled that First Reliance waived the right to request such a form when the insured had been issued and had paid for the coverage for over a year. The Plaintiff was awarded the full $500,000 in benefits. The full decision is here.

I was able to obtain a victory in the Ninth Circuit in this Salyers v. Metropolitan Life Insurance Company.  The Court held that Met Life had waived its right to require evidence of insurability when it had never asked for such a form to be completed and had deducted premiums for the life insurance coverage requested.  The Court also adopted the common law rules of agency into ERISA, holding that when an employer accepts premiums and applications for coverage from the employees, the employer is acting as an agent of the insurance company.

I recently argued a life insurance case before the Ninth Circuit Court of Appeals.  Here is a video of the oral argument.  We are awaiting the Court's decision.

We received a favorable decision in an Aetna disability case today, where the Court found that Aetna's denial was unreasonable and that it ignored the evidence in its own files: "It is puzzling that Aetna’s explanation for its denial in the letter sent to Plaintiff states that neither Dr. Wang nor Dr. Mehta provided “submitted any clinical rationale or any resent [sic] test results,” when both doctors included test results, including the recent MRI results, and all of Plaintiff’s medical records in faxes submitted to Aetna in support of their clinical assessments finding Plaintiff permanently disabled."

Here is an article that I wrote a few years ago regarding legal malpractice claims.

Here is an article that I wrote some time ago about when an insurance company must defend its insured when the insured is facing a lawsuit.

WestLaw has published another recent case of mine, Carrier v. Aetna Life Insurance Co., 116 F. Supp. 3d 1067 (C.D. Cal. 2015).  Judge O'Connell ruled that the insured was disabled under the terms of her group disability insurance plan.  In the denial letter, Aetna told Ms. Carrier that her file had been reviewed by a psychiatrist who stated that she was not disabled when in fact Aetna never hired a psychiatrist prior to the denial.

WestLaw has published a recent case of mine, Williby v. Aetna Life Insurance Company, 2015 WL 5145499 (C.D. Cal. Aug. 31, 2015).  Judge Consuelo Marshall ruled that the insured was disabled under the terms of her group disability insurance plan and that even though the benefits were self-funded, California Insurance Code § 10110.6 voided the plan's effort to make the abuse of discretion standard apply.

Here's an article published this month that I wrote regarding things to watch out for in group life, health, and disability cases.  They are subject to the Employee Retirement and Income Security Act "ERISA."

Accident policies provide coverage in the event of accidental death, dismemberment, and other specified injuries.  These policies are divided into two categories: "accidental death" policies and "accidental means" policies.  "Accidental death" policies have very broad coverage and insure for essentially any death that is not expected or intended by the insured.  Here is an article that I wrote on the subject.