Eleventh Circuit Rejects Insurer’s Attempt to Treat Early Symptoms as a “Pre-Existing Condition” in ERISA Disability Case

In Johnson v. Reliance Standard Life Insurance Co., No. 23-13443, 2025 WL _ (11th Cir. Nov. 21, 2025), the United States Court of Appeals for the Eleventh Circuit ruled in favor of an insured who was denied long-term disability benefits on the basis of her group policy’s “pre-existing” condition exclusion. The claimant was diagnosed with scleroderma, an autoimmune disorder that …

Accidental Death and Dismemberment Claims: The Fifth Circuit Accepts Insurance Company’s Interpretation of Policy Language

In the case of Byerly v. Standard Insurance Co., 984 F.3d 873 (5th Cir. 2021), the United States Court of Appeals for the Fifth Circuit addressed what happens when a minor injury combines with a serious underlying illness to cause a catastrophic loss. Gregory Byerly was an employee at Fidelity National Information Services and a participant in a workplace accidental …

Wrongful Death Law in Louisiana

Attorney David C. Pellegrin Jr. provides direct, one-on-one representation to ensure your case isn’t just another file on a desk. In Louisiana, wrongful death claims are built on Civil Code article 2315.2. This statute allows specific family members to pursue damages when a death is caused by someone else’s “fault.” “Fault” is a broad term in our legal system. To …

When an Insurer Denies Coverage Without Deciding Disability

In Newsom v. Reliance Standard Life Insurance Company, 26 F.4th 329 (5th Cir. 2022), the U.S. Court of Appeals for the Fifth Circuit addressed a situation that comes up frequently in long-term disability cases. The issue was not whether the claimant was disabled, but whether the insurance company could avoid making that decision altogether. The claimant had worked for years …

U.S. Court of Appeals for the Fifth Circuit Rules in Favor of Life Insurance Beneficiary

In a recent decision, Edwards v. Guardian Life Insurance Company of America, No. 24-60381, 2025 WL 1718263 (5th Cir. June 20, 2025), the U.S. Court of Appeals for the Fifth Circuit issued a rare ruling that favors employees and beneficiaries in group life insurance disputes. In this case, the court made clear that an insurance company cannot continue collecting premiums …

ERISA Appeals and Litigation: Understanding The Path Forward After a Denial

When a life insurance, long-term disability, or other ERISA claim is denied upon the first review, it can be tempting to want to run to the courthouse and file a lawsuit. After all, the frustrated ERISA claimant’s degree of trust in the claim review process is at an all-time low. Sure, the denial letter refers to an appeal process, but …

Fifth Circuit Ruling Out of Louisiana Shows Challenges in Long-Term Disability Fights

A recent decision by the U.S. Fifth Circuit Court of Appeals highlights just how tough it can be for people in Louisiana to hold on to their employer-sponsored long-term disability benefits. The case, Stout v. Smith International, Inc., No. 24-30571, 2025 WL 1029503 (5th Cir. Apr. 7, 2025) centers on Charles Stout, a Louisiana resident whose benefits for a heart …

Court Prioritizes Plan Participant’s Last Wishes in Life Insurance Dispute Governed by ERISA

In a recent decision, the New-Orleans based United States Court of Appeals for the Fifth Circuit affirmed a district court’s decision in an ERISA life insurance case where an insured’s formal beneficiary paperwork was incomplete but the insured’s intentions are unmistakably clear. The ruling in Morgan v. Barrera, No. 21-20497, 2025 WL 1234567 (5th Cir. Apr. 21, 2025), confirms that …

What Are Some Indications a Long-Term Disability Insurer Is About to Terminate Benefits?

Many people in Louisiana and across the country rely upon long-term disability (LTD) benefit payments to replace income lost due to a disability. Some people had long-term disability insurance as a job benefit and some bought individual policies. No matter how people get long-term disability insurance, in most cases, a for-profit insurance company will be administering the claim. Insurance companies …

Why Do So Many Long-Term Disability Cases End Up in Federal Court?

Most long-term disability case involve insurance coverage that falls under the Employee Retirement Income Security Act, often called ERISA. When a private, non-governmental employer offers a long-term disability plan as part of an employee benefits package, that plan is typically governed by ERISA. If an ERISA claim for long-term disability benefits is denied and the insured completes the insurance company’s …