This matter originated out of a challenge by Plaintiff of the termination of his disability benefits under his Company’s ERISA Plan.  The District Court granted the insurer’s motion for summary judgment – based upon an abuse of discretion standard of review – from which Plaintiff appealed. 

The Tax Cut and Jobs Act requires taxpayer disclosures and IRS returns in connection with Reportable Policy Sales. 

Amy Van Dyken is a 6-time Olympic gold medal champion swimmer who made history as the most successful athlete at the ’96 Summer Olympics in Atlanta, Georgia and the first American female athlete to win four gold medals in a single Olympic games.

The ICA was recently made aware of reports of an email sent to some of our contacts.

The ICA is pleased to welcome Linda Pierre, Conference Manager and Andrew Bird, Director of Operations, as the newest additions to headquarters staff.

Questions ranging from the language of medicine to the management of claim operations.

The warming temps, sounds of children playing outside, and my itch to swing golf clubs tells me summer has arrived!  I hope the season holds exciting vacation plans and even some rest and relaxation for all of you!

June is a time when the temperatures rise, days grow longer and according to custom, it becomes acceptable to wear white pants again.  Additionally, there is a lesser known but equally important event that occurs each June: the opening of registration for the International Claim Association’s Annual Education Conference.

The International Claims Association has been dedicated to partnering with law enforcement to supply pertinent policy information in the course of criminal investigations that may have a financial etiology since 1999.  As the Law Enforcement Inquiry Director (aka volunteer) I receive numerous inquiries from local, state, and federal law enforcement on a weekly basis asking for our members to assist them in looking for potential life insurance/annuity policy information that may be a critical turning point in their investigation.

Understanding and obtaining a claimant’s occupational duties and job functions are vital to claims adjudication and making the appropriate decision regarding the approval, or rejection of a disability claim. Assessing  a  claimant’s   occupational duties, relevant worker characteristics, and day-to-day pre-disability job demands are essential factors in this determination. In fact, understanding the material and substantial duties of this occupation is at the very core of claims management in today’s environment.

The exclusion from accident coverage for loss contributed to by illness will only apply if the disease “substantially contributed” to the loss.

Disability claims based on multiple sclerosis or “MS” are challenging.  An insurer must consider the claimant’s subjective symptoms and the medical evidence when assessing whether an insured’s functional capacity prevents him or her from performing occupational duties.  The recent unpublished ERISA decision out of the Ninth Circuit – Kibel v. Aetna Life Insurance Company, __ Fed.Appx.__, 2018 WL 832870 (9^th Cir. Feb. 13, 2018) – implies that an insured’s return-to-work efforts and subjective evidence should play a more significant role in an insurer’s analysis of an MS claim.  However, careful scrutiny of the evidence not discussed by the Court suggests that it may simply have been looking for a way to award further benefits. 

Questions ranging from the language of medicine to the management of claim operations.

Greetings everyone!!!!  I hope this correspondence finds you all well and like me, eager for spring’s arrival.  As I write this note, the Winter Olympics are in full swing and I am in awe at the display of excellence from all those competing. 

Greetings ICA members –

Our industry is facing a number of challenges.  In recent years, competitive pressures, economic volatility and regulatory changes have required insurance carriers to operate more efficiently and be more resourceful than ever before. 

In an effort to advance the ICA’s educational offerings, the ICA invites all corporate members to submit a proposal for a white paper and conference presentation that explore the same topic. Upon completion of writing assignment and necessary approvals, white paper authors will be granted one complimentary conference registration to present their white paper topic at the 109^th Annual Education Conference.  

Did you know the Coalition Against Insurance Fraud (“CAIF”) published a report on fraud in life and disability insurance?  If you are not familiar with CAIF (www.insurancefraud.org), it’s one of many different web based resources available for claims professionals to locate information.  As indicated by its name, CAIF focuses on fighting insurance fraud. 

Whoever said the “dead tell no tales” was clearly unfamiliar with forensic claims. In cases of sudden or unexpected mortality, the humble death certificate can provide essential reading for the claims examiner often in conjunction with a police report or medical examiner’s report.

We are saddened to learn of the recent passing of Alfred S. Hammond, (92), ICA Past President (1969-1970). He loved the ICA and was a mentor to many including ICA Past President Jim Adams.

Questions ranging from the language of medicine to the management of claim operations.