Archives for July 2011

Will Health Care Reform Cause Employers to Drop their Employee Health Care Plans?

In the wake of the passage of the Patient Protection and Affordable Care Act and the Health Care Education and Reconciliation Act, several commentators and political observers have suggested that employers will be financially overburdened to the point where they will need to eliminate their employee healthcare plans, thus depriving employees of health coverage and driving up the cost to taxpayers of funding the federally operated insurance exchanges. Several recent events have fueled this speculation:

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Legal v. Factual Disability

Experienced disability litigators know the general rule that disability insurance provides coverage with respect to factual, rather than legal, disabilities.  See generally, Couch on Insurance 3d § 146:9.  The prototypical “legal disability” case involves a claimant who is physically able to perform the duties of his occupation, but is prevented from doing so by either incarceration or suspension/revocation of a professional license.  Mass. Mutual Life Ins. Co. v. Millstein, 129 F.3d 688 (2d Cir. 1997); Wright v. Paul Revere Ins. Co., 291 F.Supp.2d 1104 (C.D. Cal. 2003).  Conversely, where a sickness or injury disables a claimant, benefits may be payable notwithstanding the fact that the claimant subsequently becomes incarcerated, unlicensed, or otherwise precluded from performing his or her  occupational duties.  Weissman v. First UNUM Life Ins. Co., 44 F.Supp.2d 512 (S.D.N.Y. 1999) – benefits payable where the brain injury pre-dated the legal order barring claimant from working as a securities broker;  P. Gary Stern M.D. v. Paul Revere Life Ins. Co. , 744 So.2d 1084 (FL 4th DCA 1999) – triable issue where onset of physical disability began before criminal proceedings. [Read more…]