One of the two standards of review the court applies in ERISA cases (see also standard of review and de novo). This standard of review is triggered when a policy contains a provision clearly granting the plan administrator or insurer the discretionary authority to determine eligibility. If the Policy contains discretionary authority the court is required to review the insurance company’s decision under the abuse of discretion standard. An abuse of discretion standard of review is very deferential to the insurance company or plan administrator and if there is any plausible basis or the insurer’s decision is not clearly erroneous the decision will be upheld by the court.
These are activities people typically do on a daily basis such as bathing, dressing and undressing, eating, cooking, etc. A person’s ability or inability to complete ADLs is used as a measure of their functional status and whether or not they are disabled. These are activities people typically do on a daily basis such as bathing, dressing and undressing, eating, cooking, etc. A person’s ability or inability to complete ADLs is used as a measure of their functional status and whether or not they are disabled.
See "Claim File."
Expenses associated with a case that we pay for upfront on a client’s behalf. The client is responsible for reimbursing these expenses whether or not the case is won. Typical costs include, but are not limited to: copies, medical records and reports, postage, and court filing fees.
A policy definition of disability that considers a claimant disabled if he/she cannot work in any full time capacity, regardless of the type of work (as opposed to own occupation). Under this definition a claimant is not considered disabled if there is some type of work he/she can complete on a regular basis.
See abuse of discretion. This is essentially a synonym for abuse of discretion. The court will uphold an insurer’s decision unless it was “arbitrary and capricious.”
A form most insurance companies require a claimant’s physician complete as part of the disability application process and as a periodic certification of disability.