10-3898 & 11-1006 Weitzenkamp v. UNUM Life Ins. Co. of America
Insurance ERISA; self-reported symptoms limitation The failure to include a self-reported symptoms limitation in the summary plan description (“SPD”) prevents an ERISA plan from relying on it to discontinue benefits. “Here, the SPD clearly sets out that long-term benefits will be discontinued after twenty-four months if a participant’s disability is due to mental illness or […]
2008AP2595 Brethorst v. Allstate Property & Casualty Ins. Co.
Insurance Bad faith An insured may file a bad faith claim without also filing a breach of contract claim. “[W]hile Jones held that a bad faith claim need not be accompanied by a breach of contract claim, it did not hold that a first-party bad faith claim need not be accompanied by a breach of […]
10-2112 Jackman Financial Corp. v. Humana Ins. Co.
Insurance ERISA; facility-of-payment clauses Where a life insurance policy contained a facility-of-payment clause, it did not violate ERISA for the insurer to pay the proceeds to the insured’s children. “Under the arbitrary and capricious standard, we overturn the administrator’s decision only where there is an absence of reasoning to support it. See Hess v. Reg-Ellen […]
2009AP001422 Siebert v. Wisconsin American Mutual Ins. Co.
Insurance Automobile policies; negligent entrustment An insurer is not liable for its insureds’ negligent entrustment of a vehicle if the driver was not negligent in his operation of the vehicle. “Bankert and Malone teach us that there is no coverage for Koehler’s alleged negligent entrustment of the vehicle to Raddatz because that act is not […]
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