Disability Insurance Claims Law Blog

Disability Insurance Claims Law Blog

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Unum was wrong for not considering the claimant’s job duties during its claim review

Posted in Disability Insurance Cases Nationwide, Unum / Provident / Paul Revere

In this recent case out of the Eastern District of Pennsylvania the court found that Unum had abused its discretion when it failed to consider whether the claimant could do the material and substantial duties of her regular occupation. The case answers a question posed by many claimants: Is the insurance company obligated to consider my job duties when evaluating my claim?
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Court Rules Aetna Cannot Collect SSDI Overpayment

Posted in Aetna, Disability Insurance Cases Nationwide

We have written on this subject before and the issue is one we get many questions on. Whether a disability insurance claimant must repay the insurance company for a retroactive social security award depends on the policy at issue and any subsequent agreements between the claimant and insurance company. Unfortunately, most ERISA governed long-term disability policies contain language giving the insurance company the right to recover any award of back benefits made by the Social Security Administration. Insurance companies often take it a step further by requiring claimants to sign “reimbursement agreements” by which the claimant promises to pay back any award of SSDI benefits that would result in an overpayment by the insurance company.
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Appeal Court Affirms District Court’s Ruling that Liberty Life Was Wrong in Denying a Disabled Woman’s Long Term Disability Benefits

Posted in Liberty Mutual

In an opinion issued on September 4, 2014 by the United States Court of Appeals for the Sixth Circuit, an Appeals Court upheld a District Court’s opinion that awarded Ms. Ashima James long term disability benefits. Despite Liberty Life’s two independent medical examinations and at least 4 “independent” file reviews, both Courts concluded that James produced a sufficient amount of evidence to qualify for disability benefits under the Policy.
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National Multiple Sclerosis Society Researchers Find Analyzing MRI’s May Predict MS Progression

Posted in Uncategorized

Multiple Sclerosis is a disabling illness that affects more than 2.3 million people around the world. MS is usually diagnosed between the ages of 20 and 50 and is two to three times more common in women than men. Multiple Sclerosis is a disease of the central nervous system which interrupts the flow of information to the brain and between the body and the brain such as; numbness and tingling in the extremities, fatigue, paralysis, cognitive impairment and sometimes blindness. Unfortunately, there has been no way to predict how a patient with MS will progress over time once they are diagnosed.
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Plaintiff Awarded Benefits when Sedgwick Abuses its Discretion

Posted in Disability Insurance Cases Nationwide, Sedgwick Claims

Sedgwick Claims Management is notorious for abusing its discretion when determining whether a claimant qualifies for disability benefits. The most common ways in which Sedgwick abuses its discretion includes, the failure to consider treating doctors’ opinions, failure to consider a favorable determination by the Social Security Administration, failure to speak to treating doctors regarding the claimants’ disabling conditions, failure to have the claimant examined and relying solely on paper reviews of paid doctors. A court in the Northern District of California addressed some of these very issues resulting in a very favorable outcome for the Plaintiff.
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Arkansas court grants Hartford’s motion for summary judgment for claimant’s failure to exhaust administrative remedies

Posted in Disability Insurance Cases Nationwide, Hartford

This is yet another case shedding light on the importance of timely exhausting administrative remedies before filing an ERISA lawsuit. In this recent case, which was decided by a U.S. District Court in Arkansas, Mr. Deaton, a former Walmart Stores employee, was on claim for disability with Walmart’s disability insurer, Hartford Life and Accident Insurance Company (“Hartford”).
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How Do I Get Attorney Fees Awarded In An ERISA Disability Benefit Appeal or Denial?

Posted in Disability Insurance Cases Nationwide

Long term disability lawyers Gregory Dell and Rachel Alters recently released an educational video which discusses the issues surrounding an award of attorney fees in ERISA disability claim. In this video, they discuss the standards that must be satisfied to win attorney fees and the difficulties that can arise in a court awarding ERISA attorney fees.

Greg and Rachel have litigated the issue of attorney fees extensively and this video was designed to discuss the most common issues. If you have been denied disability insurance benefits and have been forced to file a lawsuit, then you may be able to recover attorney fees. Contact any of our disability insurance lawyers to learn more about how Attorneys Dell & Schaefer may be able to assist you.

Federal Appeals Court Rules that Sun Life Can Offset VA Benefits Even Though Such Benefits Are Not Listed in the Policy

Posted in Disability Insurance Cases Nationwide, Sun Life

In an unpublished opinion issued on July 7, 2014 from the United States Court of Appeals for the Tenth Circuit, a Federal Court ruled somewhat surprisingly and approved Sun Life’s decision to “offset” VA Benefits from a disabled Veteran’s monthly disability benefits. While this case is not “binding precedent,” it can serve as a warning for those that are receiving VA Benefits, or any other income benefits, that are not listed in their Long Term Disability (LTD) ERISA Policy.
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Plan administrator gets the benefit of the doubt in another ERISA lawsuit

Posted in Uncategorized

Claimants often ask why ERISA lawsuits are so difficult. Among other reasons, the biggest obstacle for claimants in ERISA lawsuits is often the standard of review employed by the court reviewing the claim denial.

The core of every ERISA lawsuit involving the recovery of disability benefits essentially comes down to whether the court will give the claims administrator the benefit of the doubt. In most cases, where the plan gives the administrator discretionary decision making authority, the court reviews the claim denial merely for an abuse of discretion. In other words, the administrator gets the benefit of the doubt.
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