Disability Benefit Claims Law Blog : Disability Benefits Lawyer & Attorney : Dell & Schaefer : Disability Insurance Claims Law Blog

Disability Blog & Cases:
New York Federal Court Denies MetLife’s Motion To Dismiss Lyme Disease Victim’s Petition For Disability Benefits

In the case of Karen N. v. Metropolitan Life Insurance Company et. al, the United States District Court of New York, after hearing arguments from both sides regarding MetLife’s Motion to Dismiss the case, denied the motion in its entirety and directs the parties to appear for a status conference to determine how and when the case will proceed. And, while the Court did deny the insurer’s motion, that doesn’t mean that Karen N. will receive a favorable outcome in her lawsuit to receive her disability benefits. It does mean that the Court believes that the case deserves to be heard and ruled upon once all facts have been established.

Disability Blog & Cases:
Pennsylvania Pharmacy Owner Learns The Hard Way That Accuracy Is Everything When Applying for Disability Insurance Benefits

On January 28, 2011, the United Sated District Court of the Eastern District of Pennsylvania granted Berkshire Life Insurance Company of America’s Motion for Summary Judgment in Michael S. v. Berkshire Life Insurance Company of America, et. al. In addition, the plaintiff’s disability policy and FIO policy were rescinded negating...

FAQ: Social Security Disability Benefits
Can My Disability Insurance Benefits Be Denied If I Am Approved For Social Security Disability Benefits?

Disability Insurance Attorneys Gregory Dell and Cesar Gavidia discuss the misconception that a claimant will be approved for long term disability insurance benefits if social security disability benefits are approved.

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The Plaintiff, Joni D., with the help of her Alabama Disability Attorney has filed a lawsuit against Reliance Standard Life Insurance Company and the Group Long Term Disability Policy For Employees Of Madison County Community Hospital for the wrongful termination of long term disability benefits.

In Joni D. Vs. Reliance Standard, Plaintiff is suing the Defendants for the unjust termination of her long term disability benefits under the terms of the long term disability plan.

Plaintiff Needed To Use LTD Plan

Plaintiff worked as a Critical Care Registered Nurse, an occupation that required her to perform and fulfill numerous essential job functions, requirements, and qualifications associated with her occupation, including providing direct and indirect patient care, responding quickly and accurately to changes in condition or response to treatment, and performing general nursing duties. Due to her employment, Plaintiff was eligible and partook in the LTD policy that was underwritten by Reliance Standard.

On or about May 5, 2003, Plaintiff became unable to work due to a culmination of disabling physical health issues. These issues were clearly documented in the Plaintiff's medical records. Plaintiff became totally disabled on a permanent basis on or about February 25, 2010. This prevented her from any type of gainful employment as was confirmed by the Social Security Administration as of May 4, 2003. But does receiving disability benefits from the Social Security Administration mean the insurance company will also continually provide long term disability benefits? As Joni came to find out, that answer is no.

Filing of Benefits

Plaintiff filed for LTD benefits on or around November 24, 2003. Reliance Standard agreed to pay the LTD benefits effective October 31, 2003. According to the terms of the Plan, the Plaintiff's condition changed from "disability" to "inability" as of October 31, 2006.

Reliance Standard paid LTD benefits for six years. This included paying the Plaintiff disability benefits under the "any occupation" definition of disability from October 31, 2006 to August 31, 2009.

Reliance Standard Terminated the Benefits Five Times From 2003-2010

On five different occasions, Reliance Standard terminated, denied, or closed the claim between October 31, 2003 and January 7, 2010. This was despite the fact that numerous objective tests showed that the Plaintiff's back pain and radiculopathy continued to exist. The Plaintiff has also continually submitted additional evidence confirming her pain, including medical records and information from doctor visits.

Reliance Standard also improperly handled the Plaintiff's claims over the years, including a time when it claimed that the Plaintiff returned to work even though she never did. It is alleged that Reliance Standard did this to avoid paying the Plaintiff LTD benefits. Despite Reliance Standard's own "quality review unit" claiming that Plaintiff met LTD terms of the Plan and could not handle "any occupation," Reliance Standard continually terminated Plaintiff's benefits until its final termination letter on January 7, 2010.

Plaintiff Files Lawsuit Against Reliance Standard and Group

Plaintiff filed this lawsuit against Reliance Standard because Reliance Standard based its denial on its own "independent" medical examiner's report and attached physical capacity form, even though the two reports contradicted each other and the Plaintiff's submitted medical records and reports. The examiner was also provided through MES Solutions, a biased third party company that has regularly had contact with Reliance Standard, indicating a conflict of interest. Plaintiff also claims that Reliance Standard failed to consider all medical records and other information submitted by the Plaintiff.

Plaintiff Seeks The Following From This Lawsuit

Plaintiff wants the following relief from Reliance Standard and Group:

• A de novo review of the Plaintiff's claim for long term disability benefits
• All of the past due long term disability benefits
• Reinstatement of Plaintiff's claim to all present and future disability benefits so long as Plaintiff is eligible under the LTD Plan
• Award of all attorney's fees and expenses
• Interest on all past due benefits
• All other relief that the Court deems to be just and proper 

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Request a free legal consultation here or call 800-698-9162.

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Disability Blog & Cases:
Eastman Chemical Company Employee Loses Lawsuit Against MetLife for Disability Benefits

In a case recently decided by an Arkansas Federal Court, MetLife prevailed in a lawsuit filed by an Eastman Chemical Company Employee. Ultimately, due to video surveillance, a lack of medical support, and the fact that the claimant had continued working at a side job (of which he had failed to inform MetLife of) while claiming to be disabled, the Court, it seems, had no choice but to agree with MetLife’s decision to deny Long Term Disability Benefits.

Disability Blog & Cases:
Bon Secours Employee Wins Lawsuit Against Unum who had Denied Him Disability Benefits

A former Engineer Director for Bon Secours, with the help of his Pennsylvania  Disability Attorney, were forced to file a federal ERISA lawsuit after Unum repeatedly denied his claim for Long Term Disability Benefits under a disability policy he was covered under through his employment with Bon Secours. After filing Cross Motions for Summary Judgment, the Court ultimately ruled in favor of the claimant and against Unum.

Disability Blog & Cases:
Do You Know The Job Requirements To Be A Lincoln Financial Disability Claim Specialist?

As a disability lawyer that has handled thousands of disability insurance claims I often wonder about the qualifications and experience of the disability company employee that is making the decision to approve or deny my client’s claim. During our routine activities of watching The Lincoln Financial Group, I came across an internet job posting for an “Associate LTD Benefit Specialist” at Lincoln Financial in Atlanta, Georgia.The qualifications and requirements for the Lincoln benefit Specialist position are also listed at the end of this article.

Disability Blog & Cases:
A Claimant’s View of a Prudential Disability Benefit Denial

We always welcome our clients and other disability claimants nationwide to share their experiences regarding the handling of their disability insurance claim. A client of our law firm that was denied long term disability benefits by Prudential Insurance Company recently posted her thoughts...

Disability Blog & Cases:
Do You Know The Differences Between ERISA Disability Policy And NON-ERISA Disability Policy?

Watch our video to learn more about long term disability insurance claims which are subject to ERISA.

Disability Blog & Cases:
Will A $38 Million Loss Result In More Prudential Disability Insurance Claim Denials?

Prudential is not very happy right now and disability claimants may suffer as a result. Prudential’s group insurance division, which includes long-term disability insurance policies, reported a 2012 first quarter loss of $38 million compared to a gain of $39, million a year ago...

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The Plaintiff, with the help of her Massachusetts Disability Lawyer, has filed this lawsuit in the United States District Court against Standard Insurance Company (Standard) for the denial of long term disability benefits as defined by the Plan that the Plaintiff was eligible due to her employment as a nurse with UnitedHealth Group.

The Plaintiff is a 63-year-old resident of Wrentham, Norfolk County, Massachusetts, while Standard is engaged in the business of disability insurance, and is licensed and authorized to engage in the business of insurance within the Commonwealth of Massachusetts. In regards to this lawsuit, Standard engaged in the administration and, in pertinent part, insurance, of the UnitedHealth Group, Long Term Disability Plan.

In Kathleen F Vs Standard Insurance Company, Plaintiff seeks reinstatement of long term disability benefits as defined by the terms of the Plan.

Plaintiff's Background and Reasons For Submittal of Claim

Plaintiff worked as a healthcare utilization review coordinator for UnitedHealth Group, up to and including January 3, 2006. On or about January 3, 2006, Plaintiff was involved in a motor vehicle accident and suffered a right acetabular (hip) fracture. She could not perform the duties of her occupation, or any occupation, due to multiple complications of the healing of the fracture (non-union), as well as severe posttraumatic arthritis secondary to the injury and depression secondary to the injury.

Plaintiff filed for long term disability benefits under the LTD plan. She provided the necessary claim forms, physicians' statements, and supportive medical records. UnitedHealth Group, who funds the first 24 months of benefit payments, approved the claim. This would last through July 2, 2008. After this date, Standard was expected to take over the LTD payments.

Standard Decides To Not Fulfill LTD Payments To Plaintiff

Via letter dated March 31, 2008, Standard denied Plaintiff's claim for disability benefits when it was due to take over payments on July 3, 2008. Plaintiff filed an appeal of this denial, including additional medical support for her claim. However, Standard denied her appeal on July 28, 2008.

Plaintiff was offered, and through counsel, requested an additional level of review by letter dated September 22, 2008. Plaintiff thereafter submitted additional support for her claim, including a recorded video statement on DVD. Plaintiff requested a copy of the complete claim file from Standard on September 22, 2008. Standard did provide some of the requested records, but not provide any of the requested guidelines, policies, or procedures. Plaintiff again requested these relevant documents via letter dated November 27, 2008.

Standard denied Plaintiff's appeal via letter dated April 27, 2009. Standard informed Plaintiff that she has exhausted her administrative remedies. Because of this, Plaintiff has filed this lawsuit against Standard.

Merits of the Lawsuit Against Standard

Plaintiff asserts that Standard did not properly apply the provisions of the LTD plan to her claim. Plaintiff still has not received the requested documents she asked for from Standard. This has denied the Plaintiff her ERISA's statutory right to a "full and fair review" of her claim, as it has prevented her from mounting additional argument in favor of her claim and deprived her of the opportunity to submit evidence that may perfect her claim. This leads to the assertion that Standard breached its fiduciary duties as an ERISA administrator and shows a clear abuse of discretion.

Plaintiff's Relief Requests

Plaintiff wants the following relief from Standard:

• Plaintiff has been and continues to be eligible to receive LTD benefits as defined by the terms of the Plan
• Standard must pay all disability benefits to which the Plaintiff is entitled to and owed from July 3, 2008 to the present date
• All attorney's fees, interest, costs, and disbursements be paid
• All other relief that the Court determines to be necessary and just 

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Request a free legal consultation here or call 800-698-9162.

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Disability Blog & Cases:
Kentucky Woman Wins Lawsuit Against Mutual Of Omaha Insurance

Claiming that her long term disability benefits were denied improperly under the Employment Retirement Income Security Act of 1974 (ERISA) and 29 U.S.C.§ 1001, et. seq., Nancy C. and her Kentucky disability lawyer filed a disability lawsuit against her employer and disability insurer alleging that the denial of her long-term disability benefits by the insurer was “arbitrary and capricious” and constituted a “breach of fiduciary duty and/or bad faith” on the part of the defendants.

Disability Blog & Cases:
Prudential Claimants Unsuccessful At Challenging The Offsetting Of Dependents’ SSDI Benefit Award

Challenging the calculation that Prudential Insurance Company made when reducing their private benefit payments, Kathleen Schultz and Mary Kelly filed a class action lawsuit in hopes of receiving a positive, definitive decision concerning their claims.

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In Jeffrey D Vs. Unum Life Insurance Company of America, the Plaintiff, with the help of his Connecticut Disability Attorney, filed this lawsuit due to the wrongful denial of long term disability benefits as promised under theERISA welfare benefit Plan that is underwritten and insured by Unum.

History of Plaintiff

Plaintiff, who is 46 years old, worked as a machinist at two companies in Bristol, Connecticut for a total of 16 years. He then worked as an Electrical Discharge Machine Operator at EDAC Technologies Corporation (EDAC) in Farmington, Connecticut since 2000. His job required him to position and secure workpieces on a table using clamps; measure parts; manually input data into a computer; and regularly exert between 10 and 50 pounds of force with his hands to move objects.

Plaintiff suffers from gout, a form of severe arthritis characterized by joint pain, tenderness, and reduced mobility in the areas affected. These areas usually include the hands, wrists, feet, and ankles. wrists, feet, and ankles. This medical condition causes him consistent severe pain, occasional complete immobility, and a regular inability to use his hands, wrists, feet, and ankles for almost anything, including grasping, pushing, holding, walking, and standing. His dominant (right) hand and wrist are affected more than his non-dominant hand and wrist. Plaintiff first suffered from gout approximately 20 years, and it has worsened progressively over the years.

Due to the continuing deterioration of his gout, Plaintiff can no longer operate as a machinist or in any other occupation. This has been the case since late-September 2010. Plaintiff takes powerful prescription drugs to combat the consistent pain, but the serious side effects from these medications include lightheadedness, forgetfulness, nausea, and fatigue. These prevent him from driving a motor vehicle or operating other types of machinery and industrial equipment.

Plaintiff filed an application for benefits under EDAC's Unum Plan in September 2010. He was to have received 60% of his "monthly earnings" until a maximum age of "Social Security Normal Retirement Age." According to the terms of the Plan, the Plaintiff satisfied the definition of being disabled both regarding his own occupation (first 24 months of benefit collection) and any other occupation (after 24 months of benefit collection).

Unum Denies Claim

On June 29, 2011, Unum denies Plaintiff's benefit application due to the reason that the medical evidence did not support that his gout was disabling under the Plan's definition; he did not satisfy the Plan's requirement that he work 35 hours per week prior in order to qualify for benefits; and he held another part-time job that he did not disclose to Unum, which disqualified him from benefit collection.

Plaintiff filed an appeal on September 24, 2011 disputing these reasons, which Unum essentially admitted as being true and that it was mistaken in Plaintiff having a part-time job. Plaintiff added 68 pages of medical records, letters from his physicians, Unum's internal claim evaluation notes, and seven sworn records to his appeal.

Plaintiff underwent wrist surgery in fall 2010. His surgeon said in June 2011 that he will have no use of his right hand and wrist, further strengthening Plaintiff's claim that he is disabled under the terms of the Plan. A fusion procedure that is recommended for the Plaintiff would prevent him from undertaking any gainful employment that requires Plaintiff to use his right hand to any significant degree.

Plaintiff also demonstrated that he has done no work for his wife's vending cart business. Plaintiff also showed that he briefly dropped under 35 hours of work per week due to gout flare-ups in his feet.

Despite showing all of this, Unum denied Plaintiff's appeal on October 20, 2011 on the same reasons as its original denial. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit against Unum.

Reasonings Behind the Lawsuit

Plaintiff claims that Unum's failure to pay these benefits was wrongful, arbitrary, capricious, and otherwise unlawful. Additionally, Unum also chose to disregard the opinion of its own claim reviewer nurse who stated that "it is unlikely that the insured will regain his premorbid level of" functional capacity.

Unum also never requested that Plaintiff undergo an independent medical examination or functional capacity evaluation so that it could attempt to determine the severity of his gout or its impact on his ability to work in his own job or others.

Requested Relief

Plaintiff wants the following relief to be granted by this Court:

• Payment of all unpaid monthly disability payments
• All prejudgment interest
• Costs associated with filing this lawsuit
• All appropriate attorney's fees
• Reinstatement of Plaintiff's eligibility for continued disability benefit payments in the future
• All other relief deemed proper by this Court 

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Request a free legal consultation here or call 800-698-9162.

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Disability Blog & Cases:
Minnesota Disability Claimant Filed Suit Against Employer Over Terminated Disability Benefits

A Minnesota Federal Court recently ruled against a claimant and in favor of the employer with regards to disability benefits. This case is a poignant reminder that even after being on claim for nearly 7 years, a claimant can be denied at any time. It further shows why it is important to have your claim sufficiently supported with evidence from your treating physician whether the claim administer requests it or not. Let’s take a closer look at the case of Richard P. v. Kohler Co.

Disability Blog & Cases:
Court Finds MetLife Has No Right To Request An IME After Unnecessary Delay

Recently, a claimant was forced to hire a California Disability Lawyer and file a lawsuit against MetLife after being denied continued Long Term Disability Benefits. After agreeing with the claimant that she was disabled through the "own occupation" period, the Court awarded the claimant benefits for that limited time period. However, the court then asked MetLife to take a closer look at the "any occupation" period. For an unexplained reason, MetLife dragged its feet on making a determination.

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In Mary A. Vs Sun Life Assurance Company of Canada, the Plaintiff, with the help of her Alabama Disability Attorney, files this lawsuit against Sun Life seeking reinstatement of long term disability benefits as promised under the terms of the Plan.

History of Case

Plaintiff is a disabled individual who was employed by Liberty National as a Sales Agent. This occupation required her to consistently spend an average of nine hours "in the field" traveling to and from job sites. It further required 10-11 hour work days during the course of a week. The Plaintiff was required to perform and fulfill numerous essential job functions, requirements, and qualifications associated with her occupation. Some of these functions included compiling lists of prospective clients, contacting those prospective clients, calling on policyholders to deliver and explain the policy, and servicing the business of existing and new customers.

On or about January 28, 2007, Plaintiff became unable to work due to a culmination of disabling physical health issues. These issues related to seizure auras, physical pain, fatigue, sleepiness, dizziness, and problems with memory. These issues primarily relate to seizure auras, physical pain, fatigue, sleepiness, dizziness, and problems with memory. As a result of her health problems and inability to continue working, the Plaintiff filed an application for long term disability benefits with Sun Life on or around July 12, 2007.

Sun Life approved the claim and began paying out monthly disability benefits effective July 27, 2007. The Social Security Administration determined that the Plaintiff was unable to perform any gainful occupation based on her physical health problems, thereby approving her for Social Security Disability benefits upon her initial application. These benefits began to be paid out in July 2007.

Sun Life Abruptly Terminates Long Term Disability Benefit Payments

On or about July 31, 2008, Sun Life informed Plaintiff that she no longer qualified for disability payments based on a review of her records. Plaintiff filed an appeal of this decision via letter dated August 4, 2008. Plaintiff also supplied additional medical documentation that she was still disabled and unable to work. She included notes from two different physicians she had been seeing, both of whom stated that Plaintiff was not able to work.

Despite this mounting evidence, on August 17, 2009, Sun Life terminated Plaintiff's long term disability benefits retroactive to July 27, 2009. Plaintiff filed an appeal letter on or about October 21, 2009. Once again, she submitted multiple pieces of medical evidence, including statements from both treating physicians, to back her claim. Sun Life failed to respond to this latest appeal until it finally sent a letter to the Plaintiff on March 26, 2010.

Due to its failure to follow ERISA regulations, Plaintiff's administrative remedies have been exhausted, leading to the filing of this lawsuit against Sun Life.

Premise of Argument Against Sun Life

Sun Life wrongfully denied Plaintiff's claim and subsequent appeals. It relied upon several biased and erroneous physician consultant reports generated by physicians who are regularly utilized by insurance companies to deny claims.

Furthermore, these physicians were employed by third-party vendor companies Network Medical Review and Professional Disability Associates, companies which receive a substantial portion of income from providing physician consultant reviews to insurance companies and employers. These physicians ignored most of the medical evidence in the claim, cherry-picked evidence favorable to justify a termination of benefits, and misconstrued evidence and statements contained in the claim record.

Relief Sought By Plaintiff Against Sun Life

Plaintiff wants the following relief due to the wrongful termination of long term disability benefits:

• An award of penalties of $110.00 per day, per violation for each day that the Defendants fail to provide the long term disability benefits that are promised under the Plan
• An award of all associated attorney's fees and court costs
• All other relief that the Court decides to be proper and fair 

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Request a free legal consultation here or call 800-698-9162.

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Disability Blog & Cases:
Court Takes Sun Life To Task For Denial Of Disability And Life Insurance Benefits Of Man With Brain Tumor

The widow of a claimant, who died from a malignant brain tumor, brought this lawsuit with the help of her Colorado Disability Lawyer after Sun Life refused to award cancer disability benefits.

Disability Blog & Cases:
CIGNA Disability Claim Denial: A Claimant's View

Every day disability claimants around the country contact our disability attorneys about a CIGNA disability claim. Many individuals tell us similar stories about the manner in which their CIGNA disability claim has been handled. We wanted to share with you a recent comment that was posted on our website about a CIGNA denial.

Disability Blog & Cases:
Sedgwick Terminates PNC Compliance Specialist’s Long Term Disability Benefits

Recently, a former Compliance Specialist for PNC Financial Services Group was unsuccessful in her lawsuit again her former employer and Sedgwick. This case is a strong reminder that even though a claimant has been awarded disability benefits from the Social Security Administration, it does not mean that the Long Term Disability Insurance Provider must also award disability benefits.

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