Susan Till v. Lincoln National Life Insurance Company (Lincoln) is a 74 page opinion in which the plaintiff, a radiology technician who suffered with severe back pain, raised many issues in her pursuit of long-term disability benefits. Till’s application for long term disability benefits was denied and, after she exhausted her administrative appeals, she filed this ERISA law suit.
Continue Reading Alabama Court Upholds Lincoln Life’s Disability Denial to Plaintiff

Collins v. Unum Life Insurance Company of America is a case with an unfortunate result for plaintiff Daniel Collins who fractured his ankle when he fell in the employee parking lot. Initially surgery was performed and various screws put in place to hold the tibia and fibula together and securing the medial malleolus. For about three months, he had no complaints and the fracture appeared to be healing appropriately.
Continue Reading Ohio Court Upholds Unum’s Denial of Accidental Dismemberment Benefits

In Rassekh Sobh v. Hartford Life and Accident Insurance Company, Hartford paid the plaintiff benefits beyond his own occupation period as a Technical Operations Lead for Chase Bank and into the any occupation period. During that time, plaintiff had two back surgeries and claimed he was disabled. His medical records and reports from his treating physician supported his claim and he received disability benefits for many years from 2009 to 2014. His treating physician, Dr. Dryer, waffled between supporting his disability claim, failing to respond to Hartford’s request for an opinion and reporting plaintiff could work in a sedentary job.
Continue Reading Appeals Court Upholds Hartford’s Termination of Disability Insurance Benefits

Kresich v. Metropolitan Life Insurance Company (MetLife) is a federal case out of the Northern District of California favorable to a plaintiff who was harassed, accused of lying and oppressed during the processing of his disability claim. Because of MetLife’s conduct, the plaintiff sued for intentional infliction of emotional distress (IIED). Despite MetLife’s vigorous argument that the claim was preempted by ERISA and the plaintiff could not pursue his tort action, the court disagreed and found in favor of the plaintiff. Relying on precedent, the court stated “Plaintiff’s IIED claim stems not from the handling and disposition of his claim, but from independent allegations of harassment and oppressive conduct. There is no alternative enforcement mechanism under ERISA by which Plaintiff could bring such a claim.” Continue Reading California Judge Allows Lawsuit for Intentional Infliction of Emotional Distress Due to Manner in Which MetLife Investigated Disability Claim

In Owens v. Liberty Life Assurance Company of Boston (Liberty Life), plaintiff Paulette Owens quit her job at Walmart when physical restrictions prevented her from working. This opinion does not provide a job description nor mention her specific disability other than saying she quit work when “physical restrictions and limitations” prevented her from working. She was granted long term disability benefits, but one year later, her benefits were terminated. She exhausted her administrative appeals and then filed this ERISA lawsuit.
Continue Reading Liberty Life Denies Long Term Disability Benefits to Walmart Employee in Kentucky

The plaintiff in Neno v. Aetna Life Insurance Company, employed as a Senior Forensic Professional by a computer corporation, received short term disability benefits under his employer’s welfare benefit plan due to his debilitating neck and hip pain. After 24 months, those benefits were exhausted and his application for long term disability benefits was denied.
Continue Reading Court Allows Aetna to Use the Dictionary of Occupational Titles to Deny LTD Benefits

Although this California non-ERISA disability policy litigation was not handled by our disability insurance lawyers, it is relevant to contract law for those who are employed by a state or federal government and have long term disability policies not covered by ERISA.

California insurance law, not ERISA, applies to a lawsuit against a disability insurer by a former government employee

The plaintiff in Klees v. Liberty Life Assurance Company of Boston, a former employee of the University of California, a governmental employer, was initially approved for long term disability benefits due to her many medical conditions, including fibromyalgia, seronegative inflammatory arthritis and injuries she had suffered in a car accident.

When Liberty terminated the plaintiff’s benefits, she filed a lawsuit alleging breach of contract and breach of the covenant of fair dealing. Liberty responded and, among other arguments, relied on published cases citing the Employees’ Retirement Income Security Act (ERISA) in a motion to dismiss the lawsuit. The California federal court labeled Liberty’s citations of ERISA law as a “red herring” in that ERISA specifically exempts government employers from its provisions.

The termination of long term disability came after three independent medical examiners determined the plaintiff could work in some capacity. Liberty tried to convince the court to apply the ERISA definition of disability instead of using the definition of disability as it was defined in the policy terms. The California federal court had no patience with Liberty stating, “ERISA cases are irrelevant to California insurance law.”

Since the question of whether or not the plaintiff was totally disabled under the terms of the contract required resolution under California insurance law, and not by the definition of disability found in inapplicable ERISA law, Liberty’s motion to dismiss the lawsuit was denied.

If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, call Disability Attorneys Dell & Schaefer for a free consultation.

The case of Kindig v. Anthem Life Insurance Company provides an example of how claimants of long term disability benefits may sabotage their own case. A New York Federal Court concluded that Anthem did not act arbitrarily or capriciously by terminating benefits to its claimant following his hip replacement surgery when the court found:

1) his treating physician concurred with the reviewing physician’s report that he was not disabled; and
2) the claimant was actively seeking similar employment with other companies.
Continue Reading Claimant Actively Seeking Employment Denied LTD Benefits By Anthem

In Okuno v. Reliance Standard Life Insurance Company, the plaintiff was diagnosed with Crohn’s disease, Sjogren’s syndrome and possibly narcolepsy. Her claim for long-term disability was denied when Reliance determined she could perform the duties of her own occupation. She exhausted her administrative remedies and filed this lawsuit under the provisions of ERISA. In court, she claimed Reliance erred in determining she was not disabled from her own occupation instead of analyzing whether she was disabled from any occupation. The district court disagreed with the plaintiff holding that when Reliance determined she could perform her own occupation it “of course recognized that she could perform a job fitting within the plan definition of ‘any occupation.'”
Continue Reading If Claimant Can Work in Own Occupation She Can Work in Any Occupation