Disability insurance policy holders that have been denied benefits have to act expeditiously to reverse their denial. There are two types of LTD policies – ERISA – purchased through your employer or an Individual disability insurance policy – purchased on your own. Each type of plan has their own set of guidelines to appeal a denial of benefits. In this video attorney Gregory Dell and Stephen Jessup discuss the processes to appeal your denial.
A delay in benefits is a very serious problem in the world of disability insurance benefits. Often the insurance companies delay payments, because they can. The disability insurance attorneys at Dell & Schaefer cut through the clutter and get to what the insurance companies are doing to delay your claim.
Continue Reading What Can You do If There is a Delay in Receiving Your Disability Payments?
Davis v. Aetna Life Insurance Company (Aetna) involves a case where a plaintiff filed an ERISA lawsuit against Aetna alleging that she should receive long-term disability benefits under her employee benefit plan. As it turns out, there was no evidence she had ever submitted a claim for benefits. When Aetna filed its Motion for Summary Judgment, plaintiff failed to file an opposition. The Court determined there was no material issue of triable fact and granted Aetna’s motion.
Continue Reading Louisiana Court Grants Aetna’s Unopposed Summary Judgment Motion
Insurance companies are notorious for relying on file reviews when reviewing disability claims and, unlike claims for social security disability benefits, insurance companies are often allowed to rely on file reviews even in spite of conflicting opinions by treating physicians who are arguably in a better position to assess the functional limitations of an individual. However, insurance companies cannot arbitrarily dismiss the opinions of credible treating physicians without providing an explanation and in certain circumstances courts have found that mere file reviews are insufficient to serve as a basis to deny a claim for benefits.
Continue Reading Liberty Life was wrong for relying on a mere psychiatric file review in reviewing mental health claim for disability benefits
A lump sum buyout, also known as a disability settlement, is one payment for the agreed upon value of a claimants disability insurance policy. After this onetime payment is made, the claimant will no longer be paid benefits on a monthly basis.
Continue Reading If you are currently receiving long-term disability benefits from your insurance carrier you may be able to receive a lump sum buyout
People often contact us asking how they can be approved for Social Security Disability benefits yet be denied by their insurance company. Another recurring question is how the insurer can rely on the opinion of a physician hired to perform a file review over the opinion of a treating physician. While insurance companies are allowed to make a decision that is different from the SSA and/or rely on their own file reviews in many cases, they cannot do so arbitrarily. In other words, they have to provide a reason why they rely on such information over other, perhaps more credible information.
Continue Reading Michigan District Court overturns denial of benefits by Liberty Life Assurance Company of Boston
In Jacowski v. Kraft Foods, et al., the Federal District Court for the Western District of Wisconsin denied plaintiff Kathy Jacowski‘s claim that Aetna arbitrarily and capriciously terminated her long-term disability benefits in violation of ERISA.
Jacowski began working for Kraft Foods in 1981. In 2008, Jacowksi quit her job, citing her poor mental health. Her treating physician diagnosed her with depression, anxiety, and post-traumatic-stress disorder. In 2011, she was notified by Aetna, the insurer that Kraft contracted with to administer its disability benefits, that she qualified for total disability benefits. She received these benefits until February, 2014, when they were terminated.
Continue Reading Aetna Defends Claim of Arbitrary and Capricious Disability Benefits Termination
In Stupar v. Metropolitan Life Insurance Company (MetLife), plaintiff, an icer with the Kroger Company, received 24 months of long term disability benefits due to her diagnoses of post-traumatic stress disorder (PTSD), major depression, panic and anxiety disorder. At the end of the two-year period, MetLife terminated her benefits on the grounds that she was limited to 24 months of benefits under the Mental or Nervous Disorders clause of the policy. She objected, exhausted her administrative remedies, then filed this ERISA lawsuit.
Continue Reading MetLife Properly Limited Plaintiff’s Disability Benefits Under the Mental/Nervous Limitations Clause
In Corey v. Sedgwick Claims Management Services, Inc., plaintiff Bruce Corey began working as a machine operator for Eaton Corporation in 1987. Beginning in February 2014, he was periodically granted short term disability benefits when he took a few days off of work due to cluster headaches. On May 8, 2014, Corey quit working completely and again applied for short term benefits.
Continue Reading Due to Lack of Objective Evidence, Ohio Court Upholds Sedgwick’s Denial of Short Term Disability Benefits
Plaintiff Christina Saunders was employed by Proctor & Gamble when she had surgery for an ectopic pregnancy. At that time, disability claims for those employed by Proctor & Gamble in Michigan, like the plaintiff, were handled by a third party administrator, the Reed Group (Reed). Even though plaintiff did not return to work on the date her doctor said she could, Reed approved her for total disability benefits.
Continue Reading Court Affirms Procter & Gamble’s Termination of Long Term Disability Benefits