Disability Insurance Claims Law Blog

Disability Insurance Claims Law Blog

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After submission of an ERISA disability appeal, when can I file an ERISA disability lawsuit?

Posted in Disability Insurance Cases Nationwide, Prudential

Federal law governing ERISA disability lawsuits requires claimants to submit an administrative appeal of the denial of benefits before they can file a lawsuit in the federal district court. In the recent case of Lewis-Burroughs v. The Prudential Insurance of America, et al., the plaintiff filed an administrative appeal and, according to Prudential’s own rules, consistent with federal law, the insurer had a maximum of 90 days to render its decision.
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The Standard Denies LTD Benefits to California Woman with Addison’s Disease

Posted in Standard

This recent California Federal ERISA long term disability case is another example of an unreasonable denial by the Standard Insurance Company. While this lawsuit was not handled by our disability insurance lawyers, we felt that disability insurance claimants could learn a lot from the findings of this disability lawsuit.
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California Federal Court Finds that Standard Insurance Company’s Review of LTD Claim was Insufficient; Remands Claim Back to the Plan Administrator

Posted in Disability Insurance Cases Nationwide, Standard

In a case not handled by Attorneys Dell & Schaefer, but which can be utilized to our clients’ advantage in the future, a Long Term Disability (LTD) Claimant has earned a partial victory against Standard Insurance Company.
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Unum abused its discretion by disregarding results of a functional capacity evaluation (FCE) of a disabled registered nurse

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

Can a Functional Capacity Evaluation be Useful to determine if a Claimant with Fibromyalgia is disabled?

It is very common for an insurance company to deny disability benefits to individuals suffering from Fibromyalgia. This happens more often than not due to the inability to provide the insurance company with objective proof of the disability, as none exists. There are no known objective tests for fibromyalgia at this point in time. Continue Reading

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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