MetLife abused its discretion when it terminated long-term disability benefits

When Judge Stephen V. Wilson delivered his decision on January 13, 2010, it probably resulted in some mixed feelings for Kelly Lavino. She had hoped for a clear victory in her battle with Metropolitan Life Insurance Company (MetLIfe) to have her long-term disability benefits restored. Instead the judge rendered a decision that may put her at the insurance company's mercy once again.

Lavino had been a project engineer for Malcolm Pitnie, Inc. One of the benefits of employment included coverage under a short-term and long-term disability plan issued by MetLife. This entitled Lavino, if she became and remained disabled, to long-term disability benefits.

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MetLife terminates long-term disability benefits to woman with fibromyalagia

January 13, 2010 was a good day for Kelly Lavino. U.S. District Court, Central District of California Judge  Stephen V. Wilson ruled that Metropolitan Life Insurance Company (MetLife) wrongfully denied disability benefits and abused its discretion when it decided to terminate Lavino’s long-term disability benefits. Let's review what Judge Wilson considered as he made his decision.

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10th Circuit Court of Appeals validates MetLife's accidental death and dismemberment denial

Verla Hancock participated in a group benefit plan sponsored by her employer, Intermountain Healthcare. The plan's claim fiduciary was Metropolitan Life Insurance Co. (MetLife). Under the plan, Verla obtained basic life insurance, supplemental life insurance and accidental death and dismemberment coverage (AD & D).

The plan stipulated that in order to benefit from the AD & D coverage, the policy holder had to be 1) Injured in an accident; 2) The accident had to be the sole cause of injury; 3) The accident had to be the sole cause of death; 4) The death had to occur within 365 days of the accident. The District Court found that policy beneficiary Terri Hancock had failed to demonstrate that she had a claim against MetLife for accidental death and dismemberment in her mother's death.

Would Terri Hancock's appeal be successful? Let's look at the facts surrounding Verla Hancock's death.

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Unum's claim handling exposes them to a multi-million dollar bad faith disability lawsuit

Ronnie Hogan sued Provident Life & Accident Insurance Company (Provident) and Unum Group Corp. (Unum) asserting claims under Florida law that the insurance companies had failed to attempt in good faith to settle his claim. Hogan also accused the insurance companies of making misrepresentations that would have made a settlement less favorable for him. He accused them of exercising general business practices that involved mishandling claims, breaching their fiduciary duty, common law fraud, negligence and even conspiracy to commit statutory violations. Provident and Unum asked the judge to dismiss Hogan's case based on a failure to state his claim or at least to pass judgment based on the pleadings presented by the two sides.

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Standard Insurance denies disability claim to a wheelchair bound woman

Lynda Sacks worked as a mortgage loan underwriter for Countrywide Home Loans, Inc. Her employer offered both short-term and long-term disability plans issued by Standard Insurance Company (Standard) effective January 1, 2005. Standard was responsible for funding both disability plans and making the claims determinations.

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Accidental death & disability dismemberment; AIG reversed by Colorado Court

After Hans-Gerd Rasenack was struck by a hit-and-run driver he applied for benefits under the accidental death and dismemberment insurance he paid for through employee deductions. The policy was issued through AIG Life insurance Company (AIG) and administered by AIG Claim Services. The policy provided an accidental paralysis benefit which covered hemiplegia.

At issue before the U.S. Court of Appeals for the Tenth Circuit was the decision of the U.S. District Court for the District of Colorado. The matter before the court arose under the Employee Retirement Income Security Act (ERISA) which lays out the procedures the court must follow in evaluating a case.

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$4.3 million in disability benefits for general surgeon following UNUM jury verdict

Our client, a general surgeon with chronic back pain, will finally receive the long-term disability benefits that he has been denied since October 2004. The United States District Court for the Central District of Illinois entered a final judgment of $402,268.00 against UNUM (formerly known as Paul Revere Life Insurance Company).  In addition to the $402,000 our client's disability policy will pay him more than $3.9 million over his lifetime.

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Liberty Mutual reverses decision to terminate disability benefits

Attorneys Dell & Schaefer win a long-term disability appeal on behalf of a psychologist whose disability benefits were denied by Liberty Mutual. Our client’s benefits were re-instated and she will now receive several hundred thousands of dollars throughout her lifetime. 

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Attorneys Dell & Schaefer Files Class Action Law Suit Against Prudential

On February 18, 2010, Attorneys Dell & Schaefer and lead trial attorney Gregory Dell filed a nationwide class action lawsuit against Prudential Insurance Company of America (“PRUDENTIAL, NYSE:PRU”), in the Eastern District of New York Federal Court. This lawsuit was filed to protect the potentially thousands of long-term disability claimants that filed a second/voluntary appeal after November 14, 2005 in which their second/voluntary appeal was denied by the same Prudential employee that denied the claimant’s first appeal. Dell & Schaefer is seeking to stop Prudential from conducting unlawful voluntary appeal reviews which violate ERISA. Additionally, the class action seeks an order requiring Prudential to re-evaluate thousands of voluntary appeals which were denied by Prudential after November 14, 2005.

The class is currently represented by four individuals that have each had their voluntary appeals denied by the same person that denied their first appeal. The Employee Retirement Income Security Act “ERISA” requires that the decision maker on a second appeal must be an independent person who was not involved with any previous denial of a disability claim. Unbeknownst to the Plaintiffs, Prudential had instituted an undisclosed cost-saving method of appeals review that blatantly violates federal ERISA law.

“This process is manifestly unfair, and we contend, not legal,” said attorney Gregory Dell. “The whole point of the ERISA-governed appeals process is to substantially reduce lawsuit expenses and create an environment where claim denials will be objectively evaluated. Prudential’s actions are a breach of their fiduciary duty to all disability claimants,” he said.

Through the nationwide representation of multiple claimants with Prudential long-term disability claim denials, our law firm obtained internal email communications which confirms Prudential’s unilateral decision to cut administrative cost by not providing a “full and fair review” of all voluntary appeals,” said Dell.

The reassessment of denied claims could result in millions of dollars of past due benefits. Prudential is one of the country’s largest group long-term disability insurers, with coverage in force for more than two million individuals.

Click here to if you believe you may have a potential claim against Prudential Insurance Company of America

Disability Attorneys Dell & Schaefer, established in 1979, have represented thousands of clients with their claims against disability insurance companies. The firm’s disability income division, managed by Gregory Michael Dell, is comprised of eight attorneys who represent claimants nationwide, throughout all stages (i.e. applications, denials, appeals, litigation, & lump-sum policy buyouts) of a claim for individual or group (ERISA) long-term disability benefits. For a free consultation, please call 800-828-7583 or use our contact page.

US Court of Appeals Upholds Denial of Disability Benefits By Metlife

Another case appeared in the U.S. Court of Appeals that highlights the importance of exhausting all the administrative options available before taking a case to court. Additionally, this case demonstrates the importance of a treating physician responding to all requests from a disability insurance company.

What happened here? And what can you learn from this case that could help you win your claim for disability insurance benefits?

First, we will look at the history of the case. Then we will look at the law as the court interpreted it.

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