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

An Illinois disability attorney recently filed a federal lawsuit against the Guardian Life Insurance Company of America. The plaintiff had contracted with Guardian Life to provide disability income insurance. Plaintiff filed a disability lawsuit to recover disability benefits that were wrongfully withheld by Guardian.

The Facts of the Case Against Guardian Life Insurance Company Of America

"Total Disability" in the Plan is defined by the following:

"Due to sickness or injury, you are not able to perform the major duties of your occupation."

Plaintiff became disabled in December 2009, suffering a severe shoulder injury that required surgery. This has restricted him from performing the physical duties that he performed before the injury occurred.

Plaintiff sent a timely application for benefits and submitted proof of loss, including a certification of his disability by an attending physician. Other documentation that was requested by Guardian was also provided.

Guardian was to provide monthly disability income benefit payments to Plaintiff if he ever became disabled. The monthly payments were to be for $2,160, plus the cost of living benefits in the event of Total Disability. This policy has been in effect since May 22, 1989 and continues to remain in full force and effect due to all of the premiums being paid on time.

Denial of Guardian Disability Benefits Claim

Despite the submission of the materials above, Guardian continued to ask for additional documentation and failed to approve Plaintiff's claim as of July 25, 2011.

Disability Lawyer Files Lawsuit Against Guardian

According to the lawsuit, Plaintiff claims the following:

• Guardian is in breach of the contract of insurance
• Guardian owes Plaintiff total disability payments under Policy No. G509736-4, corresponding to 3 months after the date of loss
• Guardian also owes for cost of living adjustments since that time
• A declaratory judgment should be granted that declares Plaintiff is entitled to monthly benefits as long as Plaintiff continues to meet the terms and conditions of the insurance policy

Relief Sought By Plaintiff In Guardian Lawsuit

Due to Guardian's actions, Plaintiff asks for the following from the Court:

• All benefits owed to the Plaintiff, along with accrued interest
• Declaration that Plaintiff is entitled to all future benefits so long as Plaintiff meets the standard for being totally disabled in the Plan
• All other relief that the Court finds 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:
Microsoft employee forced to sue Prudential for denial of ERISA disability benefits

Forced to hire a Washington disability lawyer to represent him in United States District Court to file an ERISA lawsuit against Prudential Insurance, a Software Design Test Engineer and his attorney allege that the insurer breached its contract, violated the consumer Protection Act, acted in bad faith, and was negligent in denying him ERISA long-term disability benefits.

Disability Blog & Cases:
Two Yellow Book employees sue Liberty Life Assurance Company of Boston for failing to pay ERISA disability benefits

Two different lawsuits were recently filed in California and Alabama Federal Court under the Employee Retirement Income Security Act (ERISA) against the Liberty Life Assurance Company of Boston. In both cases, it is alleged that Liberty improperly denied both plaintiffs their claims for long-term disability (LTD) benefits.

Disability Blog & Cases:
General surgeon files lawsuit against Provident Life and UNUM for disability benefits award

Having failed to uphold its obligation to provide disability benefits to one Provident Life and Accident/UNUM policyholder, the insurer now finds itself in litigation to solve the matter. A General Surgeon and his Florida disability attorney filed a complaint on July 11, 2011 in an effort to pursue the disability benefits he is entitled to under his UNUM insurance plan.

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Recently, two different lawsuits were filed under the Employee Retirement Income Security Act (ERISA) against the Principal Insurance Company of America. In both cases filed through the respective plaintiffs' disability attorney, Principal was alleged to have wrongfully denied the respective plaintiffs their claims for long-term disability (LTD) benefits.

The First Case

The plaintiff through a California disability attorney filed a lawsuit in the Federal Court. The plaintiff was employed as a general partner in an executive search firm, Vantage Partners. This occupation required high levels of energy, concentration, and intellect to perform successfully. While working for Vantage Partners, the plaintiff participated in a disability insurance plan provided by Principal. Principal was the plan administrator for the disability insurance plan.

In 2003, Plaintiff became sensitive to several forms of technology, including cellphones, that resulted in cognitive and physical symptoms, including memory loss, numbness, and pain. He continued working, but the symptoms gradually became worse over time between 2003 and March 2008.

The pains intensified to the point where Plaintiff had heart pain, sleep disturbances, and lack of concentration. His physician diagnosed him with fibromyalgia, which the Plaintiff had suffered from years earlier.

By this time, Plaintiff's business productivity had declined because of having to reduce his workday by several hours per day and reducing the number of client field visits. He also required more frequent breaks, as well as developed blurred vision from staring at a computer screen. Plaintiff' mental awareness continued to decline.

Despite this, in May 2008, Plaintiff decided to try to work full time again. This only lasted until October 2008, when his medical condition caused him to reduce his workload to part-time status. His symptoms continued to grow more intense.

In November 2008, he submitted a claim for benefits under the terms of the Policy continuously from October 2008 to the present. His condition will likely continue beyond the age 65 policy anniversary. Plaintiff has continually provided the Defendants with sufficient proof of his loss and his necessary medical and financial documentation of his right to benefits.

Principal did not decide on Plaintiff's claim until July 14, 2009, taking the time to conduct an investigation to find any reason to deny the Plaintiff of his benefits. This included three separate instances of surveillance on the Plaintiff, with no legitimate cause to conduct surveillance on him to begin with. Additionally, it also requested a paper medical review from a company that has a reputation for finding claimants not disabled. Principal also required the Plaintiff to undergo an examination with a doctor who had no expertise in treating and evaluating patients with exposure to electromagnetic fields.

Principal paid partial disability benefits for the period of October 3, 2008 until May 12, 2009, but denied the Plaintiff's claim for the period thereafter. In the lawsuit, Plaintiff claims Defendants ignored the evidence presented to them that proves Plaintiff's condition, misrepresented facts about the Plaintiff's condition, and have taken actions to deny paying the benefits called for in the terms of the Plan.

The Second Case

In the second case, an employee of Old Hickory Furniture Co., with the help of an Indiana disability lawyer, filed an ERISA lawsuit against Principal Life Insurance Company. He was provided with a LTD coverage plan that was fully insured by Principal. At the same time, Principal was also the Claims Adjudicator for the plan. In this case, it was alleged that Principal did not have a principled and reasoned decision making process for denying the plaintiff's claim for LTD benefits, but was instead influenced by its inherent conflict of interest as a fiduciary, payer, and claims adjudicator of the Plan.

Relief Sought in the Lawsuits

In both of the cases mentioned above, the relief sought by the Plaintiffs from Principal in their lawsuits comprises of:

• A declaration that the plaintiffs are entitled to LTD benefits under their respective plans
• Benefits that have not been paid to be paid, along with interest
• Reimbursement for attorney fees and costs
• All other relief that the court deems proper 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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FAQ - General Questions:
Will a disability insurance company watch me on Facebook or other social media sites?

In this video Nationwide Disability Insurance Attorney Gregory Dell discusses the precautions that all disability insurance claimants using Facebook should consider.

Disability Blog & Cases:
Employees of Boeing and Bank of America sue Aetna for denying disability benefits under ERISA regulations

Aetna Life Insurance Company (Aetna) was recently sued three times in the Federal District Court of South Carolina by three separate Plaintiffs for short-term and/or long-term disability benefits violations under the Employee Retirement Income Security Act (ERISA). In each of the three cases filed by South Carolina disability attorneys, Aetna is accused of illegally denying the Plaintiffs’ claims for short-term disability (STD) and/or long-term disability (LTD) benefits as promised under their respective plans.

Disability Blog & Cases:
Panasonic and Microsoft employees sue Prudential in Tennessee and Indiana for denying their disability claims

Two Plaintiffs filed Employee Retirement Income Security Act (ERISA) lawsuits against the Prudential Insurance Company of America in Tennessee and Indiana Federal Court. In both cases it is alleged that Prudential wrongfully denied the claims of both Plaintiffs for long-term disability (LTD) benefits.

Disability Blog & Cases:
Wyeth Pharmaceutical/Pfizer Senior Attorney suffering from disability sues Ohio National Life Insurance Company for denial of disability benefits

A Pennsylvania disability attorney recently filed a federal lawsuit against The Ohio National Life Insurance Company. The Plaintiff worked as a Senior Attorney in the Wyeth Pharmaceutical (now Pfizer) Global Business Development Legal Group. Plaintiff purchased a Disability Insurance Policy from Ohio National on May 14, 1999, then purchased another Disability Insurance Policy from Ohio National on September 24, 1999.

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A South Carolina disability attorney recently filed a federal ERISA lawsuit against the Liberty Life Assurance Company of Boston. The plaintiff was employed by Michelin North America, Inc., who contracted with Defendant Liberty Life Assurance Company of Boston d/b/a Liberty Mutual to provide long-term disability benefits to its employees. By virtue of his employment, Plaintiff was covered by Michelin's Long-Term Disability Group Policy.

The Plaintiff was forced to file a disability lawsuit under the Employment Retirement Income and Security Act (ERISA) to recover long-term disability benefits that were wrongfully withheld by Liberty.

The Facts of the Case Against Liberty Insurance Company

Plaintiff is a United Kingdom citizen and is a resident alien of the State of South Carolina, residing in Greenville County.

In October 2005, Plaintiff began receiving medical treatment for Chronic Bi-Polar Disorder (Bi-Polar I) and Depression. His condition worsened to the point where he could no longer work as a engineer project/process manager for Michelin. He was placed on Short-Term Disability and began receiving his short-term disability benefits from Liberty on November 17, 2008.

On or about May 20, 2009, Plaintiff was placed on Long-Term Disability and received those benefits from Liberty. His condition worsened to the point in November 2009 where he had to cease his employment with Michelin after nearly 38 years of employment.

On December 27, 2009, Plaintiff's wife of 30 years died from breast cancer that turned into liver cancer, which deepened Plaintiff's depression. This continued a trend of his condition worsening to the point that he had much difficulty doing the simplest day-to-day tasks, such as paying the bills, maintaining his home, and caring for himself. This led to Plaintiff being hospitalized and receiving pharmaceutical treatment for his Bi-Polar Disorder and Depression.

Plaintiff is unable to recover to the point where he will be able to work in any sort of fulltime employment, as he continually deals with episodes of disorientation and memory loss, making the completion of daily tasks impossible.

On or about September 5, 2010, Plaintiff experienced a Grand Mal Seizure, which led to his hospitalization. He experienced another such seizure on November 19, 2010, resulting in 3 weeks of hospitalization in intensive care at the Carolina Center in Greenville County.

Denial of Liberty Disability Benefits Claim

Despite the facts mentioned above, on or about May 19, 2010, Liberty informed Plaintiff that he no longer met the Policy's definition of disability, his benefit payments would stop on May 19, 2011, and his LTD claim would be closed as of May 20, 2011.

Plaintiff requested a review of Liberty's decision to deny his LTD claim.

Despite the fact that Plaintiff was 58-years-old, unlikely to be trained for a new career that would provide enough income for him to live, and to even struggle with handling day-to-day-affairs, Liberty upheld its denial of Plaintiff's LTD claim on or about August 11, 2010.

South Carolina Disability Lawyer Files Lawsuit Against Liberty

According to the lawsuit, Plaintiff alleges that Liberty did the following to the Plaintiff:

• In bad faith, arbitrarily, maliciously, wrongfully, and without due cause deny the Plaintiff his claim for LTD benefits.
• Failed to thoroughly and adequately review Plaintiff's medical history and records, ignoring Plaintiff's seizures, and disregarded Plaintiff's physicians' opinions on Plaintiff's inability to resume employment and handle simple day-to-day tasks.
• Liberty's actions and omissions in investigating, reviewing and deciding Mr. Robinson's LTD claim were unreasonable, improper, and in bad faith.
• Liberty violated terms of the LTD benefit plan between it and the Plaintiff.
• Caused actual and consequential damages to the Plaintiff, both now and in the future, including attorney's fees and costs, as well as other damages.

Relief Sought By The Plaintiff In The Liberty Lawsuit

Due to Liberty's actions, Plaintiff seeks the following from the Court:

• A trial by jury.
• An award of full coverage under the LTD benefit plan retroactive to May 19, 2010, including any prejudgment interest that the Court may deem appropriate.
• An award for actual and compensatory damages, pre-judgment interest, and appropriate punitive damages.
• An award of attorney's fees and costs for bringing this lawsuit to the Court.
• An award of all other relief that the Court deems proper 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:
Prudential denies disability benefits to KPMG employee suffering from “sick sinus” syndrome

An Oregon disability attorney was forced to file a federal ERISA lawsuit against The Prudential Insurance Company of America after his client was wrongfully denied continued long-term disability benefits.

Disability Blog & Cases:
After being denied disability benefits, Rabbi suffering from bipolar disorder sues CIGNA

An Indiana disability attorney recently filed a federal lawsuit against the Cigna Life Insurance Company of New York (Cigna). The Plaintiff, by virtue of her employment, was covered by a monthly disability benefit plan with Cigna. When Cigna denied wrongly withheld disability benefit payments, the Plaintiff was forced to file a lawsuit.

Disability Blog & Cases:
Disabled Georgia man sues Boston Mutual for denial of disability benefits

A Georgia disability attorney recently filed a federal ERISA disability lawsuit against Boston Mutual Insurance Company of America and Disability Reinsurance Management Services (DRMS) to recover long-term disability benefits that were wrongfully withheld.

Disability Blog & Cases:
Jury orders Unum Provident to pay lifetime long term disability insurance benefits to physician

Dr. G, has been battling Provident Accident and Life Insurance Company (acquired by Unum) since his long term disability insurance benefits were denied in 1999. After two jury trials, multiple motions for summary judgment, and an appeal, Dr. G has once again won a verdict granting him lifetime disability benefits. It is likely that Unum will once again appeal the jury verdict and this case will continue for several more years. Dr. G is currently owed approximately $1,400,000 in unpaid disability benefits and prejudgment interest. This case is an extreme example of the type of litigation that can ensue if a long term disability claim is denied. Our law firm has litigated hundreds of cases of Unum Provident nationwide; however this case was not handled by our law firm. This case deals with the issue of lifetime total disability benefits in ERISA exempt disability policies.

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A Texas disability attorney recently filed a federal ERISA lawsuit against the Guardian Life Insurance Company of America after Guardian incorrectly denied long term disability benefits.

The Facts of the Case Against Guardian Life Insurance Company Of America

Plaintiff worked at Integra and was a participant of its Long-Term Employee Welfare Plan.

Plaintiff suffers from a medical condition, "organic brain syndrome" or "organic delusional or hallucinogenic syndrome," which is an exception to the limitation of coverage for "medical conditions."

This condition will not allow the Plaintiff to perform the duties of any occupation as defined in the Plan.

Denial of Guardian Disability Benefits Claim

On August 6, 2010, Guardian stopped paying LTD benefits to the Plaintiff.

Guardian also denied Plaintiff's appeal.

Plaintiff has complied with all of the requirements to exhaust every administrative appeal.

Plaintiff was and continues to be disabled as defined by the terms of the Plan.

Guardian was both the determiner of claims and the payer of claims, indicating a conflict of interest.

Texas Disability Lawyer Files Lawsuit Against Guardian

According to the lawsuit, Plaintiff claims the following:

• Plaintiff is entitled to LTD benefits as defined in the Plan, as Plaintiff has met the definition of "disability" described in the Plan.
• Plaintiff has met the obligations to make a proof of claim in accordance with the terms of the Plan.
• Guardian's decision to deny benefits to the Plaintiff was capricious and arbitrary.
• Plaintiff seeks benefits from Guardian that have not yet been paid.

Relief Sought By The Plaintiff In The Guardian Lawsuit

Due to Guardian's actions, Plaintiff seeks the following from the Court:

• An award that encompasses reasonable and necessary court costs to the Plaintiff, as well as attorney's fees due to the filing of this lawsuit.
• Guardian pays Plaintiff full employee benefits that have incurred and that have not been paid yet.
• Guardian reinstates Plaintiff on the Plan for future payments in accordance with the terms of the Plan.
• Guardian reinstates waiver of premium status for Plaintiff's life insurance.
• Guardian is to pay all reasonable attorney's fees that have been incurred as a result of filing this lawsuit.
• Guardian is to pay pre-judgment and post-judgment interest on benefits owed to the Plaintiff.
• Guardian is to pay all costs that the Court finds 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:
Standard Motor Products Employee file an ERISA Lawsuit against Prudential Insurance for denied disability benefits

Claiming ERISA (Employee Retirement Insurance Security Act) violations, Jacqueline Musgrove and her Kansas disability attorney filed a lawsuit against Prudential Insurance Company of America on July 1, 2011 for her long term disability benefits. As an assembler of electronic automotive parts, Musgrove worked for Standard Motor Products from September 28, 1988 until March 22, 2010. In March 2010, Musgrove was no longer able to perform her job duties due to “chronic lower back and left lower extremity pain.”

Disability Blog & Cases:
UnitedHealth Group, Inc. Recruiting Manager suffering from depression and anxiety denied benefits

A Minnesota disability attorney recently filed a federal ERISA lawsuit against both UnitedHealth Group Long-Term Disability Benefit Plan (UHG) and Sedgwick Claims Management Services (Sedgwick) after the client was wrongfully denied long term disability benefits.

Disability Blog & Cases:
Liberty Life Assurance Company of Boston sued under ERISA in three different cases for denial to pay disability benefits

Recently, three federal lawsuits were filed under the Employee Retirement Income Security Act (ERISA) against the Liberty Life Assurance Company of Boston. In all three cases that were filed through the respective plaintiffs’ disability attorney, Liberty was alleged to have improperly denied the plaintiffs their claims for disability (LTD) benefits.

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Two different ERISA lawsuits were recently filed by disability attorneys in California and Florida against Reliance Standard Insurance Company for the wrongful denial of disability benefits.
 

The First Case

In the first case, the plaintiff, through a California disability attorney filed a lawsuit in the District Court for Eastern California. The plaintiff was employed by Nu Skin Enterprises. While working for Nu Skin Enterprises, the plaintiff participated in Nu Skin's Long-Term Disability Package to its employees. Reliance was the plan administrator for the disability insurance plan.

The plaintiff applied for Long Term Disability through Reliance on June 1, 2007 due to falling ill and experiencing severe pain in both his hips and knees that kept him from being present at work and being unable to perform the duties of his position for three continuous years. Reliance stated its approval of Plaintiff's claim for benefits on December 14, 2007. Plaintiff applied for Social Security benefits as required by the Plan and his disability began on June 1, 2007. Plaintiff received a back award of $21,769.68 from the Social Security Administration and made a payment in this same amount to Reliance to meet the terms of the Plan. Plaintiff still receives Social Security Disability Benefits.

On September 29, 2009, Reliance informed Plaintiff that further long-term disability benefits would be denied based on the condition that the Plaintiff was suffering from a mental or nervous disorder. Reliance informed Plaintiff that because he was not in a Hospital or Institution, he could not receive further payments beyond August 30, 2009, 24 months after the first benefits were paid out.

The plaintiff appealed the denial and was issued a final denial by Reliance on October 26, 2010. In the lawsuit, the Plaintiff alleged that Reliance breached the terms of the Plan, which has caused the Plaintiff to suffer currently and to continue suffering in the future.

The Second Case

The second lawsuit was filed at the Middle District Court for the District of Florida by a Florida disability attorney. The plaintiff in this case was an employee for Southern Freight. He was provided with a LTD coverage plan that was fully insured by Reliance. Plaintiff received short-term benefits that ran from January 26, 2010 to April 27, 2010. However, despite continuing to fulfill the definition of "disabled" as defined by the Plan and being backed by the written testimony of his physicians, Reliance denied LTD benefits on July 21, 2010.

Relief Sought in the Lawsuits

In the aforementioned cases, the relief sought by the plaintiffs from Reliance in their lawsuits comprises of:

• A declaration that the plaintiffs are entitled to LTD benefits under their respective plans
• Benefits that are due and have not been paid, as well as interest
• An award of attorney's fees and costs
• Any other relief that the court deems just and appropriate

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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