The Connecticut Plaintiff, Heimeshoff, filed an ERISA lawsuit against Hartford challenging their denial of long-term disability benefits. Hartford filed a Motion to Dismiss as Heimeshoff filed her lawsuit past the 3-year statute of limitations which was clearly stated in her policy. The District Court granted Hartford's Motion to Dismiss and Heimeshoff appealed.
Continue Reading...In the matter Thurber v. Aetna, Aetna brought a counterclaim against Thurber for the return of overpaid short-term disability benefits pursuant to ERISA 29 USC §1132 (a)(3), which authorizes civil actions brought to obtain appropriate equitable relief to enforce any provisions of this subchapter or the terms of the plan. Thurber had an auto accident and was receiving no fault insurance benefits and STD payment. Thurber’s STD policy stated that benefit paid by a n-fault auto insurance company would offset the STD benefit. Aetna paid the STD benefits and sought an overpayment for any funds paid by the auto insurance carrier.
Continue Reading...The diagnosis of fibromyalgia is made purely on clinical findings based on the history obtained from the patient and the doctor's physical examination. There are no objective tests that specifically point the doctor to the diagnosis of fibromyalgia. However, there are several tests that can be done to exclude other possible diagnoses.
The National Health Institute explains that, in patients with chronic widespread body pain, the diagnosis of fibromyalgia can be made by identifying point tenderness areas (typically, but not always, patients will have at least 11 of the 18 classic fibromyalgia tender points), by finding no accompanying tissue swelling or inflammation, and by excluding other medical conditions that can mimic fibromyalgia.
Fibromyalgia patients have widespread body pain which often seems to arise in the muscles. Although many fibromyalgia patients are aware of pain while they are resting, it is most noticeable when they use their muscles. Their discomfort can be so severe it may significantly limit their ability to lead a full life. Patients can find themselves unable to work in their chosen professions and may have difficulty performing their everyday tasks. Most fibromyalgia patients learn quickly there are certain things they do on a daily basis that seem to make their pain problems worse. These actions usually involve the repetitive use of muscles or prolonged tensing of a muscle, such as muscles on the upper back while looking at a computer screen.
Courts Address Problems Producing Objective Evidence in Fibromyalgia Cases
A common reason for the denial of disability benefits when a claimant is diagnosed with fibromyalgia or chronic fatigue syndrome is the failure to provide objective medical evidence of these disorders. Some policies specifically require objective proof of illness. This policy language becomes problematic when disabling conditions such as chronic fatigue syndrome and fibromyalgia cannot be proven by blood tests, x-rays or CT scans.
The First and Second Circuit Courts have addressed this very issue, recognizing that the causes of Fibromyalgia are unknown, that there is no cure and, of greatest importance, its symptoms are entirely subjective. In the case of Cook v. Liberty Life Assurance Company, the court held that "since there are no specific laboratory findings that are widely accepted as being associated with CFS, and given the nature of Cook's disease, it was not reasonable for Liberty to expect her to provide convincing ‘clinical objective' evidence that she was suffering from CFS."
Courts do recognize, however, that there are physical limitations imposed by the symptoms of theses illness that do lend themselves to objective analysis. As a result, Fibromyalgia can be diagnosed, more or less objectively, by the 18-points test that can be performed by a rheumatologist or primary care physician.
Failure to Undergo 18 Point Tender Point Test Can Result in a Disability Denial
It is very important to treat with a physician that is experienced in the diagnosis and treatment of fibromyalgia, such as a rheumatologist or your primary care physician if he or she has experience with this disease. A primary care physician may suspect that you have fibromyalgia, but may not be familiar with the signs and symptoms and the way in which to confirm the diagnosis.
Hartford Insurance Disability Denial Upheld By Court of Appeals
On January 24, 2013, the Second Circuit Court of Appeals addressed this very issue in the case of Ianniello v. Hartford Life and Accident Insurance Company. In this case, the Plaintiff, Virginia Ianniello, was suffering from chronic fatigue and fibromyalgia and, as a result, could not perform the material duties of her occupation. Hartford denied her claim on the basis that she failed to undergo the tender points test. The Plaintiff argued that it was unreasonable for Hartford to require her to undergo such testing since her policy does not require it and she was not asked specifically to provide it. Furthermore, she argued that no objective test for fibromyalgia has been generally recognized by the medical community. The Court held that "although the terms of the policy did not require objective evidence of disability, it was not unreasonable for a plan administrator to require tender points testing so long as the claimant was notified." The records showed that the Plaintiff was well aware of the use of the tender points as a diagnostic criterion for fibromyalgia, and had the opportunity to obtain and present such testing results to Hartford. Because the Plaintiff bore the burden of showing that she was disabled, Hartford's demand for objective evidence was neither arbitrary nor capricious.
Ms. Ianneillo's failure to undergo a tender points examination cost her the long-term disability benefits she would have been entitled to collect had she provided such evidence. This is why it is extremely important for you and your treating physicians to understand the terms and conditions spelled out in your policy and to pay attention to the reasons for the initial denial. It is also important to ensure that you treat with the proper physician who specializes in the very disease or illness that prevents you from working. This case was not handled by our law firm, but with proper guidance prior to any claim denial, this seems like a claim denial that could have easily been avoided.
If your claim for short or long term disability benefits has been denied, please contact Attorneys Dell & Schaefer for a free consultation.
The case of Reindl v. Hartford Life and Accident Insurance Company is one example of what can occur if you fail to file a timely appeal. Our law firm did not handle this disability lawsuit, but we have blogged about it so that this situation does not happen to anybody with a Hartford disability claim. The Plaintiff, Ms. Reindl participated in an employee welfare benefit plan administered by Hartford during her employment with RKM Enterprises. She stopped working in 2005 and applied for disability benefits which were approved. In 2008, Hartford sent her a letter terminating her benefits claiming that she was able to work and gave her 180 days to file an appeal. Ms. Reindl hired an attorney to file the appeal for her. In December of 2008, her attorney sent a letter to Hartford requesting her claim file and medical records, but failed to file the appeal prior to the 180 day deadline. Hartford did not accept the appeal stating that it was received after the 180 days had expired. Plaintiff’s attorney claimed that the letter he sent in December of 2008 requesting records should be considered the appeal. Hartford disagreed.
A Mere Request for Records Is Not Considered an Erisa Appeal
Ms. Reindl filed a lawsuit against Hartford challenging termination of their long-term disability benefits. The District Court Judge in Missouri granted Hartford’s Motion for Summary Judgment on the basis that Plaintiff’s attorney failed to file a timely appeal and the letter sent by Plaintiff’s attorney requesting records was not considered an appeal. Plaintiff appealed the decision to the 8th Circuit Court of Appeals. The Court upheld the lower court’s decision holding that a timely administrative appeal is a prerequisite to filing an action in federal court challenging the denial of benefits under a plan governed by ERISA. The Court concluded that Hartford’s determination regarding the December 2008 letter was reasonable, as a request for records is not an appeal. Therefore, the decision of the lower court was affirmed and Plaintiff cause of action was dismissed with prejudice.
How Can You Prevent This Very Situation From Happening to You?
The best solution is to make sure to contact an experienced ERISA attorney as soon as you receive your denial letter. This way you can ensure that your attorney has ample time to investigate and build up your claim in order to put together an elaborate appeal in a timely manner. The failure to exhaust your administrative remedies will prevent you from being able to bring suit in a court of law. Once this mistake is made, it cannot be corrected. You can find helpful information about ERISA Appeals by visiting this page.
Quite often, insurance companies create a maze of entities that could confuse the most cautious policy holders. One entity may own the fund. Another entity may administer the fund. So who should a plaintiff sue when these corporate entities conspire to break a promise to pay disability benefits? Fortunately, skilled disability lawyers know these insurance company tricks and can figure out who is ultimately responsible for a wrongful denial of disability benefits. Sometimes, it depends on bringing the right claim against the right party.
The case of Franklin v. AT&T Corporation is a prime example. The plaintiff worked at AT&T as a systems analyst for eleven years. She had long-term disability benefits under the AT&T Long Term Disability Plan for Management Employees ("the Plan") that were administered by Metropolitan Life Insurance Company ("MetLife'). Sedgwick Claims Management currently handles all AT&T disability claims. In 1999, the plaintiff filed for and received the long-term disability benefits arising from a number of causes including Crohn's disease, breast cancer, chemotherapy, chills, night sweats, nausea and depression.
Three years later, MetLife reevaluated the plaintiff's eligibility for long-term disability benefits. MetLife had demanded that the plaintiff apply for Social Security disability insurance benefits and, when she obtained them, reimburse the Plan for all the social security benefits she received when the Social Security Administration agreed she had been totally disabled since 1999. Soon after cashing the check, MetLife determined that the plaintiff was not in fact totally disabled and stated she could return to full-time work in other occupations. This conclusion led MetLife to deny the plaintiff's claim for continued long-term disability benefits.
The plaintiff sued, arguing that her long-term disability benefits were wrongfully denied by MetLife and the Plan. Both defendants filed a number of motions. MetLife challenged the plaintiff's ability to hold the insurance company accountable for its role in denying coverage because AT&T had fired MetLife as the plan administrator more than a year and a half before the plaintiff filed suit. The Plan claimed that the denial was within its discretionary authority.
The Court Awards Disability Benefits for What MetLife Did
A federal court in Dallas ruled that the plaintiff was entitled to long-term disability benefits and that MetLife was entitled to be dismissed from the lawsuit as it was merely the administrator. The plaintiff could only recover the disability benefits from the Plan because it had not brought a claim against MetLife for breach of the duty of good faith and fair dealing, which requires Texas insurance companies to treat policy holders in a certain manner. Nonetheless, MetLife's actions were the central focus of why the court held the Plan responsible. The court specifically noted:
While MetLife wasn't financially responsible to the plaintiff in this case, other companies may think twice before employing MetLife as a plan administrator in the future. The federal court held that MetLife had "cherry-picked" facts in the administrative file to support its position and, for this reason, MetLife had acted in an arbitrary and capricious manner. These wrongful actions persuaded the federal court to order the Plan to reinstate the plaintiff's long-term disability benefits. Ironically, the plaintiff could have prevailed against MetLife as well (above and beyond the disability benefits recovered against the plan) had the plaintiff's lawyer brought a claim for breach of the duty of good faith and fair dealing.
Franklin v. AT&T Corp., No.03:08-CV-1031-M, 2010 WL 669762 (N.D. Tex. Feb. 24, 2010)
Disability Blog & Cases:
Boeing Employee Suffering From Severe Chronic Back Pain Sues Aetna For Denial Of ERISA Benefits
An Oregon disability lawyer has filed a lawsuit in the District Court of Oregon against The Boeing Company Employee Benefit Plan (Boeing) and Aetna Life Insurance Company (Aetna). The Plaintiff, Susan A, worked as an assistant to the Vice President and General Counsel of The Boeing Company. Due to her employment, Plaintiff was protected by Boeing's Employee Benefit Plan.
Disability Blog & Cases:
Unum Disability Denial With Medical Record Review Only
Can Unum deny disability claims and appeals by merely conducting paper reviews of a claimant’s medical records? Yes, apparently they can.
Disability Blog & Cases:
Sedgwick And AT&T Disability Denial Scheme Exposed In ERISA Lawsuit
On May 14, 2012, the U.S. District Court for the Northern District of California issued an order on a very hot topic for ERISA Disability Lawsuits. The issue concerns how much “Discovery” a denied person is able to obtain from the Disability Insurance Company while litigating a case.
FAQ: Appeals & Lawsuits:
If my long term disability benefits are governed by ERISA and I win at trial, does the insurance company have to pay me for the remainder of the policy life, or a lump sum amount?
Should your case go to trial under an ERISA governed disability plan and you win the insured is only entitled to an award of disability benefits that have not been paid by the insurance company. This is further contingent on whether the insurance company denied your claim under the “own occupation” or “any occupation” definition of disability...
Disability Blog & Cases:
California Federal Court Finds That MetLife Abused Its Discretion And Awards Financial Analyst Long-Term Disability Benefits
Shelia W. and her California disability lawyer prevailed in a lawsuit against MetLife when the United States District Court of the Southern District of California found the insurer to have abused its discretion when it terminated Shelia’ disability benefits under the “own occupation” standard.
Disability Blog & Cases:
Sun Life Pays Disability Benefits For Three Years To A Claimant Who Wasn’t Actually Covered Under A Sun Life Policy
In the case of Pamela P. v. Sun Life and Health Insurance Company, the court record shows that Pamela P. applied for long-term disability benefits under an employee benefits plan that was maintained by Los Padres Bank for its employees and was awarded disability benefits for over three years. Said plan was underwritten by Sun Life with its Group Certificate governed by ERISA (the Employee Retirement Income Security Act)...
Disability Blog & Cases:
Another Cigna Hired Gun Doctor To Be Exposed!
Utah Court Wants To Know Relationship Between Dr. Carol Flippen and Cigna Life Insurance
The Plaintiff, Christopher L., with the help of his Texas Disability Attorney, has filed this lawsuit against Sedgwick Claims Management Services , Inc. (Sedgwick), Administrator of the Hewlett-Packard (HP) Company Disability Plan.
In Christopher L. v. Sedgwick Claims Management Services, Inc., Plaintiff has filed this lawsuit to regain all short-term and long-term disability payments that were wrongfully terminated.
Plaintiff's Rights of Disability Benefits Under The Plan
Plaintiff is a 44 year old man who is a citizen and resident of Tomball, Texas. Sedgwick was responsible for funding and administering the Plan, which Plaintiff was entitled to the benefits of based on his employment with HP as a Project Manager.
Plaintiff was forced to cease work on April 25, 2008 due to bipolar disorder, schizophrenia, chronic fatigue, diabetic neuropathy, memory loss, sleep issues, fibromyalgia, depression, vision problems, high blood pressure, and sunlight sensitivity.
Plaintiff filed applications for short term and long term disability benefits. Plaintiff's claim for short term disability benefits were granted by Sedgwick. Plaintiff later filed for long term disability benefits, which were initially granted by Sedgwick on December 1, 2008.
Sedgwick Changes Decision And Denies Future Long Term Disability Benefits
On August 20, 2010, Sedgwick denied further long term disability benefits to the Plaintiff. Plaintiff had 180 days to appeal this decision. The disability standard to apply in order to approve or deny a claim was being unable to perform "Any Occupation." If the application was approved, the Plan would pay a monthly benefit of $4,351.72.
Plaintiff requested an administrative review of the denial of benefits on December 6, 2010. Plaintiff included medical records to show his total disability, and thus, his argument for being approved for further long term disability benefits. In addition, the Social Security Administration issued a fully favorable decision on Plaintiff's claim for disability benefits under Title II and Title XVI of the Social Security Act.
Despite this, Sedgwick upheld its original denial on March 17, 2011. Sedgwick also informed Plaintiff that he had exhausted all administrative remedies. Due to this, Plaintiff has filed this lawsuit against Sedgwick.
Lawsuit Filed Against Sedgwick
Plaintiff filed a lawsuit against Sedgwick because Sedgwick discounted the opinions of Plaintiff's treating physicians, of others, and of the documented limitations that the Plaintiff suffers from due to his medical conditions, thereby preventing him from fulfilling the duties of any occupation and entitling him to the long term disability benefits as detailed under the Plan.
Plaintiff claims that Sedgwick failed to give proper weight to the evidence submitted to them regarding Plaintiff's condition and his inability to work. Plaintiff also claims that Sedgwick did not properly define disability as outlined in the terms of the Plan, calling it "unreasonable, arbitrary, and capricious." Plaintiff claims that Sedgwick failed to fulfill its contractual obligations to provide disability benefits to the Plaintiff.
The Relief Sought
Plaintiff wants a judgment against Sedgwick for the following:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Aetna Is Sued For Failure To Pay ERISA Benefits To Boeing Employee For Injuries Sustained In A Shooting
A Washington disability lawyer filed a federal lawsuit in the District Court for the Western District of Washington, at Seattle, against Aetna Life Insurance Company (Aetna) and The Boeing Company Long Term Disability Plan (Boeing). The Plaintiff, Patrick D., worked as a real-time software engineer for Boeing, which contracted with Aetna to provide long-term disability coverage to its employees. The Plaintiff’s employment with Boeing afforded him the protections under this Plan.
Disability Blog & Cases:
Unum Sued By An Ophthalmologist And A BJC Healthcare Employee Who Both Were Denied Disability Benefits
Unum Life Insurance Company Of America (Unum) was sued in two different lawsuits filed in the Federal Courts of Missouri, by two plaintiffs who did not receive the long-term benefits that were entitled to them under the terms of their respective Plans that were issued and administered by Unum.
Disability Blog & Cases:
Misrepresentation By Claimant Results in Unum Disability Claim Denial
Unum disability claimants need to be aware that when filling out an application for disability insurance benefits it is necessary to disclose your medical history accurately and to make sure your insurance agent is doing the same. Should the insurance company discover a material misrepresentation, the policy could be rescinded, and the claimant could be required to pay back any and all benefits previously paid and then be subject to a fraud investigation...
In Hoang N VS Unum Life Insurance Company of America and Northrop Grumman Long Term Disability Plan, Plaintiff wants reinstatement of long term disability payments that were originally paid, then terminated, by Unum.
The Plaintiff, with the help of his California Disability Attorney, has filed this lawsuit in the United States District Court Central District of California against Unum.
Plaintiff's History and Reasons For Filing a Claim
Plaintiff worked as a systems administrator and network engineer at Northrop Grumman. His employment entitled him to be a participant in the Long Term Disability plan and other employee benefit plans that were established and maintained by Northrop Grumman.
Plaintiff suffered serious injury to his cervical spine when a heavy metal door fell on his head at work and knocked him to the ground unconscious. This accident caused the Plaintiff to become disabled as defined under the terms of the LTD Plan. Plaintiff filed a claim with the Defendants for LTD benefits under terms of the Plan. The Defendants originally approved the claim for LTD benefits.
Unum and Northrop Grumman Improperly Terminate Long Term Disability Benefits
On or about November 4, 2008, Defendants abruptly terminate the LTD benefits received by the Plaintiff. From the period of November 2008 through June 2009. Plaintiff's doctor reports that the Plaintiff was suffering from the following conditions:
Plaintiff filed an appeal of Defendants' denial on June 12, 2009. Unum replied to Plaintiff on June 15, 2009 that they could not review Plaintiff's claim because the appeal came after the 180-day deadline, meaning that the original decision on the claim must stand.
After Plaintiff received a Social Security Administration decision in his favor, Plaintiff again requested that Defendants reinstate his long term disability benefits on April 25, 2011. Once again, on May 2, 2011, Defendants deny Plaintiff's request.
Due to the fact that Plaintiff has exhausted all administrative remedies required under ERISA, Plaintiff has filed this lawsuit against Unum and Northrop Grumman.
Basis for Plaintiff's Lawsuit
Plaintiff claims that Defendants failed to allow Plaintiff to file an administrative appeal against California's notice-prejudice rule, which only prevents a person from filing an administrative appeal after a deadline if the Defendants are actually and substantially prejudiced by the delay. Plaintiff also claims that Defendants prevented Plaintiff from filing an administrative appeal when Defendants knew that the Plaintiff was suffering from severe cognitive problems.
Plaintiff also claims that Defendants did not provide any reasonable explanation of why Plaintiff's appeal was not considered, nor why his original claim was denied. Defendants also did not provide any explanation of what materials could have been added to increase the chances of a successful claim.
Plaintiff also claims that Defendants failed to adequately inform the Plaintiff of notice requirements under ERISA. Additionally, Defendants failed to properly investigate the merits of the Plaintiff's claim.
Type of Relief Requested from the Court
Plaintiff requests that the Court grant the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
New York Federal Court Denies MetLife’s Motion To Dismiss Lyme Disease Victim’s Petition For Disability Benefits
In the case of Karen N. v. Metropolitan Life Insurance Company et. al, the United States District Court of New York, after hearing arguments from both sides regarding MetLife’s Motion to Dismiss the case, denied the motion in its entirety and directs the parties to appear for a status conference to determine how and when the case will proceed. And, while the Court did deny the insurer’s motion, that doesn’t mean that Karen N. will receive a favorable outcome in her lawsuit to receive her disability benefits. It does mean that the Court believes that the case deserves to be heard and ruled upon once all facts have been established.
Disability Blog & Cases:
Pennsylvania Pharmacy Owner Learns The Hard Way That Accuracy Is Everything When Applying for Disability Insurance Benefits
On January 28, 2011, the United Sated District Court of the Eastern District of Pennsylvania granted Berkshire Life Insurance Company of America’s Motion for Summary Judgment in Michael S. v. Berkshire Life Insurance Company of America, et. al. In addition, the plaintiff’s disability policy and FIO policy were rescinded negating...
FAQ: Social Security Disability Benefits
Can My Disability Insurance Benefits Be Denied If I Am Approved For Social Security Disability Benefits?
Disability Insurance Attorneys Gregory Dell and Cesar Gavidia discuss the misconception that a claimant will be approved for long term disability insurance benefits if social security disability benefits are approved.
The Plaintiff, Joni D., with the help of her Alabama Disability Attorney has filed a lawsuit against Reliance Standard Life Insurance Company and the Group Long Term Disability Policy For Employees Of Madison County Community Hospital for the wrongful termination of long term disability benefits.
In Joni D. Vs. Reliance Standard, Plaintiff is suing the Defendants for the unjust termination of her long term disability benefits under the terms of the long term disability plan.
Plaintiff Needed To Use LTD Plan
Plaintiff worked as a Critical Care Registered Nurse, an occupation that required her to perform and fulfill numerous essential job functions, requirements, and qualifications associated with her occupation, including providing direct and indirect patient care, responding quickly and accurately to changes in condition or response to treatment, and performing general nursing duties. Due to her employment, Plaintiff was eligible and partook in the LTD policy that was underwritten by Reliance Standard.
On or about May 5, 2003, Plaintiff became unable to work due to a culmination of disabling physical health issues. These issues were clearly documented in the Plaintiff's medical records. Plaintiff became totally disabled on a permanent basis on or about February 25, 2010. This prevented her from any type of gainful employment as was confirmed by the Social Security Administration as of May 4, 2003. But does receiving disability benefits from the Social Security Administration mean the insurance company will also continually provide long term disability benefits? As Joni came to find out, that answer is no.
Filing of Benefits
Plaintiff filed for LTD benefits on or around November 24, 2003. Reliance Standard agreed to pay the LTD benefits effective October 31, 2003. According to the terms of the Plan, the Plaintiff's condition changed from "disability" to "inability" as of October 31, 2006.
Reliance Standard paid LTD benefits for six years. This included paying the Plaintiff disability benefits under the "any occupation" definition of disability from October 31, 2006 to August 31, 2009.
Reliance Standard Terminated the Benefits Five Times From 2003-2010
On five different occasions, Reliance Standard terminated, denied, or closed the claim between October 31, 2003 and January 7, 2010. This was despite the fact that numerous objective tests showed that the Plaintiff's back pain and radiculopathy continued to exist. The Plaintiff has also continually submitted additional evidence confirming her pain, including medical records and information from doctor visits.
Reliance Standard also improperly handled the Plaintiff's claims over the years, including a time when it claimed that the Plaintiff returned to work even though she never did. It is alleged that Reliance Standard did this to avoid paying the Plaintiff LTD benefits. Despite Reliance Standard's own "quality review unit" claiming that Plaintiff met LTD terms of the Plan and could not handle "any occupation," Reliance Standard continually terminated Plaintiff's benefits until its final termination letter on January 7, 2010.
Plaintiff Files Lawsuit Against Reliance Standard and Group
Plaintiff filed this lawsuit against Reliance Standard because Reliance Standard based its denial on its own "independent" medical examiner's report and attached physical capacity form, even though the two reports contradicted each other and the Plaintiff's submitted medical records and reports. The examiner was also provided through MES Solutions, a biased third party company that has regularly had contact with Reliance Standard, indicating a conflict of interest. Plaintiff also claims that Reliance Standard failed to consider all medical records and other information submitted by the Plaintiff.
Plaintiff Seeks The Following From This Lawsuit
Plaintiff wants the following relief from Reliance Standard and Group:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Eastman Chemical Company Employee Loses Lawsuit Against MetLife for Disability Benefits
In a case recently decided by an Arkansas Federal Court, MetLife prevailed in a lawsuit filed by an Eastman Chemical Company Employee. Ultimately, due to video surveillance, a lack of medical support, and the fact that the claimant had continued working at a side job (of which he had failed to inform MetLife of) while claiming to be disabled, the Court, it seems, had no choice but to agree with MetLife’s decision to deny Long Term Disability Benefits.
Disability Blog & Cases:
Bon Secours Employee Wins Lawsuit Against Unum who had Denied Him Disability Benefits
A former Engineer Director for Bon Secours, with the help of his Pennsylvania Disability Attorney, were forced to file a federal ERISA lawsuit after Unum repeatedly denied his claim for Long Term Disability Benefits under a disability policy he was covered under through his employment with Bon Secours. After filing Cross Motions for Summary Judgment, the Court ultimately ruled in favor of the claimant and against Unum.
Disability Blog & Cases:
Do You Know The Job Requirements To Be A Lincoln Financial Disability Claim Specialist?
As a disability lawyer that has handled thousands of disability insurance claims I often wonder about the qualifications and experience of the disability company employee that is making the decision to approve or deny my client’s claim. During our routine activities of watching The Lincoln Financial Group, I came across an internet job posting for an “Associate LTD Benefit Specialist” at Lincoln Financial in Atlanta, Georgia.The qualifications and requirements for the Lincoln benefit Specialist position are also listed at the end of this article.
Disability Blog & Cases:
A Claimant’s View of a Prudential Disability Benefit Denial
We always welcome our clients and other disability claimants nationwide to share their experiences regarding the handling of their disability insurance claim. A client of our law firm that was denied long term disability benefits by Prudential Insurance Company recently posted her thoughts...
Disability Blog & Cases:
Do You Know The Differences Between ERISA Disability Policy And NON-ERISA Disability Policy?
Watch our video to learn more about long term disability insurance claims which are subject to ERISA.
Disability Blog & Cases:
Will A $38 Million Loss Result In More Prudential Disability Insurance Claim Denials?
Prudential is not very happy right now and disability claimants may suffer as a result. Prudential’s group insurance division, which includes long-term disability insurance policies, reported a 2012 first quarter loss of $38 million compared to a gain of $39, million a year ago...
The Plaintiff, with the help of her Massachusetts Disability Lawyer, has filed this lawsuit in the United States District Court against Standard Insurance Company (Standard) for the denial of long term disability benefits as defined by the Plan that the Plaintiff was eligible due to her employment as a nurse with UnitedHealth Group.
The Plaintiff is a 63-year-old resident of Wrentham, Norfolk County, Massachusetts, while Standard is engaged in the business of disability insurance, and is licensed and authorized to engage in the business of insurance within the Commonwealth of Massachusetts. In regards to this lawsuit, Standard engaged in the administration and, in pertinent part, insurance, of the UnitedHealth Group, Long Term Disability Plan.
In Kathleen F Vs Standard Insurance Company, Plaintiff seeks reinstatement of long term disability benefits as defined by the terms of the Plan.
Plaintiff's Background and Reasons For Submittal of Claim
Plaintiff worked as a healthcare utilization review coordinator for UnitedHealth Group, up to and including January 3, 2006. On or about January 3, 2006, Plaintiff was involved in a motor vehicle accident and suffered a right acetabular (hip) fracture. She could not perform the duties of her occupation, or any occupation, due to multiple complications of the healing of the fracture (non-union), as well as severe posttraumatic arthritis secondary to the injury and depression secondary to the injury.
Plaintiff filed for long term disability benefits under the LTD plan. She provided the necessary claim forms, physicians' statements, and supportive medical records. UnitedHealth Group, who funds the first 24 months of benefit payments, approved the claim. This would last through July 2, 2008. After this date, Standard was expected to take over the LTD payments.
Standard Decides To Not Fulfill LTD Payments To Plaintiff
Via letter dated March 31, 2008, Standard denied Plaintiff's claim for disability benefits when it was due to take over payments on July 3, 2008. Plaintiff filed an appeal of this denial, including additional medical support for her claim. However, Standard denied her appeal on July 28, 2008.
Plaintiff was offered, and through counsel, requested an additional level of review by letter dated September 22, 2008. Plaintiff thereafter submitted additional support for her claim, including a recorded video statement on DVD. Plaintiff requested a copy of the complete claim file from Standard on September 22, 2008. Standard did provide some of the requested records, but not provide any of the requested guidelines, policies, or procedures. Plaintiff again requested these relevant documents via letter dated November 27, 2008.
Standard denied Plaintiff's appeal via letter dated April 27, 2009. Standard informed Plaintiff that she has exhausted her administrative remedies. Because of this, Plaintiff has filed this lawsuit against Standard.
Merits of the Lawsuit Against Standard
Plaintiff asserts that Standard did not properly apply the provisions of the LTD plan to her claim. Plaintiff still has not received the requested documents she asked for from Standard. This has denied the Plaintiff her ERISA's statutory right to a "full and fair review" of her claim, as it has prevented her from mounting additional argument in favor of her claim and deprived her of the opportunity to submit evidence that may perfect her claim. This leads to the assertion that Standard breached its fiduciary duties as an ERISA administrator and shows a clear abuse of discretion.
Plaintiff's Relief Requests
Plaintiff wants the following relief from Standard:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Kentucky Woman Wins Lawsuit Against Mutual Of Omaha Insurance
Claiming that her long term disability benefits were denied improperly under the Employment Retirement Income Security Act of 1974 (ERISA) and 29 U.S.C.§ 1001, et. seq., Nancy C. and her Kentucky disability lawyer filed a disability lawsuit against her employer and disability insurer alleging that the denial of her long-term disability benefits by the insurer was “arbitrary and capricious” and constituted a “breach of fiduciary duty and/or bad faith” on the part of the defendants.
Disability Blog & Cases:
Prudential Claimants Unsuccessful At Challenging The Offsetting Of Dependents’ SSDI Benefit Award
Challenging the calculation that Prudential Insurance Company made when reducing their private benefit payments, Kathleen Schultz and Mary Kelly filed a class action lawsuit in hopes of receiving a positive, definitive decision concerning their claims.
In Jeffrey D Vs. Unum Life Insurance Company of America, the Plaintiff, with the help of his Connecticut Disability Attorney, filed this lawsuit due to the wrongful denial of long term disability benefits as promised under theERISA welfare benefit Plan that is underwritten and insured by Unum.
History of Plaintiff
Plaintiff, who is 46 years old, worked as a machinist at two companies in Bristol, Connecticut for a total of 16 years. He then worked as an Electrical Discharge Machine Operator at EDAC Technologies Corporation (EDAC) in Farmington, Connecticut since 2000. His job required him to position and secure workpieces on a table using clamps; measure parts; manually input data into a computer; and regularly exert between 10 and 50 pounds of force with his hands to move objects.
Plaintiff suffers from gout, a form of severe arthritis characterized by joint pain, tenderness, and reduced mobility in the areas affected. These areas usually include the hands, wrists, feet, and ankles. wrists, feet, and ankles. This medical condition causes him consistent severe pain, occasional complete immobility, and a regular inability to use his hands, wrists, feet, and ankles for almost anything, including grasping, pushing, holding, walking, and standing. His dominant (right) hand and wrist are affected more than his non-dominant hand and wrist. Plaintiff first suffered from gout approximately 20 years, and it has worsened progressively over the years.
Due to the continuing deterioration of his gout, Plaintiff can no longer operate as a machinist or in any other occupation. This has been the case since late-September 2010. Plaintiff takes powerful prescription drugs to combat the consistent pain, but the serious side effects from these medications include lightheadedness, forgetfulness, nausea, and fatigue. These prevent him from driving a motor vehicle or operating other types of machinery and industrial equipment.
Plaintiff filed an application for benefits under EDAC's Unum Plan in September 2010. He was to have received 60% of his "monthly earnings" until a maximum age of "Social Security Normal Retirement Age." According to the terms of the Plan, the Plaintiff satisfied the definition of being disabled both regarding his own occupation (first 24 months of benefit collection) and any other occupation (after 24 months of benefit collection).
Unum Denies Claim
On June 29, 2011, Unum denies Plaintiff's benefit application due to the reason that the medical evidence did not support that his gout was disabling under the Plan's definition; he did not satisfy the Plan's requirement that he work 35 hours per week prior in order to qualify for benefits; and he held another part-time job that he did not disclose to Unum, which disqualified him from benefit collection.
Plaintiff filed an appeal on September 24, 2011 disputing these reasons, which Unum essentially admitted as being true and that it was mistaken in Plaintiff having a part-time job. Plaintiff added 68 pages of medical records, letters from his physicians, Unum's internal claim evaluation notes, and seven sworn records to his appeal.
Plaintiff underwent wrist surgery in fall 2010. His surgeon said in June 2011 that he will have no use of his right hand and wrist, further strengthening Plaintiff's claim that he is disabled under the terms of the Plan. A fusion procedure that is recommended for the Plaintiff would prevent him from undertaking any gainful employment that requires Plaintiff to use his right hand to any significant degree.
Plaintiff also demonstrated that he has done no work for his wife's vending cart business. Plaintiff also showed that he briefly dropped under 35 hours of work per week due to gout flare-ups in his feet.
Despite showing all of this, Unum denied Plaintiff's appeal on October 20, 2011 on the same reasons as its original denial. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit against Unum.
Reasonings Behind the Lawsuit
Plaintiff claims that Unum's failure to pay these benefits was wrongful, arbitrary, capricious, and otherwise unlawful. Additionally, Unum also chose to disregard the opinion of its own claim reviewer nurse who stated that "it is unlikely that the insured will regain his premorbid level of" functional capacity.
Unum also never requested that Plaintiff undergo an independent medical examination or functional capacity evaluation so that it could attempt to determine the severity of his gout or its impact on his ability to work in his own job or others.
Requested Relief
Plaintiff wants the following relief to be granted by this Court:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Minnesota Disability Claimant Filed Suit Against Employer Over Terminated Disability Benefits
A Minnesota Federal Court recently ruled against a claimant and in favor of the employer with regards to disability benefits. This case is a poignant reminder that even after being on claim for nearly 7 years, a claimant can be denied at any time. It further shows why it is important to have your claim sufficiently supported with evidence from your treating physician whether the claim administer requests it or not. Let’s take a closer look at the case of Richard P. v. Kohler Co.
Disability Blog & Cases:
Court Finds MetLife Has No Right To Request An IME After Unnecessary Delay
Recently, a claimant was forced to hire a California Disability Lawyer and file a lawsuit against MetLife after being denied continued Long Term Disability Benefits. After agreeing with the claimant that she was disabled through the "own occupation" period, the Court awarded the claimant benefits for that limited time period. However, the court then asked MetLife to take a closer look at the "any occupation" period. For an unexplained reason, MetLife dragged its feet on making a determination.
In Mary A. Vs Sun Life Assurance Company of Canada, the Plaintiff, with the help of her Alabama Disability Attorney, files this lawsuit against Sun Life seeking reinstatement of long term disability benefits as promised under the terms of the Plan.
History of Case
Plaintiff is a disabled individual who was employed by Liberty National as a Sales Agent. This occupation required her to consistently spend an average of nine hours "in the field" traveling to and from job sites. It further required 10-11 hour work days during the course of a week. The Plaintiff was required to perform and fulfill numerous essential job functions, requirements, and qualifications associated with her occupation. Some of these functions included compiling lists of prospective clients, contacting those prospective clients, calling on policyholders to deliver and explain the policy, and servicing the business of existing and new customers.
On or about January 28, 2007, Plaintiff became unable to work due to a culmination of disabling physical health issues. These issues related to seizure auras, physical pain, fatigue, sleepiness, dizziness, and problems with memory. These issues primarily relate to seizure auras, physical pain, fatigue, sleepiness, dizziness, and problems with memory. As a result of her health problems and inability to continue working, the Plaintiff filed an application for long term disability benefits with Sun Life on or around July 12, 2007.
Sun Life approved the claim and began paying out monthly disability benefits effective July 27, 2007. The Social Security Administration determined that the Plaintiff was unable to perform any gainful occupation based on her physical health problems, thereby approving her for Social Security Disability benefits upon her initial application. These benefits began to be paid out in July 2007.
Sun Life Abruptly Terminates Long Term Disability Benefit Payments
On or about July 31, 2008, Sun Life informed Plaintiff that she no longer qualified for disability payments based on a review of her records. Plaintiff filed an appeal of this decision via letter dated August 4, 2008. Plaintiff also supplied additional medical documentation that she was still disabled and unable to work. She included notes from two different physicians she had been seeing, both of whom stated that Plaintiff was not able to work.
Despite this mounting evidence, on August 17, 2009, Sun Life terminated Plaintiff's long term disability benefits retroactive to July 27, 2009. Plaintiff filed an appeal letter on or about October 21, 2009. Once again, she submitted multiple pieces of medical evidence, including statements from both treating physicians, to back her claim. Sun Life failed to respond to this latest appeal until it finally sent a letter to the Plaintiff on March 26, 2010.
Due to its failure to follow ERISA regulations, Plaintiff's administrative remedies have been exhausted, leading to the filing of this lawsuit against Sun Life.
Premise of Argument Against Sun Life
Sun Life wrongfully denied Plaintiff's claim and subsequent appeals. It relied upon several biased and erroneous physician consultant reports generated by physicians who are regularly utilized by insurance companies to deny claims.
Furthermore, these physicians were employed by third-party vendor companies Network Medical Review and Professional Disability Associates, companies which receive a substantial portion of income from providing physician consultant reviews to insurance companies and employers. These physicians ignored most of the medical evidence in the claim, cherry-picked evidence favorable to justify a termination of benefits, and misconstrued evidence and statements contained in the claim record.
Relief Sought By Plaintiff Against Sun Life
Plaintiff wants the following relief due to the wrongful termination of long term disability benefits:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Court Takes Sun Life To Task For Denial Of Disability And Life Insurance Benefits Of Man With Brain Tumor
The widow of a claimant, who died from a malignant brain tumor, brought this lawsuit with the help of her Colorado Disability Lawyer after Sun Life refused to award cancer disability benefits.
Disability Blog & Cases:
CIGNA Disability Claim Denial: A Claimant's View
Every day disability claimants around the country contact our disability attorneys about a CIGNA disability claim. Many individuals tell us similar stories about the manner in which their CIGNA disability claim has been handled. We wanted to share with you a recent comment that was posted on our website about a CIGNA denial.
Disability Blog & Cases:
Sedgwick Terminates PNC Compliance Specialist’s Long Term Disability Benefits
Recently, a former Compliance Specialist for PNC Financial Services Group was unsuccessful in her lawsuit again her former employer and Sedgwick. This case is a strong reminder that even though a claimant has been awarded disability benefits from the Social Security Administration, it does not mean that the Long Term Disability Insurance Provider must also award disability benefits.
The Plaintiff, with the help of a California disability attorney, filed this lawsuit in the United States District Court against Standard Insurance Company (Standard) and the Oscient Pharmaceuticals Corporation Employee Benefit Plan (Oscient). The lawsuit claims that the Plaintiff did not continue to receive the disability benefits that she was entitled to under the Plan that she was eligible for due to her employment with Oscient.
In Christine W. Vs Standard Insurance Company, Plaintiff has filed this lawsuit to gain the rightful disability benefits owed to her under the Plan that were not paid by Standard.
How Plaintiff Was Covered Under The Plan
Plaintiff worked for Oscient as a sales representative, which entitled her to be a participant in Group Insurance Policy Number 139943-B. This Plan would entitle Plaintiff to long term disability benefits equivalent to 67% of Plaintiff's monthly earnings minus any other income benefits beginning 90 days after the approval of a claim until Plaintiff's 65th birthday.
Plaintiff began suffering significant neck pain over several years. She also endured several treatments in an attempt to alleviate this pain, which continued to worsen over time. These treatments began on or about May 29, 2007 and continued until September 11, 2007. These treatments included two right sacroiliac joint block injections, a right L4, L5, S1 and medial branch nerve blocks, an MRI of her lumbar spine, a lumbar epidural steroid injection, and right S1 selective nerve root block.
Plaintiff continued to receive more treatments and have more visits with her physicians, but the pain continued to worsen. It was advised that she stay out of work until at least November 25, 2007 so that she could collect short term disability payments.
Plaintiff filed for long term disability payments, which was approved by Standard on or about March 12, 2008. Plaintiff was also granted life insurance waiver of premium on or about September 2, 2008. Treatments and more appointments occurred between May 21, 2009 and April 6, 2010.
Standard Decides To Cut Off Plaintiff's Long Term Disability Benefits
On or about August 16, 2010, Standard denied Plaintiff's claim for ongoing disability benefits beyond August 18, 2010. Plaintiff still continued to suffer from symptoms of severe neck pain, as evidenced by a follow-up examination by Tina L., MD on or about November 29, 2010.
On or about December 28, 2010, Plaintiff filed an appeal of Standard's denial. Plaintiff consulted with Regina N., MD regarding her increasing difficulties with fine motor movements, speech, and word-finding. This prompted Plaintiff to supplement her denial with a follow-up letter on or about February 11, 2011.
Despite two more follow-up examinations with two other physicians in February and April 2011, Standard denied Plaintiff's appeal on or about May 5, 2011. This has forced Plaintiff to file this lawsuit against Standard.
Merits of the Case Against Standard
This lawsuit was filed because Standard ignored the opinions of Plaintiff's treating physicians. Standard also did not give proper consideration of Plaintiff's medical records and her overall condition. Standard's denial of benefits was wrongful, capricious, arbitrary, and irrational.
The Relief Sought Against Standard
Due to the hardship experienced by the Plaintiff, Plaintiff requests following relief against Standard:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Are Independent Medical Evaluation (IME) Providers Really “Independent”?
After being twice denied continued disability benefits, an Addiction Medicine Physician, with the help of his California Disability Attorney, was forced to file a lawsuit against Hartford.
Disability Blog & Cases:
North Carolina Court Determines That Sedgwick Abused Their Discretion And Wrongfully Denied Disability Benefits For BellSouth Employee
A BellSouth Customer Service Assistant, with the help of his North Carolina Disability Attorney, was forced to file a lawsuit against Sedgwick after being denied continued disability benefits.
Disability Blog & Cases:
American Red Cross Worker Sues Reliance Standard Life Insurance Company For Wrongful Termination of Long Term Disability Benefits
In Joanne C. Vs Reliance Standard Life Insurance Company, the Plaintiff seeks the reinstatement of her long term disability benefit payments as defined by the terms of the Plan.
Disability Blog & Cases:
Two Takes on Fibromyalgia
A representative from the American Chronic Pain Association and a Fibromyalgia physician recently appeared on a local news station to discuss Fibromyalgia and methods for treating Fibromyalgia.
Disability Blog & Cases:
Total Knee Replacement, Yet Sedgwick Still Denies AT&T Employee’s Disability Claim
The unreasonable Sedgwick Claims Management disability denial of AT&T employees appears to be a daily occurrence. Recently, it seems as if Sedgwick does not feel the need to comply with ERISA regulations.
In Daniel C. Vs Reliance Standard Life Insurance Company, the Plaintiff has filed a lawsuit with the help of his Ohio Disability Lawyer for the termination of long term disability benefits that were promised under the Plan provided by Plaintiff's employer, United Dairy Farmers, Inc. (UDF).
History of the Plaintiff
Plaintiff worked at UDF from 1988 to 2006, seven years as a Store Manager, six years as an Area Supervisor, and five years as a Zone Manager for multiple UDF stores. Plaintiff was earning a monthly salary of $5,441.67 when he was unable to continue his work duties due to complications from human immunodeficiency virus disease (HIV).
Plaintiff's HIV led to his developing Acquired Immune Deficiency Syndrome (AIDS), as well as a related peripheral neuropathy of his lower extremities, which caused pain so severe that it required daily pain treatment with morphine, along with the multiple medications he needed to control his HIV.
Reliance approved Plaintiff's application for long term disability benefits according to the terms of the Plan in February 2007, with an effective date for benefits of December 18, 2006. In November 2009, Plaintiff was approved for total disability benefits through the Social Security Administration, with an effective date of March 2007. Reliance continued to pay LTD benefits to the Plaintiff through October 24, 2010.
Reliance Cuts Plaintiff Off From Further Long Term Disability Benefits
Via letter dated October 11, 2010, Reliance informed Plaintiff that a review of his medical records determined that he could do work at a sedentary level. Based on this, Reliance terminated future long term disability benefits effective October 24, 2010.
Plaintiff appealed this decision and presented additional records and comment from his primary care physician, a board certified family practice physician and specialist in the treatment of HIV and AIDS. The doctor concluded that the Plaintiff could work no longer than four hours per day. Additionally, his pain from peripheral neuropathy was only moderately controlled by the multiple narcotic medications he took, but these medications also caused added fatigue and concentration problems.
Reliance hired an occupational medicine specialist to perform a file review and independent medical examination of Plaintiff in July 2011. The Reliance IME physician concluded there was not sufficient information in the clinical record to support the plaintiff's doctor's peripheral neuropathy diagnosis or to confirm that the Plaintiff was actually taking the prescribed medications that caused his reported side effects. The IME physician stated that the Plaintiff was capable of light demand level, full-time work "if motivated."
As a result, of this review and examination, Reliance rejected Plaintiff's appeal on August 11, 2011. Due to the exhaustion of all administrative remedies, Plaintiff has filed this lawsuit against Reliance.
Basis of Lawsuit Against Reliance
Plaintiff claims that Reliance unfairly, wrongfully and arbitrarily denied Plaintiff's claim for long term disability benefits despite the Plaintiff's submission of medical evidence from his primary care physician, a qualified specialist in his illness, that established that the Plaintiff remains unable to perform the duties of any full-time occupation.
Plaintiff Seeks Following Relief From Reliance
Plaintiff wants the Court to provide the following relief from Reliance:
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. To request a free legal consultation call 800-411-9085.
Resolved Cases:
AT&T Employee Dealing With Sedgwick Has Horrible Disability Benefit Claim Experience
Our client, an AT&T employee for more than 40 years became disabled and unable to do her job due to cervical myeolapathy neck pain, chronic headaches and a torn rotator cuff in her shoulder. Her claim for short term disability benefits under the AT&T disability benefits plan has been nothing but a “headache”. AT&T hires Sedgwick Claims Management to handle the administration of all disability benefit claims.
Disability Blog & Cases:
KeyCorp District Manager Sues The Prudential Insurance Company Of America For Improper Termination Of Long-Term Disability Benefits
A New York attorney recently filed a federal lawsuit against The Prudential Insurance Company of America (Prudential). The Plaintiff, Gaye D., was employed by KeyCorp as a District Manager/Area Retail Leader. Her employment enabled Plaintiff to be covered by KeyCorp’s long-term disability Plan, which was funded by Prudential.
Disability Blog & Cases:
DRS Technologies Employee Sues Prudential For The Wrongful Termination Of Long-Term Disability Benefits
An attorney from California recently filed a federal lawsuit against The Prudential Insurance Company of America (Prudential). The Plaintiff, Brian W., was employed as a Field Technician by DRS Technologies, Inc. (DRS). This employment entitled the Plaintiff to short-term and long-term disability benefits under DRS’ Disability Plan.
Disability Blog & Cases:
Court Compels Metlife To Reconsider Its Decision To Terminate Claimant's Long-Term Disability Benefits
The United States District Court for the Southern District of New York recently held that MetLife's decision to deny benefits to a Plaintiff was unreasonable and ordered MetLife to reconsider Plaintiff's Long Term Disability claim.
Disability Blog & Cases:
Unum Tries To Hide Fact That Its “Independent” Medical Advisors Are Actually Employees Of Unum
This case sheds light on some of the questionable practices that some disability companies engage in when reviewing a disability claim.
Disability Blog & Cases:
Unum CEO Testifies At US Senate Hearing About Disability Insurance
On March 22, 2012, UNUM insurance company’s CEO Tom Watjen spoke at a United States Senate Committee hearing about the value of disability insurance coverage for individuals and the need for the private disability insurers and the government to work together in order to offer the coverage to more employees.
Disability Blog & Cases:
Microsoft Employee Sues Prudential For Wrongful Denial Of Long-Term Disability Benefits
A Washington lawyer just filed a federal lawsuit against The Prudential Insurance Company of America (Prudential). The Plaintiff, Jewel T., worked as an Escalation Specialist for Microsoft. This employment entitled to the Plaintiff to short-term and long-term disability benefits via Microsoft’s Group Disability Insurance Plan that was funded by Prudential.
Disability Blog & Cases:
Toyota Quality Assurance Monitor Sues Life Insurance Company Of North America For Denial Of Long-Term Disability Benefits
A disability attorney in the state of Indiana recently filed a federal lawsuit in Indiana against Life Insurance Company of North America (LINA) and Toyota Motor Long-Term Disability Plan (Toyota). The Plaintiff, Julie S., was employed by Toyota as a Quality Assurance Monitor, which made her eligible for Toyota’s long-term disability plan, which was funded by LINA.
Disability Blog & Cases:
Illinois Insurance Law Gives Claimant A Fighting Chance Against Disability Insurance Company
An Illinois district court refused to let Hartford, a disability insurance company, evade an Illinois law, which was enacted to protect consumers. The law was passed to basically “level the playing field” for insurance companies and the consumers that rarely have a fighting chance against these corporate giants.
Disability Blog & Cases:
Pennsylvania Court Awards STD Benefits And $27,000 In Attorneys’ Fees To Phlebotomist
A Pennsylvania court recently awarded $27,000 in attorneys’ fees to Ms. G. after she and her disability attorney won a judgment against Life Insurance Company of North America (“LINA”) also known as CIGNA for short-term disability (“STD”) benefits. This case is a good discussion of the analysis a court will go through in order to award attorney fees to a prevailing disability insurance claimant.
The Prudential Insurance Company of America (Prudential) was sued in three separate cases in the Federal Courts of Missouri, Georgia, and Arizona for the wrongful termination of long-term disability benefits that are promised under the Employee Retirement Income Security Act (ERISA). In all three cases filed through the respective plaintiffs' disability lawyers, Prudential is accused of denying the Plaintiffs the short-term or long-term disability benefits that were promised under the Plaintiffs' respective plans.
The Missouri Case
In Mary J. Vs. The Prudential Insurance Company of America, a long-term disability lawsuit was filed by the Plaintiff against Prudential via a Missouri disability attorney in the Eastern District of Missouri Eastern Division. The Plaintiff had been employed full-time by Harrah's Operating Company, Inc. (Harrah's) since 2000, making her eligible for long-term disability benefits through Harrah's Group Policy No. 42111 Plan. This Plan was insured by Prudential.
The Plaintiff ceased working in October 2007 due to degenerative arthritis of both knees and filed for long-term disability benefits. Prudential approved the claim on February 21, 2008. However, Plaintiff was notified on September 23, 2009 that she would no longer receive long-term disability benefits after February 20, 2010.
Plaintiff appealed the denial on February 9, 2010, but Prudential upheld the denial on August 30, 2010. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit against Prudential.
The Georgia Case
In Deborah D. Vs. The Prudential Insurance Company of America, Plaintiff was employed as a Program Manager by DRS Technologies, Inc., which provided both short-term and long-term disability benefits via an insurance plan that was insured and paid for by Prudential.
Plaintiff became disabled on or about August 23, 2010, leading to her filing a timely short-term disability claim, along with medical documentation, with Prudential. Prudential initially approved the STD claim and paid Plaintiff through October 24, 2010.
However, beginning October 24, 2010, Prudential terminated Plaintiff's benefits on the basis that it had not received enough medical information to continue providing STD benefits. Plaintiff appealed this termination, but via letter dated March 7, 2011, Prudential upheld its original denial.
On September 2, 2011, Plaintiff again appealed and provided additional medical and vocational information to support her claim. However, on October 6, 2011, Prudential upheld its previous denials and declared that this decision was its final decision on the Plaintiff's claim. Plaintiff has exhausted all administrative remedies and has filed this lawsuit against Prudential.
The Arizona Case
In Gerard L. Vs. Prudential Insurance Company of America and Anheuser-Busch Companies, Inc. (Anheuser-Busch), Plaintiff was employed by Anheuser-Busch as a local employee until on or about March 31, 2009 when he became disabled and unable to work as a Senior Manager of Accounting due to serious medical conditions. This employment enabled the Plaintiff to be covered under Anheuser-Busch's group long-term disability insurance policy, which was funded by Prudential.
Plaintiff filed a disability application for Total and Permanent Disability and Group Life Insurance benefits under the terms of the Plan. Prudential denied his claim via letter dated December 14, 2010. Plaintiff filed an appeal of this decision and submitted additional medical evidence to support his claim. This included an Independent Medical Evaluation performed on January 26, 2010 that stated that Plaintiff would be unable to work for at least the next 12 months. In addition, Plaintiff applied for and received Social Security Disability benefits through the Social Security Administration.
Despite the additional evidence, Prudential upheld its original denial via letter dated March 23, 2011. Plaintiff again filed an appeal and submitted additional medical evidence. Prudential issued a final denial via letter dated August 1, 2011. Plaintiff has exhausted all administrative remedies and has filed this lawsuit against Prudential.
Relief Requested From The Lawsuits
In the three aforementioned cases, the Plaintiffs seek the following relief from Prudential in their lawsuits:
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. To request a free legal consultation call 800-698-9162.
Disability Blog & Cases:
Clopay Corporation Customer Service Representative Sues Prudential For The Wrongful Denial Of Long-Term Disability Benefits
An attorney recently filed a federal lawsuit in the Ohio district court against The Prudential Insurance Company of America (Prudential) and Clopay Corporation Long-Term Disability Coverage (Clopay). The Plaintiff, Kimberly G., was employed as a Customer Service Representative at Clopay Corporation, providing her with short-term with Principal Financial and long-term disability benefits with Prudential.
Disability Blog & Cases:
Asurion Employee Files Lawsuit Against Life Insurance Company Of North America For Wrongful Termination Of Long-Term Disability Benefits
A lawyer from Colorado just filed a federal lawsuit in Federal Court of Colorado against the Life Insurance Company of North America (LINA). The Plaintiff, Carl E., was employed by Asurion. This made the Plaintiff eligible and covered by a group disability insurance plan provided by Asurion and administered and funded by LINA.
Disability Blog & Cases:
Court orders Life Insurance Company of North America to pay claimant long-term disability benefits
After failing to pay a LINA disability policyholder his entitled disability benefits the insurance company was forced by a New York court to follow through with its contractual obligations. Curt, a former employee of BorgWarner Morse TEC Inc. received long-term disability benefits under the group insurance policy issued by LINA. LINA later concluded the BorgWarner employee no longer met the definition of disabled under the policy and terminated his benefits.
An Illinois disability lawyer filed a federal lawsuit in Federal court against Liberty Life Assurance Company of Boston (Liberty) and Allstate Cafeteria Plan (Allstate). The Plaintiff, William B., was employed by Allstate as a Claim Senior Manager. Due to this employment, Plaintiff was eligible to receive short-term and long-term disability benefits under the Allstate STD Program, which was funded by Liberty.
In William B. Vs. Liberty Life Assurance Company Of Boston and Allstate Cafeteria Plan, Plaintiff seeks payment of wrongfully terminated long-term disability benefits by Liberty.
Case Facts Against Liberty and Allstate
Plaintiff worked as a Claim Senior Manager for Allstate until February 17, 2010 when he stopped working due to a combination of several psychiatric impairments. Before he stopped working, Plaintiff filed a claim for short-term disability benefits under the Allstate STD Program, which was approved by Liberty. Plaintiff began receiving STD benefits from February 25, 2010 to July 7, 2010.
Liberty informed Plaintiff via letter on August 4, 2010 that he was also eligible to receive long-term disability benefits as of July 8, 2010. From August 19, 2010 to May 2011, Plaintiff also received LTD benefits from a separate LTD policy he had purchased on his own.
Termination of Long-Term Disability Benefits By Liberty
On May 5, 2011, Plaintiff was notified by Liberty that he would no longer receive LTD benefits after May 12, 2011. This denial was made primarily due to the results of a file review performed by a non-examining physician.
On July 15, 2011, Plaintiff filed an appeal of this denial, supplying additional evidence that he was still participating in an extended treatment plan and that his doctor refused to grant permission to the Plaintiff to return to work based on his current condition. Despite this additional evidence, Liberty denied the Plaintiff's appeal on September 9, 2011, again basing their decision on the file reviews conducted by non-examining physicians.
Due to the fact that all administrative remedies have been exhausted, Plaintiff has filed this lawsuit against Liberty and Allstate.
Disability Lawyer Files Lawsuit Against Liberty And Allstate
According to the lawsuit, the Plaintiff claims that Liberty committed the following wrongful actions against the Plaintiff:
The Following Relief Is Sought By The Plaintiff Against Liberty And Allstate
Due to the actions of Liberty and Allstate, Plaintiff requests the following relief to be granted by the Court:
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. To request a free legal consultation call 800-698-9162.
Disability Blog & Cases:
Employees of Staples & Nortel Networks among Four Plaintiffs To Sue Prudential For Wrongful Denial Of Long-Term Disability Benefits
The Prudential Insurance Company of America (Prudential) had four different lawsuits filed against it by four Plaintiffs in the District Courts of South Carolina (2 cases), New York, and West Virginia. In all four cases filed via the respective Plaintiffs’ disability lawyers, Prudential is accused of wrongfully denying or terminating the Plaintiffs’ claims for long-term disability benefits as promised under their respective plans and by ERISA.
Disability Blog & Cases:
Kirk & Blum/CECO Environmental Employee Files Lawsuit Against Lincoln Financial Group For Wrongful Termination Of Long-Term Disability Benefits
An attorney has filed a Federal disability lawsuit in Ohio Federal Court against Lincoln Financial Group (Lincoln). The Plaintiff, George P., was employed by Kirk & Blum, a subsidiary of Ceco Environmental, as a metal fabricator. This employment enabled the Plaintiff to be covered by a group insurance policy provided on behalf of Ceco Environmental employees and insured by Lincoln.
FAQ: Overpayment Issues:
Can a disability company sue me to recover an SSDI overpayment?
This case shows how a long-term disability insurance company can claim an overpayment once a claimant is approved for social security disability income benefits.
Disability Blog & Cases:
Hartford Disability Denial of Insurance Agent with Fibromyalgia and Chronic Fatigue is Reversed
A Utah Federal Judge reversed a Hartford long term disability insurance benefit denial on the basis that it was “unreasonable and, thus, arbitrary and capricious”. The judge’s opinion in this case is a great victory for disability insurance claimants disabled by Fibromyalgia or by...
Disability Insurance Law TV:
Episode 24: Top Five Reasons for Disability Insurance Denials
Nationwide Disability attorneys Gregory Dell and Rachel Alters discuss the top five reasons that Disability Insurance Claims are denied. The information in this video applies to both ERISA and Non-ERISA disability insurance policies.
A Virginia disability lawyer recently filed a federal lawsuit against The Guardian Life Insurance Company Of America (Guardian). The Plaintiff, Randal M., worked as a Master HVAC Installer for Parrish Services in Manassas, Virginia since October 15, 2008. Due to this employment, he was eligible for and enrolled in an employee welfare benefit plan that provided long-term disability benefits. These benefits were sponsored by Parrish Services and were underwritten and administered by Guardian.
In Randal M. Vs The Guardian Life Insurance Company Of America, Plaintiff filed a disability lawsuit to recover the long-term disability benefits wrongfully denied by Guardian.
Case Facts Against Guardian
Plaintiff worked as a Master HVAC Installer for Parrish Services in Manassas, Virginia since October 15, 2008. Plaintiff also had certifications to work as a gasfitter, plumber, HVAC, and electrician for Parrish Services.
In August 2009, Plaintiff was first diagnosed with an injury or illness to his spine at Lumbar 3 (L-3) and Lumbar 4 (L-4), which eventually led to his being totally disabled. Plaintiff applied for and received short-term disability benefits from Guardian. Plaintiff then applied for long-term disability benefits after the short-term disability benefit payments had run out.
Denial of Long-Term Disability Benefits By Guardian
In April 2010, Guardian denied Plaintiff long-term disability benefits due to the stated reason that the Plaintiff's condition was pre-existing, making him ineligible for long-term disability benefits as defined by the Plan.
Plaintiff applied for Social Security Benefits and received them beginning on June 1, 2010. Due to the fact that Guardian's Long-Term Disability benefit is a greater amount than Plaintiff's Social Security Disability benefit, Guardian is required to supplement the Social Security Benefit amount.
Plaintiff became totally disabled at age 51. Guardian's Long-Term Disability benefit is to provide LTD benefits to the Plaintiff up to the age of 65. Plaintiff was never diagnosed or treated for an injury or illness to L-3 and/or L-4 before August 2009, thereby negating Guardian's stated reason of a pre-existing injury or illness making Plaintiff ineligible for LTD benefits as defined by the Plan.
Plaintiff has exhausted his administrative remedies, thereby leading to the filing of this lawsuit against Guardian.
Disability Attorney Files Disability Lawsuit Against Guardian
In the lawsuit, Plaintiff claims that Guardian failed to provide the following to the Plaintiff:
Plaintiff claims that Guardian committed the following wrongful actions against the Plaintiff:
Relief Sought By Plaintiff In Guardian Lawsuit
Due to the wrongful actions of Guardian, Plaintiff seeks the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Medical Doctor suffering from disabling chronic conditions sues AXA Equitable for wrongful denial of disability benefits
A Montana disability lawyer recently filed a federal lawsuit against the AXA Equitable Life Insurance Company (AXA). The Plaintiff, Marise J., M.D., was employed as a licensed medical doctor and was board certified in internal medicine. She had been practicing medicine for over 30 years.
Disability Blog & Cases:
Aetna Disability Denial of Marriott Employee Upheld by Louisiana Federal Judge
A former Marriott Employee was unsuccessful in his lawsuit seeking a reversal of Aetna Life Insurance Company’s disability insurance denial. As a former director of engineering, earning more than $200,000 a year, this former Marriott employee stopped working due to disabling lumbar herniations and back pain...
Disability Blog & Cases:
Who is Making the Decisions on a Sun Life Disability Benefits Claim?
Disability insurance claimants are routinely telling our disability insurance attorneys about their dissatisfaction with the manner in which a disability insurance company has handled their claim for disability benefits. Let’s take a look at why this disappointment is taking place.
FAQ: Tax Issues
How can a claimant exclude their disability insurance benefit payments from Federal Income Tax?
What actions can a claimant take in order to exclude Disability Insurance Benefits from personal income tax?
Aetna Life Insurance Company (Aetna) was recently sued in three cases in the Federal Courts of Oregon, Tennessee, and Missouri by three separate Plaintiffs due to the wrongful denial of long-term disability benefits as covered by the Employee Retirement Income Security Act (ERISA). All three cases claim that Aetna wrongfully denied the rightful long-term disability benefits to the Plaintiffs as defined by the terms of their respective Plans.
The Oregon Case
In Troy R. Vs Aetna Life Insurance Company, Plaintiff was employed as a residential appraiser by Bank of America for the past 20 years. Plaintiff was enrolled in a group long-term disability Plan that was issued by Aetna, who also is the claims administrator of the Plan.
On or about May 6, 2009, Plaintiff became disabled as defined by the terms of the Plan and submitted a timely claim for benefits. Aetna began paying short-term disability benefits on May 6, 2009 and continued doing so until November 3, 2009. Plaintiff provided all information requested by Aetna throughout the process, leading to the initial claim for short-term disability (STD) benefits.
Plaintiff submitted a claim for long-term disability (LTD) benefits, but on November 4, 2009, Aetna denied this claim despite the fact that Aetna had not received any new information about the Plaintiff's condition from the time the last STD extension was granted on October 20, 2009 to the date that LTD benefits were denied on November 4, 2009.
Plaintiff appealed the denial, adding more reports and medical information to support his claim that the denial should be overturned. However, on November 23, 2010, Aetna made a final administrative denial of the Plaintiff's appeal and claim for benefits based on "a lack of medical evidence" regarding his condition and his inability to work. Due to exhausting all administrative appeals, Plaintiff has filed this lawsuit against Aetna.
The Tennessee Case
In Eileen S. Vs Aetna Life Insurance Company and Gannet Company, Inc. (Gannet), Plaintiff was employed as a copy editor for the Tennessan, a newspaper based in Nashville, Tennessee and owned by Gannet Company, Inc. Plaintiff was covered under an Income Protection Plan that provide a sick pay program, a short-term disability program, and a long-term disability program. Gannet maintained this program for its employees, while Aetna was the claims administrator.
Due to a disability, Plaintiff ceased working on July 12, 2008. Plaintiff filed a timely claim for STD benefits, which should have been paid between July 19, 2008 and January 10, 2009. Plaintiff's claim for STD benefits were approved, but only paid through October 30, 2008.
Aetna sent a letter to Plaintiff dated November 12, 008 that terminated her STD benefits due to a lack of documented evidence of her medical conditions. Plaintiff appealed this denial and sent substantial amounts of additional evidence to prove her claim. She also submitted a claim for disability benefits to the Social Security Administration (SSA) as required under the terms of the Income Protection Plan, which was granted a Fully Favorable Decision on April 20, 2010.
Despite this, Aetna issued a final denial of STD and LTD benefits via a December 8, 2010 letter to the Plaintiff. Plaintiff has exhausted all administrative remedies, leading to the filing of this lawsuit against Aetna.
The Missouri Case
In Sandra A. Vs Aetna Life Insurance Company, Plaintiff was employed by Verizon Wireless (Verizon) and was covered by the disability insurance company as provided by Verizon, which was fully insured by Aetna.
Due to her medical conditions, Plaintiff has been totally disabled as defined by the terms of the Plan since November 1, 2009. Plaintiff submitted a claim for benefits, but was denied by Aetna. Plaintiff has exhausted all administrative appeals and has filed this lawsuit against Aetna.
Plaintiffs Seek The Following Relief
In all of the aforementioned cases, Plaintiffs seek the following relief from Aetna:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Assistant Vice President of Meadowbrook Insurance Group files a lawsuit against CIGNA for denied disability benefits claim
In a lawsuit against CIGNA Group, Paul M. and his Massachusetts disability lawyer allege that the insurer is guilty of...
Disability Blog & Cases:
56-year-old disabled District Manager of Dollar Financial Group sues AETNA for denial of disability benefits
Carmen R. and her Florida disability lawyer take AETNA to task in a suit filed on December 19, 2011 in the United States District Court for the Southern District of Florida Fort Lauderdale Division. Claiming AETNA violated ERISA and other employment laws, Carmen and her lawyer accuse the insurer of wrongfully denying Carmen her entitled long term disability benefits after she became unable to perform her job duties as a result of degenerative and traumatic injuries.
Disability Blog & Cases:
Hartford interview request is a trap used to support a disability denial
As disability attorneys that have handled hundreds of Hartford disability claim denials nationwide, we are always trying to warn Hartford disability claimants about the claim handling tactics used by Hartford. Hartford handles every disability claim in a similar manner and they can be relentless in their pursuit of a claim denial. Our suggestion is to never allow a Hartford employee to interview you without representation...
Disability Blog & Cases:
Liberty Mutual Disability Denial Of Wachovia Employee Upheld By Appellate Court
This case is another reminder of the importance to comply with ERISA disability Appeal time deadlines. Plaintiff was a commissioned securities broker for Wachovia Corporation, and a participant in Wachovia’s Long Term Disability Plan (“the Plan”). Liberty Mutual was the administrator of the plan. He was awarded Long term disability benefits in 2005, though he disputed the amount he was being paid monthly.
Disability Blog & Cases:
Lincoln Financial Disability Denial: Determining a Date of Disability is Critical
Applying for disability insurance benefits is a complex process that requires a claimant to be familiar with all of the requirements in a disability policy. We often see that disability claims are denied benefits because a claimant does not select the correct date of disability.
A Colorado disability attorney filed a federal lawsuit in the Federal court against Liberty Life Assurance Company of Boston (Liberty) and Estes Express Lines (Estes). The Plaintiff, David F., was employed by Estes as an over-the-road truck driver. Due to this employment, Plaintiff was covered by an employee welfare benefit plan that was sponsored by Estes and insured by Liberty.
In David F. Vs Liberty Life Assurance Company of Boston and Estes Express Lanes, Plaintiff seeks the reinstatement of short-term disability benefits and the payment of long-term disability benefits as defined by the Plan.
Case Facts Against Liberty and Estes
Plaintiff worked as an over-the-road truck driver for Estes' facility in Colorado until he became disabled due to seizure disorder, vertigo and balance problems, severe neck and facial pain, poor concentration, and other ailments. These ailments caused the Plaintiff to cease working on approximately October 25, 2010.
On or around October 25, 2010, Plaintiff applied for short-term disability benefits, which were granted by Liberty under the "own occupation" definition of disability as described in the Plan. The STD benefits began to be paid out on October 30, 2010, though the amount received was miscalculated. Liberty informed Plaintiff via letter dated February 8, 2011 that the STD benefits would run through February 8, 2011.
Termination of Short-Term Disability Benefits By Liberty
Liberty informed Plaintiff via letter dated March 28, 2011 that the STD benefits would be terminated after February 8, 2011. Plaintiff filed an appeal letter on April 14, 2011, pointing out that his numerous ailments led to his commercial driving license being terminated by the U.S. Department of Transportation, thereby qualifying him to continue receiving STD benefits.
However, Liberty denied the appeal letter on May 2, 2011. Liberty also informed Plaintiff that all administrative appeals were exhausted and that the only other option was to file a civil lawsuit under ERISA.
Disability Attorney Files Lawsuit Against Liberty
The terms of the lawsuit state that Liberty failed to provide the following to the Plaintiff:
The terms of the lawsuit claim that Liberty committed the following wrongful acts against the Plaintiff:
Denying benefits based on "cherry-picking" portions of the Plaintiff's medical record
Failure to perform other acts that constitute a full and fair review of the Plaintiff's claim
Using a conflict of interest to wrongfully deny Plaintiff's claim, as Liberty was both the decision-maker and payer of the claim and benefits under the Plan
Plaintiff Seeks The Following Relief From The Court
Due to Liberty's actions against the Plaintiff, Plaintiff seeks the following relief from Liberty:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Weston Engineering employee sues AETNA Life Insurance Company for denied disability benefits
Richard R. and his Illinois disability attorney filed a lawsuit in the United District Court in the Northern District of Illinois, Eastern Division on December 9, 2010 against his employer and AETNA Life Insurance Company for long term disability benefits. A Weston Engineering Inc. employee since July 6, 2009, Richard R., a headache sufferer since he was a teenager, complained to his family doctor of intensification of his headache problems. Consequently, Richard R.’s doctor increased Richard R.’s pain medication to try to remedy the situation.
FAQ: Disability Policy Language
What should I be aware of if I am buying a disability insurance policy?
It is important to take into consideration that every disability income policy may have different features.
FAQ: Disability Companies
What are the differences between an individual disability insurance policy and an ERISA / Group disability policy?
Most group disability policies (also known as ERISA policies) are governed by a very complex federal statute called the Employees Retirement Income Securities Act (“ERISA”). An individual usually has a disability policy governed by ERISA, if they received the disability policy as an employee benefit from an employer.
Product Analyst, Nancy W., 49, and her Arizona disability attorney filed a complaint in the United States District Court for the District of Arizona on October 26, 2011 against her employer Intel Corporation, Aetna Life Insurance Company and Reed Group (the administrator of Intel's Aetna Plan) to force them to provide her with her entitled disability benefits per the terms and conditions of her employee disability insurance policy.
Citing ERISA (the Employee Retirement Insurance Security Act of 1974) violations and 29 U.S.C. § 1132(a)(1)(B) provision violations that the Defendants engaged in regarding Nancy W.'s disability claim, Nancy W.'s attorney petitioned the District Court to provide Nancy W. with:
Arizona Claimant Denied Aetna Short Term Disability Benefits in 2007
Nancy W. became disabled in 2007 and applied for her short term disability benefits through her employee disability benefits plan. Nancy W. was denied continuing short term disability benefits in November 20, 2007 at which time she appealed the termination of those benefits and after exhausting all administrative appeals, filed a Complaint on May 20, 2010. Eventually, Nancy W. and her disability attorney voluntarily dismissed the complaint after the plan administrator Reed Group agreed to conduct supplemental review of Nancy W.'s claim. Reed Group upheld the earlier decision, Nancy W.'s disability benefits remain terminated, and Nancy W. filed suit again in the United States District Court of Arizona.
Background of Aetna Claimant's Disabling Condition
The first termination of Nancy W.'s benefits occurred when two physicians indicated that Nancy W.'s previous blood pressure condition had stabilized and stated that her medical records "failed to show that the severity of her symptoms precluded her from performing job duties." Providing the insurer with contradicting medical records, Nancy W. challenged the two doctors' opinions to no avail. So, Nancy W. applied for her long term disability benefits. Unfortunately, since her short term disability benefits had been terminated and Nancy W. had only used 183 days of her 364 days of short term disability benefits, she was disqualified from being eligible for long term disability benefits.
Lawyer Backs up Client's Claim with Ample Case Law
Citing case law to back up Nancy W.'s claim, Nancy W.'s lawyer asks the District Court to consider that Aetna might have a conflict of interest in that the insurer not only provides the claimant's employee insurance plan but is involved in the administrative decisions determining if a claimant has a legitimate claim as well. The pair allege that Aetna deliberating or negligently refused to comply with it obligation to inform claimants of why a claim decision was made denying benefits. They accuse Reed Group as an affiliate of Aetna of being negligent as well.
In the suit, Nancy W. and her disability lawyer ask the District Court to:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
CIGNA faces a lawsuit by American Homecare Supply Respiratory therapist for termination of disability benefits
In a December 2, 2011 lawsuit filed in the United States District Court for the Middle District of Pennsylvania, Sharon H. and her Pennsylvania disability attorney allege that CIGNA Group Insurance unjustly terminated Sharon H.’s disability benefits.
Disability Blog & Cases:
Long time Bank of America employee sues AETNA for denial of disability benefits
Filing a lawsuit under ERISA (the Employee Retirement Insurance Security Act of 1974) against AETNA, Leslie R, and her Arizona disability lawyer accuse the insurer of operating under a conflict of interest in the denial of Leslie R.’s short term disability benefits. As the decision maker and payor of benefits, AETNA has a bias toward denying benefits. And, according to Leslie R.’s disability lawyer in such incidents like Leslie R., the insurer is inclined to deny short term disability benefits in an effort to not have to follow through with long term disability benefits payments.
Disability Blog & Cases:
Sedgwick continues to deny disability benefits to AT&T employee
An AT&T employee recently shared her experience about dealing with Sedgwick for a short term disability claim. This story is a routine situation for people that are forced to deal with Sedgwick for the handling of their disability insurance claim.
Cigna again finds itself in court over termination of entitled disability benefits. In the United States District Court of the Eastern District of Pennsylvania case Gena N. v. Liberty Insurance Company of North America a/k/a Cigna, Gina N. and her Pennsylvania disability attorney have appealed to the District Court to enter a judgment against the insurer for an award of her full and complete payment of long term disability benefits from the date of the termination of her long term disability benefits moving forward per the terms of her employee CIGNA plan, reasonable attorneys' fees, costs and "expenses as permitted under ERISA, interest and any other equitable relief" the Court deems appropriate.
Office Manager Hires Disability Attorney to File Lawsuit against Cigna
Gina N. was employed at Drexel University College of Medicine as the Office Manager until February 7, 2003 when she ceased work as the result of a serious lower back injury which she sustained when she slipped and fell on ice in a parking lot. After intensive medical treatments and failed surgeries, Gina N. was forced to stop working, applied for her Cigna disability benefits, was awarded those benefits, and was awarded Social Security Disability Benefits. Then in January of 2009, some seven years later, Cigna terminated Gina N.'s disability benefits, basing its decision on its allegation that Gina N. "was not in compliance with the policy for failure to attend a scheduled Functional Capacity Evaluation (FCE), and by February 2010, Gina N. had exhausted all her administrative appeals forcing her to seek the assistance of a disability attorney to litigate her case.
Attorney Says Cigna was Arbitrary and Capricious in Denial of Disability Benefits
Charging Cigna with arbitrarily and capriciously terminating and denying her long term disability benefits, Gina N. and her disability attorney state that Gina N. had at all times sent medical documentation to the insurer as required, verifying her disabled condition. In addition, while Gina N. did miss one FCE appointment, she did undergo an FCE on November 17, 2009 and the test revealed that Gina N. did have limited movement and did suffer from back pain; the report did not, however, evaluate whether Gina N. had the "exertional capacity to re-engage in even a sedentary level position." In fact, Gina N. provided Cigna with this FCA report in one of her appeals to no avail. Gina N. and her attorney believe, and state in her complaint, that the insurer upheld its termination of Gina N.'s disability benefits on the exclusive opinion of a doctor from MLS Group of Companies, a peer review and report ordered by Cigna.
Doctor for Cigna Passed Judgment without Examining Claimant in Person
The doctor who evaluated Gina N.'s claim did not personally interview or evaluate Gina N.'s medical condition and, in fact, used a "standard form instruction sheet that it transmits to the physicians it selects and contracts with to conduct evaluations, which form is not contained in Cigna's claim file," but which instructs evaluating physicians to "ignore subjective complaints" and limits the scope of any investigation. Gina N.'s attorney thus alleges that Gina N.'s assessment was "intentionally constrained" and that the assessment ignored her medical records and that the evaluation of "her condition was unfair, inappropriate, misleading, and did not constitute anything remotely resembling an 'independent medical evaluation'."
In addition, Gina N. and her attorney allege that Cigna breached its disability insurance contract with Gina N. in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) by not providing a full and fair review of Gina N.'s claim. They allege that these violations entitle Gina N. to a judgment of wrongful denial on Gina N.'s claim, and seek to reinstate her long term benefits and compensation for attorneys' fees and other damages to be determined by the District Court.
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Texas claimant takes Reliastar to task for denied disability benefits
Suffering from multiple medical conditions and unable to function in a daily job, a health care professional and her Texas disability lawyer filed a lawsuit against Reliastar Life Insurance Company to force the insurer to pay disability benefits as contracted in an employee welfare benefit plan.
Disability Blog & Cases:
Wells Fargo disability claimants in Alabama and Florida file lawsuits against Liberty Life Assurance Company of Boston for unpaid long term disability benefits
Wells Fargo disability claimants in Alabama and Florida file lawsuits against Liberty Life Assurance Company of Boston for unpaid long term disability benefits
Recently, two Wells Fargo employees were forced to file Federal Lawsuist against Liberty Life after being denied disability benefits. Utilizing the services of an Alabama Disability Attorney and a Florida Disability Lawyer, the two lawsuits are currently pending. Let’s take a closer look at both cases:
Disability Blog & Cases:
Tempur employee suffering from chronic fatigue syndrome sues Union Central Life for denial of disability benefits
A federal lawsuit was recently filed in the U.S. District Court in Pennsylvania against the Union Central Life Insurance Company (Union) by a Pennsylvania disability attorney. The Plaintiff, Janet G., worked as a Direct Sales Supervisor for Tempur World, Inc. (Tempur). Due to her employment at Tempur, Janet was provided long-term disability insurance with Union Central.
An Alabama Claimant and her Alabama disability attorney filed suit against Liberty Life Assurance in the United States District Court for the Northern District of Alabama Northeastern Division. A former DIRECTV Group, Inc. employee, Juarlesa W. worked as a customer service representative and was fully vested in her company's Liberty Life Insurance Plan when she became disabled in January 2010.
Suffering from the "combined effects of several impairments, including cervical/lumbar degenerative disc disease, lumbar/cervical radiculitis, osteoarthritis, fibromyalgia, degenerative joint disease of the right shoulder, chronic pain syndrome, post-op knee arthropathy, hypertension, GERD, migraines, restless leg syndrome, and insomnia," Juarlesa W. and her disability attorney filed suit against the insurer on November 7, 2011 for denial of Juarlesa W.'s long term disability benefits.
Background of Alabama Claimant's Suit against Liberty Life
Approved for her short term disability benefits by Liberty Life, Juarlesa W. has an issue with only the denial of her long term disability benefits. After her short-term disability benefits expired, Liberty life began paying Juarlesa W. her long-term disability payments, but arbitrarily decided to terminate those payments in September 2010. The insurer asked for further information from Juarlesa W.' treating physician to further evaluate her disability claim. In response, Juarlesa W.'s treating physician submitted a letter in November 2010, confirming that Juarlesa W.'s condition remained the same, meaning the same as when Liberty Life approved Juarlesa W.'s disability claim and paid her disability benefits.
Ignoring Juarlesa W.'s physician's opinion as well as the insurer's own physician consultant, Liberty Life continues to stand by their opinion that Juarlesa W.'s is not disabled and denies her further disability benefits. According to the complaint filed by Juarlesa W.'s disability attorney, "Liberty Life redid its prior decision concluding that [Juarlesa W.] was no longer disabled for the very same reasons it previously approved her claim." In addition, the insurer has not provided any other evidence that would indicate that Juarlesa W. is not disabled. After appealing and losing all administrative challenges to Liberty Life's decision to terminate her long term disability benefits, Juarlesa W. hired a disability attorney to litigate her claim in District Court.
Disability Attorney States Case against Liberty Life
Offering up Juarlesa W.'s lengthy medical history as well as the opinions of her treating physician and Liberty Life's own evaluating physician, Juarlesa W.'s attorney claims that Liberty Life wrongfully terminated Juarlesa W.'s disability benefits in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) as well as in violation of Liberty Life's own policies. Consequently, Juarlesa W. and her disability attorney ask the District Court to:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
At least five lawsuits were recently filed in Florida District Courts against Prudential for non-payment of disability benefits to deserving claimants
With at least five suits filed against them in July for denying disability benefits, Prudential Insurance Company of America has a lot of unhappy claimants in Florida.
Disability Blog & Cases:
California Consultant sues Northwestern Life Insurance Company for unpaid disability benefits
Northwestern Insurance beneficiary Todd W. and his California disability attorney‘s complaint against the insurer accuses Northwestern of breach of the Duty of Good Faith and Fair Dealing and Breach of Contract in response to its denial of Todd W.’s disability benefits.
Disability Blog & Cases:
Duke University Doctor sues UNUM Life Insurance Company for long term disability benefits
Dr. Karen M. and her North Carolina disability attorney filed a lawsuit against UNUM in the United Stated District Court for the Eastern District of North Carolina to acquire her long term disability benefits. The beneficiary of disability benefits under a plan provided through her employer Private Diagnostic Clinic PLLC at Duke University Medical Center, Dr. Karen ceased working as a general practitioner on February 23, 2007.
Wanda N. and her North Carolina disability attorney filed a lawsuit in the United States District Court for the Eastern District of North Carolina Western Division, claiming that Liberty Life wrongfully terminated Wanda N.'s long term disability benefits in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) and other federal statutes.
In the suit, Wanda N.'s disability attorney petitions the District Court to rule in favor of Wanda N. by:
Claimant's Disability Benefits are Terminated by Liberty Life in Violation of ERISA
As an employee at Kidde Aerospace & Defense, a subsidiary of United Technologies Corporation, Wanda N. was enrolled in her employer's insurance policy benefit plan when she became disabled due to back pain in February of 2010. After receiving her short term disability benefits for six months and being approved for her long-term disability benefits in August 2010, Wanda N. discovered that her disability benefits would be terminated in December 2010. Apparently, the insurer concluded that Wanda N. was no longer disabled and believed that the previous evidence it had of Wanda N.'s disabled condition "no longer supported [Wanda N.'s] claim." On appeal of this decision, Wanda N. was denied.
Disability Attorney Presents Claimant's Case in Their Complaint
A Floater at Kidde Aerospace, Wanda N. "performed various jobs when co-workers were absent from work or when additional workers were required for a particular job." Prior to her work stoppage, Wanda N. had a two-year history of "lower back pain radiating into her buttocks and legs, with numbness and tingling in her buttocks and thighs." Wanda N. underwent surgery in an effort to relief her back problem in March 2010, with some improvement of her condition, but no complete resolution. On various medication and attending to her healing process through physical therapy, Wanda N. received short-term disability benefits from Liberty life through August of 2010. Still recuperating, Wanda N. then applied for long term disability benefits, provided the insurer with her a completed Physical Job Evaluation Form, and Liberty Life approved her long term disability claim with plans to re-evaluate her situation in November 2010.
In November, a Liberty Life physician, in dispute with Wanda N.'s treating physician, determined that Wanda N. could perform light-duty work. Unfortunately, the Liberty life physician ignored Wanda N.'s medical records, which explicitly described how much pain Wanda N. was in and that her activity level potential was far short of the requirements of her position at Kidde Aerospace. In response Wanda N. "submitted a one-page appeal to Liberty Life in January 2011" and "advised Liberty Life that she could not sit up straight in a chair, could not sit for more than 15 minutes at a time without pain, could not stand for more than 10 minutes without pain, could not bend over, she laid down in the afternoons with a heating pad to help with the pain, she was currently on Zanaflex, Vicodin, Neurontin and Mobic, she was not allowed to drive a car due to the medication she was taking, and she remained under the care of" two doctors.
After another Liberty Life physician concluded that Wanda N. could work, Liberty Life again denied Wanda N.'s appeals resulting in Wanda N. hiring a disability lawyer to fight for her disability benefits in District Court.
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Question writer for Jeopardy/Sony Pictures files suit against Prudential
A California disability attorney and his client filed suit against The Prudential Insurance Company of America (Prudential) in the United States District Court Central District of California on October 28, 2011 for unpaid long term disability payments due per the terms of an employee disability insurance plan.
Disability Blog & Cases:
CIGNA under fire in Minnesota Federal Court for termination of claimant's disability benefits
Beverly S. and her Minnesota disability attorney filed a lawsuit against CIGNA in the United States District Court for the District of Minnesota in an effort to procure her entitled disability benefits.
Disability Blog & Cases:
Electrical assembly worker for Northrop Grumman files a complaint against UNUM for denial of long term disability benefits
Fifty-nine-year old, former Northrop Grumman Corporation employee Rita L. and her Utah disability lawyer filed suit against UNUM Life Insurance Company and her employer in Federal Court in Utah. Claiming that the UNUM Plan Administrator erroneously denied Rita her disability benefits, the complaint asks the District Court to right this wrong.
On November 10, 2011, Liberty Life Assurance Company of Boston claimant, Dana E., and his California disability lawyer filed a complaint against the insurer in the United States District Court for the Northern District of California under the Employee Retirement Income Security Act of 1974 (ERISA) and 29 USC § 1132(a)(1)(B) in an effort to force the insurer to release his entitled disability benefits.
Dana E., age 55, was a Senior Local Sales Account Executive for Comcast, when he ceased working in compliance with his doctor's recommendation on July 25, 2009. At the time, Dana E. was suffering from fatigue, joint pain, skin lesions and photosensitivity caused by Lupus. Lupus, a chronic inflammatory disease, causes its victims immune system to attack healthy tissue that results in multiple debilitating symptoms.
Claimant and Disability Attorney File Complaint in California District Court after Denial of Disability Benefits on Appeal
As confirmed by his treating rheumatologists, Dana E. was disabled from performing the duties of his occupation in August 2009. Needing periodic rest due to fatigue and pain management, Dana E. became extremely limited in his daily activities and was unable to work the long hours of sitting at a desk that his Comcast position required. A Liberty life employee policy holder, Dana E. applied for longer term disability benefits, providing the insurer with sufficient medical corroboration of his disabled condition in addition to the recommendations from his treating physicians of his disabled condition. Dana E. received long term disability benefits until July 2011, at which time Liberty Life denied him further benefits. On appeal, the insurer continues to deny Dana E.'s claim, leading to the hiring by Dana E. of a disability lawyer to claim his entitled Liberty Life disability benefits.
Liberty Life Accused of Breach of Its Obligation to California Claimant
In the complaint, Dana E.'s disability lawyer alleges that Liberty life "breached its obligation under the long term disability plan by denying coverage for [Dana E.'s] disability payments" when he clearly meet s the requirements of eligibility. In the complaint, it is asserted that Liberty Life "arbitrarily and unreasonable relied on retained consultants'' opinions as opposed to [Dana E.'s] own treating doctors" when deciding to discontinue Dana E.'s disability benefits. Forced to retain the services of a disability lawyer to protect his rights, Dana E. and his attorney petition the District Court to rule against Liberty Life and provide compensatory damages, costs of suit, reasonable attorney fees, prejudgment interest on all back benefits, and "such other and further relief as the court may deem 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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Office Depot employee files suit against employer and Aetna for unpaid disability benefits
An Office Depot employee and her Georgia disability attorney filed suit against her employer and Aetna Life Insurance for unpaid disability benefits on November 3, 2011 in the United States District Court for the Northern District of Georgia Atlanta Division.
Disability Blog & Cases:
New Jersey BankUnited employee files suit against Lincoln National
Robert B. and his New Jersey disability lawyer go to battle against The Lincoln National Life Insurance Company to retrieve Robert B.’s entitled disability benefits as promised in his employee disability benefits plan.
Disability Blog & Cases:
New Jersey claimant files suit against New York Life, Unum and Paul Revere for miscalculated disability benefits
William M. never suspected that should he need to make use of his disability insurance policy (which he had faithfully paid premiums on for years) that the promised disability benefits would be denied him when he needed them most.
A sales representative for Long Forms, Inc., President and part owner of Advanced Transportation Systems, Inc. and The Institute of Logistical Management as well as an hourly employee of Temple University as a Criminal Justice instructor, William was diagnosed with Hodgkin’s’ Lymphoma in 1997. Between January 1997 and February 1998, William underwent surgeries, biopsies, chemotherapy, and radiation to combat the progression of the disease.
On August 24, 2011, a pre-screener for the Detroit Area Agency on Aging (DAAA) and her disability lawyer filed a lawsuit against Prudential Insurance Company of America in the United States District Court for the Western District of Wisconsin. According to their complaint, Della Davis and her Wisconsin disability lawyer allege that the insurer owes Davis:
Claimant Designated as Disabled by SSA
An employee covered by an employee insurance policy administered by Prudential for her employer the Detroit Area Agency on Aging, Davis worked at the DAAA from 2001 through 2006 when she succumbed to her medical conditions, ceased working and applied for her Prudential disability benefits. With years of documentation of her various ailments, Davis was awarded her claim. Initially receiving her entitled disability benefits, Davis was declared disabled by the Social Security Administration and awarded Social Security Income Disability Benefits (SSDB) retroactive until September 2006. Prudential, promptly, required Davis to repay the $1,310.28 in over-payment of benefits to correlate with her SSDB, which she complied with.
Filing of Lawsuit against Prudential in United States District Court of Wisconsin
Then, shortly afterward the SSDB award and over-payment notification, Prudential scheduled Davis to participate in an Independent Medical Evaluation (IME) in which the evaluating doctor stated that "there were no objective findings to support [Davis'] inability to perform activities." With reams and reams of medical documentation, doctor's letters, proof of surgery, and therapy, Davis found herself without disability benefits and without a premium life insurance waiver from Prudential when the insurer discontinued her disability benefits payments. Diagnosed with and treated for "cervical radiculopathjy, cervicalgia, herniated disks, degenerative disc disease, spondylosis and osteoarthritis, forminal stenosis, chronic thoracolumbar strain, degenerative changes in the lumbosacral spin, fibromyalgia, bilateral carpal tunnel syndrome ('CTS'), right shoulder pain with impingement syndrome, deltoid atrophy, arthritis of the left knee, sleep apnea, chronic fatigue syndrome, vertigo/imbalance disorder, and thoracic outlet syndrome," Davis had no other option but to file a lawsuit against Prudential to attempt to retrieve her disability benefits.
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. To request a free legal consultation call 800-411-9085.
A California disability lawyer has recently filed a federal lawsuit in a district court in California against Liberty Life Assurance Company of Boston (Liberty Life). The Plaintiff, Kimberly S., worked as a registered nurse at the University of California at Davis (UC Davis). Being employed by UC Davis, Plaintiff was covered by its Supplemental Disability Insurance Plan, which was funded and administered by Liberty Life.
In Kimberly S. v. Liberty Life Assurance Company Of Boston, Plaintiff has filed a lawsuit to regain the benefits that were abruptly and wrongly terminated by Liberty Life.
Case Facts Against Liberty Life
Plaintiff worked as a registered nurse at the University of California at Davis until on or around September 29, 2009, when Plaintiff suffered a loss compensable under the terms of the Plan. Due to physical sickness, she was unable to perform the material and substantial duties of a registered nurse, requiring her to take a disability leave. Plaintiff submitted a long-term disability claim to Liberty Life, which was approved and began taking effect on September 29, 2009.
Termination of Long-Term Disability Benefits By Liberty Life
Effective September 28, 2011, Liberty Life wrongfully terminated Plaintiff's long-term disability benefits. Liberty Life claims this was due to its conclusion that Plaintiff's disability was due to a mental condition, making the payment of benefits subject to 24-month benefit limitation period.
Lawsuit Filed Against Liberty Life By California Disability Lawyer
In this lawsuit, Plaintiff claims that Liberty Life committed the following wrongful actions against the Plaintiff:
Plaintiff Seeks Following Relief From Liberty Life Via Court Ruling
Due to Liberty Life's actions against the Plaintiff, Plaintiff seeks following remedies from the Court:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Northwestern Mutual sued by shareholder attorney for underpaying and denying long-term disability benefits
A Washington disability attorney filed a federal lawsuit in the District Court serving the Western District Court of Washington at Seattle against Northwestern Mutual Life Insurance Company (Northwestern). The Plaintiff, Scott D., worked as a shareholder attorney at a law firm in the state of Washington. Plaintiff was covered under a long-term disability policy purchased from Northwestern, who was contracted by the law firm to provide these benefits to its employees.
Disability Blog & Cases:
Bank of America, Boeing, and Cytec Industries employees file lawsuits against Aetna Life Insurance Company over disability benefits
Recently, three separate ERISA actions were filed against Aetna in Federal Court for wrongfully denying disability benefits to those covered under Aetna Long Term Disability Policies. Lets take a closer look at each of these cases.
Disability Blog & Cases:
Dental surgeon sues Paul Revere Life Insurance Company for wrongful denial of long-term disability benefits
A California disability lawyer filed a federal lawsuit in Federal Court against The Paul Revere Life Insurance Company (Paul Revere). The Plaintiff, Eric W., DDS, was employed as a dental surgeon and took out an individual long-term disability coverage policy by Paul Revere. The Plaintiff had paid all premiums on time, making him eligible for all benefits covered by the terms of the policy.
In Maryland Federal Court, a four-year employee (working as a receiver) at Weis Markets, Inc. ceased working in October 2009 due to cervical surgery that she had to undergo for repair of injuries she sustained in a car accident in October 2008. After being denied long term disability benefits by Guardian, she was forced to hire a Maryland disability attorney and file suit.
Suffering from occipital headaches, neck pain, stiffness, and radiation in her arms, the claimant was diagnosed with cervical radiculopathy that required surgery for a "cervical fusion and decompression of C5-C6 with replacement o instrumentation," which left her with a "30% permanent partial impairment of her neck."
Denied Long Term Disability Benefits
Not eligible for short term disability benefits, the claimant applied to Guardian Life Insurance Company of America for her long term disability benefits as provided by her employee plan with Weis Markets, Inc. In a letter dated June 18, 2010, Guardian Life denied the claimant her long term disability benefits, after it concluded that the claimant was capable of performing her "prior job duties," which included the "ability to life a heavy garage door." The claimant appealed the insurer's decision, sent additional documents in support of her inability to work at her previous job, and was again denied her Guardian Life disability benefits. On June 21, 2011, the claimant received her final denial from Guardian Life, in which the insurer upheld its original decision, forcing the claimant to hire a disability lawyer to file a lawsuit to try to collect on the disability benefits she is entitled to through her employee disability plan.
Lawyer Appeals to Maryland District Court for Relief
Claiming that Guardian failed to "conduct a full and fair review and that the decision to deny disability benefits to the claimant was unreasonable and not supported by substantial evidence" for the denial of her benefits, the claimant and her lawyer filed suit in District Court on August 17, 2011. In the complaint, the claimant and her lawyer ask the Court for the following relief:
Maryland District Court will Decide if The claimant is Disabled or Not
The issue in this suit revolves around the question as to whether or not she meets the definition of disabled per her employee insurance policy. The claimant and her attorney are confident that she does meet the criteria as she cannot lift the heavy garage door that is a duty under her employment requirements. Consequently, they claim that her lawsuit has substantial evidence that Guardian has not conducted a full and fair review of her claim and that the insurer unreasonably denied her claim as a result of that failure. The claimant and her disability attorney allege that Guardian has breached her contract with her by not providing her disability benefits as promised, and that the insurer's denial of her disability benefits is "arbitrary, illegal, capricious, unreasonable, discriminatory and not made in good faith."
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Registered nurse at Temple University Hospital denied disability benefits, sues Cigna
A Pennsylvania disability attorney recently filed a lawsuit in District Court of Pennsylvania against Cigna. The Plaintiff, Jamy V., was employed as a registered nurse for Temple University Health Systems (TUHS) through April 1, 2006. Due to her employment with TUHS, Plaintiff was covered by TUHS’s Group Long-Term Disability Plan. This plan was administered by Cigna.
Disability Blog & Cases:
Employees of Wells Fargo, Heinz, and Otis Elevator sue Liberty Life for denial of ERISA benefits
Liberty Life Assurance Company of Boston (Liberty) was sued by three Plaintiffs in District Courts in Pennsylvania, Ohio, and California for failure to provide disability benefits as promised by ERISA. In all three cases that were filed via the Plaintiffs’ respective attorneys, Liberty is accused of wrongfully denying the claims of all three Plaintiffs for long-term disability benefits as promised under their respective plans.
Disability Blog & Cases:
CIGNA has three new lawsuits to deal with for unpaid disability benefits
Three recent ERISA complaints were filed against CIGNA in Kentucky, New York and Texas for denying short-term and long-term disability benefits. In each of the cases, with the assistance of a disability attorney, the claimants are suing for claims that were allegedly wrongfully denied. Lets take a look at each case:
Finding itself named as the defendant in multiple lawsuits throughout the United States this summer, Aetna Life Insurance has a lot of denied and terminated long term disability benefit claims to answer for in District Courts.
Case 1: Aetna Life Lawsuit in Georgia
Donald W. and his Georgia disability attorney filed a lawsuit in the United State District Court Southern District of Georgia Augusta Division on August 8, 20011 under ERISA (Employee Retirement Income Security Act of 1974) in an effort to recover Donald W.'s disability benefits he is entitled to pursuant to his ADP Total Source, Inc. disability plan. An employee of ADP Total Source, Inc., Donald W. purchased long term disability group insurance from his employer that was underwritten by Aetna. The plan stipulated that Donald W. would be paid his disability benefits after twenty-four (24) months of his qualification of such benefits provided: "(1) he was unable to perform the material duties of his own occupation solely because of disease or injury; and, (2) that his work earnings were 80% or less of his adjusted pre-disability earnings."
As the result of a pre-existing back condition, Donald W., a heavy duty diesel mechanic, was unable to work at any reasonable occupation and was declared disabled on February 1, 2010. Upon submission of his disability claim, Donald W. was denied; and after filing all his administrative appeals, Donald W. continues to be denied his disability benefits by Aetna. Consequently, Donald W. and his Georgia disability attorney filed a lawsuit against the insurer to try to convince the Court that Aetna's denial of Donald W. ‘s disability benefits is contrary to the terms of the policy, that that decision is erroneous, capricious and unreasonable, and he and his Georgia disability lawyer asked the Court to order Aetna to fulfill its obligation to pay Donald W. his disability benefits as well as reimburse him for reasonable attorney's fees, Court costs and interest on his denied benefits.
Case 2: Aetna Lawsuit in Kentucky
Priscilla J. and her Kentucky disability attorney filed a lawsuit against Aetna in the United States District Court of the Western District of Kentucky at Bowling Green on July 13, 2011 in an effort to recover Priscilla J.'s disability benefits due to be paid to her "under the terms of her employee benefit plan." An employee at Sensus Metering Systems, Priscilla J. was notified by Aetna in a letter dated April 2, 2009 that her appeal of the termination of her short term disability benefits would be terminated because the insurer determined Johnson's "medical information did not support functional impairment that would prevent her from performing the essential duties of [her] own occupation." Priscilla J.'s disability benefits were initially approved on July 12, 2008 and continued through November 27, 2008.
Priscilla J.'s disability lawyer alleges that the reason Aetna denied Priscilla J.'s disability benefits was due to the insurer's failure to be contacted by Priscilla J.'s treating physician as her treating physician was out of town and unaware that his input was needed. Upon returning from his out-of-town absence, Priscilla J.'s treating physician tried to contact Aetna's reviewer to verify Priscilla J.'s disability, but was ignored by the insurer. Consequently, since Priscilla J.'s short term disability benefits were terminated, she had no way of procuring her long term disability benefits and petitions the District Court to order the insurer to conduct a "full and fair review" of her disability claim in its entirety.
Stating that the denial of her claim was "unreasonable, arbitrary and capricious" and has resulted in "great hardship to [Priscilla J.] and her family," Priscilla J. and her disability attorney ask the Court to reverse Aetna's denial of Priscilla J.'s claim, reinstate her benefits, reinstate her ability to apply for long term disability benefits, reimburse her for attorney's fees, and provide any other appropriate relief.
Case 3: Aetna Lawsuit in Minnesota
On July 15, 2011, a Hubbell, Inc. warehouse associate and his Minnesota disability lawyer filed a lawsuit against Aetna Life Insurance Company in the United States District Court of Minnesota under 29 U.S.C. § 1132(e)(2) and ERISA § 502(e)(2) to recover Charles B.'s long term disability benefits under his employee disability plan. Employed by Hubbell Inc., Charles B. had to stop working in May of 2008 as a result of his disability. Disabled on May 30, 2008, Charles B. applied for and was approved and paid long term disability benefits from November 30, 2008 until December 22, 2008. His disability benefits were terminated by a letter from Aetna with the insurer alleging that Charles B.'s disability "was a result of an exacerbation of a pre-existing condition." After several appeals, Charles B. eventually exhausted all his administrative remedies available per Aetna's procedures and hired a disability attorney to help him bring his case to the Minnesota District Court for a decision.
In their complaint Charles B. and his lawyer request the District Court to enter a judgment against Aetna to compel the insurer to pay Charles B. retroactive disability benefits from May 30, 2008, declare Charles B. entitled to ongoing disability benefits under his Aetna plan, accrued interest, court costs, disbursements and other litigation expenses, and any "further relief as the Court may deem just and proper."
Case 4: Aetna Lawsuit in New Jersey
A complaint against Aetna Life Insurance Company was filed on August 8, 2011 by Jennifer M. and her New Jersey disability lawyer in the United District Court of New Jersey to collect all past due long term disability benefits and all out-of-pocket medical expenses incurred by Jennifer M. as a result of Aetna's wrongful denial of her Aetna disability benefits. In possession of a valid Aetna disability insurance policy, Jennifer M. began receiving disability benefits from Aetna on June 1, 2008. But, on July 16, 2009, Aetna denied Jennifer M.'s long term disability claim contending that her condition was a pre-existing one and thus disqualified her in receiving disability benefits ongoing.
Disabled and unable to engage in gainful employment in any capacity, Jennifer M. exhausted all her administrative appeals with Aetna and had to file this lawsuit to reclaim her disability benefits. Jennifer M. was employed by Camuto VCS Group at the time of her disabling event. And, since Aetna has refused to provide Jennifer M. with her disability benefits as set forth in her employee disability insurance policy, Jennifer M. and her disability lawyer allege that she has sustained damages as a direct and proximate result of Aetna's denial of her disability benefits.
In the lawsuit Jennifer M. and her lawyer demand judgment against Aetna and request:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Five disability lawsuits recently filed against UNUM in Tennessee, Ohio, Missouri, and Michigan
Five ERISA disability lawsuits have been recently filed against the UNUM Life Insurance Company of America for the wrongful denial of disability benefits. In each of the cases, a disability attorney from Tennessee, Ohio, Missouri and Michigan have filed suit for the payment of disability benefits that have been wrongfully denied and owed to their clients. Let’s take a closer look at each of the lawsuits.
Disability Blog & Cases:
Disabled attorney forced to sue UNUM for her disability benefits
A 53-year-old disabled attorney and her New York disability attorney filed a Federal lawsuit against the insurer UNUM on July 15, 2011 for collection of her disability benefits. A Toxic Tort Trial and Litigation Attorney and partner at a well-known firm, the claimant was forced to stop working due to her deteriorating medical condition in April 2009.
Disability Blog & Cases:
Aetna Life Insurance Company sued by Bank of America and Huhtamaki employees for failing to provide ERISA benefits
Two Plaintiffs filed cases against Aetna Life Insurance Company (Aetna) in the Maine and California District Courts due to the failure to provide disability benefits provided by the Employee Retirement Income Security Act (ERISA) of 1974. In the previously mentioned cases filed through the plaintiffs’ disability lawyers, it is alleged that Aetna has wrongfully denied the Plaintiffs’ claims for disability benefits as provided by the terms of those respective plans.
On April 13, 2011, a Morgan Stanley employee and her California disability attorney filed a lawsuit against First UNUM Life Insurance Company for breach of the Employee Retirement Income Security Act of 1974(ERISA), after she was denied long term disability benefits.
On June 22, 2007, the claimant became disabled due to "a series of physical medical conditions, inter alia, a variant of Dejerine Roussy (Central Pain) Syndrome called central hypoperfusion syndrome, fibromyalgia, severe immunodeficiency, and server adrenal deficiency." Suffering from "chronic disabling pain of her right lower abdomen, whole body pain of muscles, joints and bones (including sensations of severe numbness and burning in her legs, face and neck, irritable bowel syndrome, dizziness and nausea, severe fatigue, severe migraine headaches, and chronic hormonal imbalances," the claimant takes powerful corticosteroids and other medications that cause side effects of cognitive difficulties, sleepiness, dizziness, fatigue and other symptoms that preclude her from performing her occupation as a Morgan Stanley Banking Associate.
Background of Banking Associate's Disability Lawsuit against UNUM Life
Unable to perform "the substantial and material duties of her prior occupation as a Banking Associate," the claimant applied for long term disability benefits from UNUM, and was awarded those benefits on November 13, 2007. Approved for $5,000 per month in disability benefits, the claimant's disability benefits were calculated incorrectly by taking into consideration only Sconiers' base salary and failing "to calculate her basic monthly earnings as her HWEE defined as prior year annual gross W-2 earnings" as specified by the UNUM plan. In addition, without "conducting any reasonable or thorough investigation" and without having evidence supporting that the claimant's condition had improved, UNUM terminated her disability benefits on March 24, 2010. The insurer asserted that the claimant "suffered from a mental condition" that had passed the disability plan's 24-month limitation period and thus she "was no longer disabled under the terms of the Group Policy."
Disability Lawyer Goes to Battle for Claimant in California District Court
After filing several appeals to UNUM's termination and miscalculation and being denied at every turn, the claimant and her disability attorney filed the subject lawsuit to obtain her entitled disability insurance benefits through litigation. Alleging that the insurer violated ERISA (the Employee Retirements Insurance Security Act of 1974), California law, and its fiduciary duty in respect to the management of her Stanley Morgan disability insurance plan, the claimant and her California disability attorney accuse the insurer of:
The claimant and her disability attorney, in her complaint, ask the District Court to permanently enjoin UNUM from "ever again serving as a fiduciary with respect to the Plan," award the claimant attorney's fees and costs, provide the claimant with appropriate equitable relief from UNUM and issue an order awarding the claimant the "full amount of benefits due since November 13, 2007," plus interest and "other losses resulting from UNUM's breach."
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. To request a free legal consultation call 800-411-9085.
Liberty Life Assurance Company of Boston was recently sued by three separate Plaintiffs for Employee Retirement Income Security Act (ERISA) violations in Michigan Federal Courts. In all three cases filed by Michigan disability attorneys, Liberty is alleged of wrongfully denying the claims of all Plaintiffs for long-term disability (LTD) benefits.
The First Case
Amy W. was employed by Chico's FAS, Inc. as a Purchasing Assistant, thereby making her eligible for its long-term disability plan, which was covered by Liberty.
Plaintiff ceased working on April 15, 2008 due to her degenerative and traumatic injuries. To the current date, Plaintiff suffers from narcolepsy, fibromyalgia, depression, and anxiety. Plaintiff filed for short-term disability benefits, which were granted by Liberty.
Plaintiff filed for long-term disability benefits through the Plan. On October 16, 2008, Liberty denied Plaintiff's request for LTD benefits under the Plan and informed Plaintiff she had 180 days to appeal this decision.
On April 13, 2009, Plaintiff requested administrative review of the denial of benefits as she was entitled to under the Plan. Plaintiff submitted administrative appeal to Liberty and included additional documentation and medical records detailing her total disability that prevented her from working at her own occupation or at any other occupation according to the terms of the Plan. Plaintiff also included documentation of the fully favorable decision of total disability as deemed by the Social Security Administration.
On July 8, 2009, Liberty again denied Plaintiff's claim for long-term disability benefits. Plaintiff filed a second appeal on February 5, 2010 and added additional documentation and medical records to further prove her claim for LTD benefits under the Plan. Liberty issued its final denial on March 31, 2010.
Due to exhausting her administrative remedies, Plaintiff filed this lawsuit, claiming that Liberty did not properly evaluate the evidence presented to it regarding Plaintiff's condition, is interpreting the terms of the plan for total disability in an unreasonable manner, and has not fulfilled its contractual obligation to furnish the promised benefits under the Plan.
The Second Case
Amy S. was a Customer Service Representative for Advance America Cash Advance Center, making her eligible for the long-term disability Plan that was insured by Liberty.
Due to degenerative and traumatic injuries that caused seizure-like episodes, Plaintiff ceased work on September 3, 2008. Plaintiff filed for short-term disability benefits, which were granted by Liberty. Plaintiff applied for long-term disability benefits through the Plan, but was denied by Liberty on December 4, 2008. Plaintiff was informed that she had 180 days to appeal this decision.
Plaintiff requested administrative review of the denial of benefits on July 11, 2009. She sent a letter to Liberty that included additional information and medical records to substantiate her claim that she is totally disabled under the terms of the Plan, preventing her from working at her own occupation or from any other occupation. Liberty denied Plaintiff's appeal on March 3, 2010.
Plaintiff filed a second appeal on August 30, 2010, which included additional information and medical records to substantiate her claim that she is totally disabled. Liberty issued its final denial on October 8, 2010.
Plaintiff has exhausted her administrative remedies, which has led to the filing of this lawsuit. Plaintiff claims that Liberty failed to properly evaluate the evidence presented to it regarding Plaintiff's condition, did not interpret the terms of the plan for total disability in a reasonable manner, and did not fulfill its contractual obligation to furnish the promised benefits under the Plan.
The Third Case
Allyse F. has been an employee of PNC Financial Services Group since 2004. This made her eligible for the disability benefits package that was insured by Liberty.
Due to a serious motor vehicle accident on July 12, 2008, Plaintiff has not worked since December 2008. Plaintiff is totally disabled and unable to work due to ongoing problems with depression and physical and emotional symptoms caused by the accident, as supported by her psychologisti. This prognosis was also supported by Plaintiff's orthopedic surgeon at the University of Michigan, as well as by the Plaintiff's primary care physician, who also believes that the Plaintiff will be on disability for at least the next three years.
Liberty stopped Plaintiff's benefits in August 2010, recklessly disregarding the opinions of the Plaintiff's treating physicians. Due to the exhaustion of administrative remedies, Plaintiff has filed this lawsuit, claiming that Liberty is in violation of the LTD benefits contract.
Relief Sought in the Lawsuits
In the three aforementioned cases, the Plaintiffs seek the following relief from Liberty in their lawsuits:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Radio personality files lawsuit against UNUM to recover disability benefits
A Radio Station employee and her Montana disability lawyer filed a lawsuit against UNUM Group in Montana Federal Court alleging that the insurer violated the Employee Retirement Insurance Security Act of 1974 (ERISA) when it wrongfully denied her entitled disability benefits per a policy she had with her employer, KMSO Radio.
Disability Blog & Cases:
CIGNA/LINA sued by Lockheed Martin employee for unpaid disability benefits
A lawsuit was filed August 1, 2011 in the Federal Court of New Jersey against CIGNA by a hardware analyst and her New Jersey disability attorney in an effort to procure the employee’s disability benefits. After suffering from melanoma of the uterus and courageous attempts to continue working, the claimant was unable to and filed for long term disability benefits. When CIGNA denied those benefits, the claimant was forced to hire an attorney and sue.
Disability Blog & Cases:
Liberty Life faces disability benefit lawsuits in Florida and Maryland for denying disability benefits
Four individuals, include two Comcast employees, with the help of their disability attorneys have filed Federal Lawsuits against Liberty Life Assurance Company of Boston for failing to pay long term disability benefits. Let’s take a closer look at each case.
A federal lawsuit was recently filed by a Florida disability attorney against the Berkshire Life to recover monthly disability benefit payments wrongly withheld. As a Senior Strategic Accounts Manager for Walgreen's, Inc., George F., was covered by Berkshire's monthly disability benefit plan.
The Facts of the Case Against Berkshire Life Insurance Company Of North America
The plaintiff, George F., suffers from multiple medical conditions and symptoms, including herniated disk, radiculitis, spondylosis, spinal stenosis, intractable radiculopathy, and L5-S1 retrolisthesis. Plaintiff has undergone diskectomy, foraminotomy, and L5-S1 facetectomy due to these conditions and symptoms.
Due to these conditions, Plaintiff attempted to work in a reduced capacity from July 27, 2009 to September 30, 2009, but ceased working on September 30, 2009 due to being unable to work in a reduced capacity.
In accordance with the procedures set forth in the Plan and fitting the terms of the "Total Disability" provision in the Plan, Plaintiff filed an Individual Disability Claims Notice of Claim Form to Berkshire on January 20, 2011.
Delay of Berkshire Disability Benefits Claim
Berkshire has not yet made a determination in regards to Plaintiff's disability claim. According to the Plan, Plaintiff may bring legal action against Berkshire within 60 days after a submittal of proof of loss, as Plaintiff has done.
Plaintiff also added an Attending Physician Statement in his submittal to Berkshire on May 24, 2011. An Orthopedic Surgeon informed Berkshire that he was restricting Plaintiff's workload, including not lifting objects that weighed more than five to eight pounds. The doctor also stated that Plaintiff was a likely candidate for additional surgery in the future to correct his spinal ailments. All of this further aids the claim that Plaintiff meets the definition of "Total Disability" as defined in the Plan.
Berkshire's failure to reach a decision in a timely and reasonable manner regarding the Plaintiff's claim violates the terms of the Plan and Florida law. As a result, Plaintiff has retained an attorney and has filed this lawsuit.
Florida Disability Lawyer Files Lawsuit Against Berkshire
According to the lawsuit, Berkshire is alleged to have failed to provide the following to the plaintiff:
Relief Sought By The Plaintiff In The Berkshire Lawsuit
Due to Berkshire's actions, Plaintiff wants the following relief from the Court:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Liberty Mutual must consider disability appeal submitted 2.5 years after denial
A Massachusetts Federal District Court recently entered a very favorable opinion for disability insurance claimants. This case against Liberty Mutual is very fact specific so it does not abolish the 180 day ERISA regulation requirement to submit an appeal in 180 days. This case is an example of how important it is to make sure your disability insurance company is complying with the terms of a disability policy. Disability insurance companies cannot make up their own rules.
Disability Blog & Cases:
Five lawsuits recently filed in Florida Courts against Prudential for non-payment of disability benefits to deserving claimants
With at least five suits filed against them in July, Prudential Insurance Company of America has a lot of unhappy claimants in Florida. Florida Disability Attorneys recently filed Five Lawsuits against Prudential for the denial of long term disability benefits. Let’s take a closer look at each case.
Disability Blog & Cases:
Microsoft employee denied disability benefits by Prudential
A Microsoft account representative and her California disability lawyer filed suit against Prudential Insurance and Tanaka’s employer under the Employee Retirement Income Security Act of 1974 (ERISA) on August 1, 2011 in an effort to get a Federal Court to order the insurer to pay her entitled disability benefits. The Employee became disabled in March 2006 due to the worsening of her fibromyalgia condition which included symptoms of pain, fatigue and cognitive dysfunction. Initially approved for receipt of her disability benefits in May 2007 retroactive to September 13, 2006, Tanaka thought she was set for continuing disability benefits per the terms of her employee Prudential policy.
Disability Blog & Cases:
CIGNA denies disability claim and gets sued by neurologist
A complaint recently filed in Pennsylvania Federal Court by a Pennsylvania disability attorney against CIGNA and Life Insurance Company of North America petitions the Court to provide denied long term disability benefits.
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:
Relief Sought By Plaintiff In Guardian Lawsuit
Due to Guardian's actions, Plaintiff asks for the following from the Court:
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. To request a free legal consultation call 800-411-9085.
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.
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:
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. To request a free legal consultation call 800-411-9085.
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.
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:
Relief Sought By The Plaintiff In The Liberty Lawsuit
Due to Liberty's actions, Plaintiff seeks the following from the Court:
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. To request a free legal consultation call 800-411-9085.
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.
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:
Relief Sought By The Plaintiff In The Guardian Lawsuit
Due to Guardian's actions, Plaintiff seeks the following from the Court:
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. To request a free legal consultation call 800-411-9085.
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.
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:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Nestle Waters employee sues Assurant for denial of disability benefits under ERISA
A Pennsylvania disability attorne y recently filed a Federal lawsuit in Pennsylvania against Assurant, Inc. (Assurant), Assurant Employee Benefits (AEB), and Union Security Insurance Company (Union).
Disability Blog & Cases:
Disability attorney and client suffering from fibromyalgia and hypertension sue UNUM for unpaid long term disability benefits
On July 5, 2011, Annie T. Merion and her Georgia disability attorney filed a lawsuit against UNUM Life Insurance Company of America in the United States District of Georgia, Macon Division on a claim for long term disability benefits. As a governmental employee plan for disability benefits, Merion’s claim is excluded from being a plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). Merion, however, was entitled to her disability plans as she was covered under a UNUM disability plan that was provided through the Peach County Board of Education. As such, Merion brought her claim against UNUM Life because of its termination of her disability benefits that are owed her.
Disability Blog & Cases:
Ladenburg Thalmann Branch Manager suffering from injured back sues CIGNA for denial of disability benefits
A New York disability attorney recently filed a federal ERISA lawsuit against the CIGNA Life Insurance Company of New York (CIGNA). The Plaintiff was forced to file suit after CIGNA repeatedly denied her disability claim.
Disability Blog & Cases:
Ohio National Life Insurance Company denies claim after 7 years of disability payments
The plaintiff, with the help of an Oklahoma disability attorney , was forced to file a disability lawsuit against The Ohio National Life Insurance Company after Ohio National wrongfully withheld long term disability benefits from her.
Filing a lawsuit under the Employee Retirement Income Security Act (ERISA) against Prudential Insurance Company of America and KeyCorp Group Insurance Plan in Ohio Federal Court, Tom Morgan and his Ohio disability attorney are seeking to have Prudential award Morgan his rightfully owed disability benefits. Having exhausted all administrative appeals available, Morgan and his disability attorney have no other recourse but to seek a verdict in Court.
An employee at KeyCorp, Morgan was a vested participant in the company's group long term disability plan and "meets the criteria for payment of benefits under said Plan." Morgan was hired at KeyCorp in March of 2008, was issued a Prudential plan that included disability benefits and promised in the event of disability, he would be entitled to monthly disability benefits should he need it. On March 24, 2010, Morgan ceased working at KeyCorp as the result of a "combination of medical problems." Morgan properly applied for his disability benefits under the insurer's plan and met the criteria for receiving his disability payments, but was denied those benefits upon initial application and all administrative appeals that followed.
Morgan and His Disability Attorney Accuse Prudential and KeyCorp of Being Unreasonable
Alleging that Prudential and his KeyCorp Group Plan has unjustifiably denied Morgan benefits, Morgan and his disability attorney filed their ERISA lawsuit on June 21, 2011. According to the complaint, Morgan and his disability attorney claim that Prudential owes Morgan long-term disability payments from September, 22, 2010 to the present and continuing. They allege that Prudential's denial of Morgan's long term disability application was unreasonable as well as "arbitrary and capricious" because the insurer filled the dual role of evaluator and payor of benefits. Therefore, the decision to deny Morgan his long term disability benefits contains an inherent conflict of interest.
Morgan and his disability attorney believe that Morgan's medical records conclusively reflect that Morgan "is not capable of performing his own occupation or any other occupation due to his documented medical impairments and that he meets the definition of disability under the policy in question." The complaint states that Prudential and KeyCorp acted "arbitrarily and capriciously" when it refused Morgan's offer to be subject to a multi-day Function Capacity Evaluation (FCE)to prove his disabled condition. The complaint goes on to allege that Prudential "improperly denied [Morgan's] application for benefits in violation of the appropriate standard under ERISA statutes.
Relief that Morgan and His Disability Attorney Seek
Consequently, due to the insurer's violation of ERISA standards, Morgan and his attorney ask the Court to:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Prudential Insurance Company of America recently sued three times under ERISA for denying disability benefits
Three different lawsuits were recently filed under the Employee Retirement Income Security Act (ERISA) against the Prudential Insurance Company of America in Federal Courts by attorneys in Kansas, Oklahoma, and Pennsylvania for failing to pay disability benefits.
Disability Blog & Cases:
Delta Air Lines Customer Service employee files lawsuit against Sedgwick Claims Management Services, Inc. for denial of disability benefits
An employee of Delta Air Lines and his California disability attorney recently sued Sedgwick to recover disability benefits under the Delta Family-Care Disability and Survivorship Plan. The employee charged the insurer of illegally denying him his short term and long term disability benefits as provided for in his insurance plan and thus, neglecting to uphold its duties in approving his claim.
In possession of five insurance policies from Northwestern Mutual Life Insurance Company, Frank De Jong and his New Jersey disability attorney were forced to take the insurer to court as a last resort for De Jong to collect his disability benefits. Filed on July 5, 2011 in the United States District Court for the District of New Jersey, the complaint against Northwestern Mutual requests that the Court order Northwestern Mutual to pay damages to De Jong for "breach of contract, together with interest, attorney's fees and cost of suit." De Jong and his disability attorney are asking to recover compensatory, consequential and punitive damages from Northwestern Mutual.
Painter Purchased Five Individual Disability Insurance Policies from Northwestern
In June 2006, De Jong purchased several individual disability insurance policies from Northwestern Mutual. In those policies, the definition of disability that the insurance company provided De Jong stated that "the insured is totally disabled when both unable to perform the principal duties of the regular occupation and not gainfully employed in any occupation." De Jong submitted an application to claim his disability benefits to Northwestern Mutual on April 10, 2010. His complaint was that since he was experiencing "a constant ringing in his right ear, severe to profound hearing loss bilaterally, and an inability to concentrate and focus due to the constant distraction of the ringing noise and balance issues due to loss of equilibrium, he is unable to perform the required duties of a painter." De Jong's profession as a painter requires him to use ladders, climb scaffolds, and work in and around heights, and he is unable to perform those duties as a result of his present condition.
De Jong and His Disability Attorney File a Complaint against the Insurer for Breach of Contract on Two Counts
Stating that De Jong "was capable of performing his own occupation" in a letter dated November 30, 2009, Northwestern denied De Jong his long term disability benefits. Having provided Northwestern with appropriate proof of his condition, De Jong and his attorney contend in the First Count of their complaint that Northwestern breached their contract of disability insurance with De Jong. De Jong was up to date in his payment of insurance premiums and accuses Northwestern of breaching not only its contractual obligations but its obligation of good faith and fair dealing in the denial of De Jong's disability benefits.
In the Second Count of the complaint, De Jong and his attorney claim that Northwestern breached its contractual obligation by denying De Jong's claim for loss of business income. Even though De Jong provided the insurer with proof of the loss of business income as a result of his disability, the insurer stated that in its opinion, De Jong's "loss of business income was not the result of any disability."
A complicated issue, De Jong v. Northwestern Mutual Life Insurance Company may prove to be a precedent-setting case for solo business owners everywhere.
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Disabled South Carolina doctor sues Berkshire Life for disability benefits
A South Carolina disability attorney recently filed a federal lawsuit in South Carolina against the Berkshire Life Insurance Company of America. The plaintiff, a physician, paid for disability policies that were underwritten and insured by Berkshire. When the doctor applied for disability benefit, Berkshire refused to pay.
Disability Blog & Cases:
TRW Automotive Holdings Corporation financial analyst suffering from Type II diabetes and heart condition sues Prudential
A Michigan disability attorney recently filed a federal ERISA lawsuit in the district court for the Eastern District of Michigan against Prudential Financial Inc. in order to recover short-term and long-term disability benefits that were wrongfully withheld by Prudential and TRW.
Disability Blog & Cases:
Life Insurance Company of North America sued under ERISA in three different cases for denial to pay disability benefits
Three different lawsuits were recently filed by disability lawyers under the Employee Retirement Income Security Act (ERISA) against the Life Insurance Company of North America (LINA) in the Federal Courts of Illinois and Minnesota for improper denial of claims for disability benefits.
The plaintiff Laura Schlitt worked as a Regional Marketing Director for Camden Property Trust. She was a participant to a group Prudential disability insurance policy which was fully insured and administered by Prudential by virtue of her employment with Camden Property Trust.
Disability Benefits Application with Prudential
On January 8th 2010, the plaintiff became disabled under the term of the policy and was unable to perform the duties required of her occupation. According to the lawsuit, the plaintiff applied for short term disability benefits which were paid in full. Upon the expiry of her short term disability benefits, the plaintiff applied for long term disability benefits and was notified by Prudential on June 14th 2010 that she was approved for long term disability benefits for the period of April 9, 2010 through May 31, 2010.
Prudential Denies Long Term Disability Benefits and Arizona Attorney Files Suit
In the June 14th 2010 letter, the plaintiff was also informed that Prudential was terminating her disability benefits beyond June 1st 2010 as there was a lack of medical documentation supporting her inability to return to her regular occupation. In response, the plaintiff appealed the decision to deny her claim for long term disability benefits on July 25th 2010. To support her appeal, she submitted additional medical evidence to Prudential.
During the ERISA appeal, Prudential had a review done on the plaintiff's medical record by a consulting physician from MES Solution. According to the lawsuit, the plaintiff stated that the review done was based on selective review of the evidence and ignored evidence in order to provide opinions or reports which supported the denial of claim. Hence, on August 27th 2010, Prudential informed the plaintiff that it was upholding its prior decision to terminate the plaintiff's disability benefits beyond June 1st 2010.
The plaintiff made a second appeal to Prudential on February 18th 2011. Again, to support her appeal, the plaintiff submitted additional medical evidence including a Functional Capacity Evaluation (FCE) that indicated "inability to perform tasks, even at the sedentary work level, due to her restrictions and limitations".
Another "paper review" was done by Prudential and the plaintiff was notified by Prudential on May 13th 2011 that it was denying her appeal. At the same time, Prudential also informed the plaintiff that she had exhausted her administrative appeals and could file a civil action lawsuit in federal court pursuant to ERISA.
Arizona Disability Lawyer Files Lawsuit Against Prudential
In the case of Laura Schlitt vs. Prudential Insurance Company of America, Camden Property Trust, Camden Property Trust Employee Disability Plan filed at the District Court for the District of Arizona, the plaintiff alleged that the Prudential Insurance Company of America (Prudential) was denied her claim for long term disability benefits in order to save itself money in the long run.
The plaintiff alleged in the lawsuit that:
Relief Sought By The Plaintiff
In the lawsuit, the plaintiff stated that she is seeking from the Court the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Steel fabricator suffering from disability wins lawsuit against Lincoln National
A Federal Court recently ruled in favor of a man denied long-term disability benefits by Lincoln. The court agreed with his Michigan disability attorney in this ERISA Lawsuit and ordered reinstatement of LTD benefits along with past due benefits with interest.
Disability Blog & Cases:
Two Comcast employees and a registered nurse file three ERISA lawsuits against Liberty Life Insurance in Pennsylvania for denial of disability benefits
Liberty Life Assurance had three ERISA lawsuits filed against it in the United States District Courts of Pennsylvania in July 2011 by Pennsylvania Disability Attorneys. All three cases allege that Prudential is not upholding its duties in the awarding of disability benefits to entitled employees under the Employee Retirement Income Security Act (ERISA).
Disability Blog & Cases:
Wisconsin disability attorney and client sue Prudential Life Insurance for its “baseless” denial of ERISA disability benefits
Claiming that Prudential violated ERISA by improperly refusing to pay entitled disability benefits under her long term disability and life insurance policy, Della Davis and her Wisconsin disability attorney filed a complaint against Prudential.
After receiving disability benefits for 5 years from Sun Life insurance Company, Connie never expected her disability insurance benefits would be denied. Connie Hepburn was a "participant" in a Sun Life Disability benefit plan ("the Plan,") due to her employment with Toyoda-Koki Automotive North America, Inc. ("Toyoda") as a Shipping Supervisor in the Production Control Department. Sun Life acted as the plaintiff's group disability insurer during the period for which her claim for benefits accrued, in addition to being the claims administrator for these benefits. The abovementioned plan was initially underwritten and administered by Genworth Financial prior to its employee benefits business being sold to Sun Life in 2007.
Sun Life Disability Application History
In April 2004, the plaintiff had developed a pituitary tumor known as a "pituitary adenoma." As a result of a decline in her health, the plaintiff stopped working on May 26th 2004. The plaintiff also stated that she underwent surgery to remove the tumor on the following day, May 27th 2004.
Claim For Sun Life Disability Benefits
On August 3rd 2004, the plaintiff filed a claim for long-term disability benefits with Genworth Financial on the ground that the surgical treatments the plaintiff underwent to remove the tumor had left her impaired both cognitively and functionally. The plaintiff's claim was approved by Genworth Financial and her disability benefits was continuously recertified for a period of five (5) years based on her substantial medical proof of disability.
The plaintiff stated in the lawsuit that her condition had progressively worsened, and her memory problems have correspondingly worsened as well. She also developed a series of immunodeficiency ailments, including Gullian-Barre disease, a rare and very serious disorder which leads to paralysis of the limbs and restricts gait and movement. In addition, she has also been diagnosed with a number of intestinal and bladder infections which cause her great personal discomfort throughout the day and have permanently altered her ability to lead a normal life.
Termination of Long Term Disability Benefits After Receiving Payments for 5 Years
On October 20th 2009, Sun Life terminated Plaintiff's long term disability benefits. Sun Life's purported "reason" for terminating the plaintiff's benefits was that "the medical on record does not support an inability to perform any gainful occupation at a sedentary level of activity."
The plaintiff submitted an ERISA appeal to the decision to terminate her disability benefits by Sun Life. Sun Life, however, upheld its denial on March 4th 2010. Subsequently, the plaintiff made another appeal to Sun Life's denial and was again denied on November 2nd 2010 on the ground that the plaintiff did not provide "satisfactory proof' that she remained disabled under the contract. This was despite the fact that in all of her appeals, the plaintiff provided substantial, credible, and overwhelming medical evidence of her continuing disability.
On November 2, 2010, Sun Life, again, upheld the termination of the claim stating, that, in its discretionary review of her claim, Plaintiff had not provided "satisfactory proof' that she remained disabled under the contract. The plaintiff claimed that her medical condition has been in a period of steady deterioration of both her mental and physical abilities. Specifically, the Plaintiff stated that she suffered a loss of:
The plaintiff also stated that she suffered a series of debilitating physical ailments which have permanently altered her mobility and she had been rendered totally and permanently disabled within the definition of the Plan. The plaintiff also informed Sun Life that the Social Security Administration had determined the plaintiff to be totally and permanently disabled.
In the lawsuit filed by her Tennessee disability lawyer, the plaintiff alleged that after losing the above mentioned argument, Sun Life purported to review Plaintiff's medical evidence and concluded that she suffers from "no disability" in the face of multiple different medical experts and the Social Security Disability Administration, all of whom found her to be totally disabled.
Legal Grounds For Lawsuit Filed by Tennessee Disability Insurance Attorney
Accordingly, under ERISA, the Plaintiff's claim has been improperly denied as:
Relief Requested by the Plaintiff
The plaintiff seeks the following relief from the Court:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
12 years of disability payments paid, but CIGNA suddenly determines claimant can perform sedentary job
A disability claimant receiving benefits from CIGNA can never let their guard down. CIGNA is constantly evaluating their claims and if they have an opportunity to deny disability benefits then they will do so. This case is an example of a woman that was paid over 12 years, before CIGNA decided to unreasonable pull the plug. Despite a deterioration of this woman’s medical condition, how could CIGNA really expect this woman to return to a 40 hour job?
Disability Blog & Cases:
Shaw Industries Group employee suffering with fibromyalgia and lupus sues Unum Life Insurance Company for denial of disability benefits
In Chrilon Daniels Vs Unum Life Insurance Company of America the plaintiff filed a disability lawsuit under the Employment Retirement Income and Security Act (ERISA) to recover long-term disability benefits that were wrongfully withheld by Unum.
Disability Blog & Cases:
Disability attorney sues Aetna Life Insurance for failure to pay short term disability benefits to Huhtamaki Americas employee
A Maine disability attorney recently filed a lawsuit in the District Court for the district of Maine against the Aetna Life Insurance Company (Aetna). In Bonnie Ramsdell vs Huhtamaki Americas, Inc and Aetna Life Insurance Company, the plaintiff, suffering with post traumatic stress disorder brought the disability lawsuit under the Employment Retirement Income and Security Act (ERISA) to recover short and long term disability benefits that were wrongfully denied by Aetna.
Unfortunately for employees of AT&T, if you are disabled you will be forced to deal with Sedgwick Claims Management Services Inc. ("Sedgwick"). Sedgwick is a third party administrator that has been hired to administer and make claim decisions on AT&T short term and long term disability claims. The AT&T disability benefit plan is written with language that makes it very difficult for disability claimants to obtain benefits. Sedgwick is notorious for unreasonable claim denial and has been sued on numerous occasions. Despite an approval of SSDI benefits and a finding of disability by a doctor hired by Sedgwick, this claimant's disability benefits were still denied.
The Facts of the Sedgwick Disability Claim
The plaintiff was an employee of BELLOUTH TELECOMMUNICATIONS Inc (now known as AT&T, Inc due to the merger between BELLSOUTH and AT&T). By virtue of her employment with BELLSOUTH a Network Manager of Construction and Engineering, the plaintiff was a participant in the BELLSOUTH SHORT AND LONG TERM DISABILITY PLAN FOR MANAGEMENT EMPLOYEES, (now known as the AT&T Umbrella Benefit Plan No. 1) an employee welfare benefit plan that was administered by Sedgwick Claims Management Services Inc. (Sedgwick).
Claim for Short Term disability Benefits
On August 10, 2007, due to her medical conditions, including but not limited to post traumatic stress disorder, anxiety and major depressive disorder, the plaintiff stopped working. She became disabled as a result of these medical conditions and subsequently filed a claim for Short Term disability benefits under the abovementioned plan. Sedgwick approved her claim for short term disability benefits and the plaintiff began receiving short term disability benefits effective from August 20th 2007. According to the lawsuit, Sedgwick paid the plaintiff the maximum 52 weeks of short term disability benefits under the Plan, from August 20th 2007 to August 17th 2008 and withheld premium from after tax dollars for supplemental Long Term disability benefits purchased by the plaintiff.
Claim for Long Term disability Benefits
On May 9th 2008, the plaintiff was notified by Sedgwick that that continued benefit payments were contingent on the results of an Independent Medical Evaluation (IME).
As such, the plaintiff attended the IME scheduled for her on June 3rd 2008. The result of the IME supported the Plaintiff's continued disability. Hence, the plaintiff was approved for long term disability benefits on August 18th 2008.
On November 20th 2009, the plaintiff was approved for disability benefits from the Social Security Administration. From the payment of her retroactive Social Security Award, Sedgwick recovered from the plaintiff an overpayment of benefits amounting to $19,679.48. Despite the favorable IME and approval of her claim for Social Security Disability benefits, on April 28th 2010, Sedgwick notified the plaintiff that recent review of her claim showed that she may have some work capacity and continued benefits were contingent on a vocational review.
Long Term Disability Benefits
Thus, on June 8th 2010, Sedgwick terminated the plaintiff's long term disability benefits on the grounds that she did not satisfy the definition of disability under the Plan. The plaintiff appealed Sedgwick's termination of her disability benefits and improper withholding of taxes from her long term disability supplemental benefits by a letter dated November 22nd 2010. The plaintiff stated that despite her continuing disability consistently documented by her treating providers, medical literature, and other medical reports demonstrating that Ms. Arnold is unable to perform the duties of any occupation, Sedgwick upheld the termination of benefits on January 7th 2011.
The plaintiff alleged that Sedgwick had ignored some medical records and deemphasized others, including consistent reports of the plaintiff's treating physician, favoring her claim for disability benefits. She also argued that the decision to terminate her disability benefits was an abuse of discretion, a breach of the terms of the Plan, and was wrong, arbitrary and capricious and having exhausted all her administrative remedies is entitled to seek relief from the Court under ERISA.
Plaintiff Hires A Disability lawyer to File her Lawsuit
The case of Debra A. Arnold vs. AT&T, Inc., AT&T Umbrella Benefit Plan No. 1 F/K/A SBC Umbrella Plan No. 1, Bellsouth Long Term Disability Plan For Management Employees And Sedgwick Claims Management Services, Inc was a legal action under the Employee Retirement Income Security Act of 1974 (ERISA) and was filed at District Court for the Middle District of Florida. Acting through a Florida disability attorney, the plaintiff alleged that Sedgwick Claims Management Services Inc (Sedgwick) and the Plan Administrator for the AT&T Umbrella Benefit Plan had violated the provisions of ERISA in the denial of her claim for long term disability benefits.
The plaintiff alleged that she is entitled to these benefits under the Plan since she had:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Medical Doctor sues Guardian / Berkshire Life Insurance Company Of America for $1.2 million dollars following denial of disability insurance benefits
Recently, in the case of Laser & Cosmetic Dermatology S.C and Jawdat Abboud Vs. Guardian Life Insurance Company Of America, Berkshire Life Insurance Company of America filed at the District Court for Northern Illinois Eastern Division, the plaintiff Jawdat Abboud through his Illinois disability attorney alleged that the Berkshire Life Insurance Company of America (a subsidiary of Guardian Life Insurance Company Of America) had caused him and his business to suffer damages due to the Berkshire Life Insurance Company of America (Berkshire) wilful conduct in constructively denying the plaintiff’s disability claim benefits due under the insurance policies that he purchased and contracted from Berkshire.
Disability Blog & Cases:
Medical Secretary suffering from “failed back syndrome” and leukemia sues The Standard Insurance Company for disability benefit denial
Despite numerous disabling medical conditions, The Standard Insurance Company Denied disability benefits. The plaintiff was a medical secretary working at a private practice. By virtue of her employment, the plaintiff became eligible for coverage under the Standard Insurance’s Select Trust Group Policy, Long Term Disability Benefits, Group Policy. Under the terms of the Plan, Standard Insurance is the Plan fiduciary and insurer.
Disability Blog & Cases:
CIGNA pays disability benefits for 10 years, offers a lump sum buyout and then denies disability claim
The case of Therese Regan vs. CIGNA Corporation d/b/a CIGNA Group Insurance and Pactiv Corporation concerns a former Pactiv Corporation’s Lab Technician who recently, through a New York disability attorney, filed a lawsuit at the District Court for the Northern District of New York against the CIGNA Corporation for wrongfully denying her claim for disability benefits.
An Illinois disability attorney, on behalf of a FedEx employee, recently filed a lawsuit at the District Court for the Northern District Of Illinois against the Life Insurance Company of North America (now part of CIGNA Group) for wrongfully classifying the post of a Line Haul Manager as a sedentary occupation thereby resulting in the claimant being denied his long term disability benefits.
Fedex Disability Insurance Claim Against Cigna
The case of Robert Best vs. Life Insurance Company of North America concerned the plaintiff who worked as a line haul manager for the FedEx Freight Systems, Inc. (FedEx). The plaintiff participated in an employee welfare benefit plan, as defined by the Employee Retirement Income Security Act (ERISA) that was issued by FedEx and administered by CIGNA. The plan provided for payments of disability benefits in the event the insured became disabled. Under the plan, the insured is:
Considered Disabled if solely because of Injury or Sickness, you are:
- Unable to perform the material duties of your Regular Occupation; and
- Unable to earn 80% or more of your Indexed Earnings from working in your Regular Occupation.
After Disability Benefits have been payable for 12 months, you are considered Disabled if, solely due to Injury or Sickness, you are:
- unable to perform the material duties of any occupation for which you are, or may reasonably become, qualified based on education, training or experience; and
- unable to earn 80% or more of your Indexed Earnings.
We will require proof of earnings and continued Disability.
While working with FedEx, the plaintiff began experiencing significant arthritis pain in his back and right hip which affected his ability to perform his tasks as a Line Haul Manager for FedEx. As a result of his medical condition, the plaintiff was forced to take medical leave in November of 2009. Subsequently, in April 2010, the plaintiff submitted a claim for long term disability benefits to CIGNA.
On June 3rd 2010, CIGNA approved the plaintiff's Claim for long term disability benefits effective from November 11th 2009. Although CIGNA began paying long term disability benefits to the plaintiff in June 2010, CIGNA informed the plaintiff that it was "unable to continue paying benefits beyond September 9, 2010... Since you are able to perform a sedentary job, you are capable of returning to your job as a Line Haul manager which is a sedentary job," and therefore the "claim has been closed."
The plaintiff alleged that CIGNA's determination that the Line Haul Manager position is a "sedentary job" was contrary to the evidence and affidavits provided to CIGNA which established that the position is clearly not a sedentary job but instead involves significant physical activity. Although the plaintiff appealed CIGNA's decision and exhausted all avenues of administrative appeal, CIGNA continued to uphold its decision to deny the plaintiff his claim for long term disability benefits.
Alleged Legal Grounds For Lawsuit Against CIGNA filed by Illinois Disability Lawyer
In the lawsuit, the plaintiff alleged that CIGNA's action to deny his claim for long term disability benefits was arbitrary and capricious as CIGNA's denial was based on an erroneous basis that the plaintiff's position as a Line Haul Manager was a sedentary position.
Relief Sought by the Plaintiff
The plaintiff also stated in the lawsuit that as a result of CIGNA's actions, he had suffered damages and is seeking through the Court the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Group Health Plan Inc’s Actuary sues Reliastar Life Insurance Company and ING Disability Claims Management Services for recovery of disability benefits under The Ramsey Health Care Services Short Term Disability Plan
A Minnesota disability attorney recently filed a lawsuit on behalf of a client against the Reliastar Life Insurance Company and ING Disability Claims Management Services (Reliastar & ING) for denying her claim for short term disability benefits. The case of Susan Fonseth vs Ramsey Health Care Services Short Term Disability Plan, Reliastar Life Insurance Company, and ING Disability Claims Management Services was filed at the District Court for the District of Minnesota.
Disability Blog & Cases:
Prudential denies disability benefits despite FCE Exam stating former Data Distributor Inc. employee with heart condition cannot perform sedentary occupation
A Georgia disability attorney recently filed a long term disability lawsuit due to Prudential Insurance Company’s wrongful denial of disability benefits to a former project manager. This case shows that despite strong objective evidence and a positive FCE exam in support of multiple disabling conditions, Prudential can still hire physicians that can review a file and determine that a claimant has no restrictions and limitations.
Disability Blog & Cases:
Court of Appeals, Seventh Circuit ruled Unum Life Insurance Company Of America is prevented from using Self-Reported Symptoms Limitation Clause to discontinue long term disability benefits payments for woman with fibromyalgia
In the case of Susie Weitzenkamp, Vs. Unum Life Insurance Company Of America, the Court of Appeals, Seventh Circuit recently ruled that the Unum Life Insurance Company Of America (UNUM) cannot rely on a Self-Reported Symptoms Limitation Clause to discontinue the plaintiff’s long term disability benefits as UNUM had failed to include the self-reported symptoms limitation in the Summary Plan Description (SPD).
The Aetna Life Insurance Company (AETNA) was recently sued in three separate cases in Florida and Texas for denying claims for disability insurance benefits under employee welfare benefit plans that was administered by it. Let us have a closer look at the circumstances of the different cases below.
Lawsuits filed by Bank of America employees against AETNA - Failure to comply with the Provisions of ERISA in claims for disability benefits
The following two cases below both concerned Bank of America's employees filing lawsuits against AETNA for denying their claims under the Bank of America short term and long term disability insurance plans. Let us examine in more detail the two cases.
Rachel Jones vs. Aetna Life Insurance Company And Bank Of America Corporation
The case of Rachel Jones vs. Aetna Life Insurance Company And Bank Of America Corporation was also filed by a Florida disability attorney for the plaintiff at the District Court for the Middle District of Florida. The plaintiff Rachel Jones was a Bank of America (BOA) employee. By virtue of her employment, she was a participant in the Bank of America Short Term and Long Term Disability Plans which was administered by AETNA.
In the lawsuit, the plaintiff claimed that although she had satisfied all the conditions for her to be eligible for the disability benefits, AETNA had continued to deny both her claim for short term and long term disability benefits. The plaintiff stated that in deciding her claim for long term disability benefits, AETNA failed to act within the stipulated 45 days time frame provided by ERISA. As such, the plaintiff alleged that AETNA had failed to follow claims procedures that were consistent with the requirements of ERISA. It is not uncommon for Aetna to fail to render a claim decision within 45 days.
Christopher Koberstine vs. Aetna Life Insurance Company – Unreasonable Claim Process
The case of Christopher Koberstine vs. Aetna Life Insurance Company was filed at the District Court for the Middle District of Florida for the plaintiff by a Florida disability attorney. The plaintiff Christopher Koberstine was a participant of an employee welfare benefit plan sponsored by his employer and administered by AETNA. The plan provided for both short and long term disability insurance benefits. According to the lawsuit, the plaintiff alleged that AETNA had subjected the plaintiff to an unreasonable claim process by failing to provide a decision within the time limits provided by the Employee Retirement Income Security Act (ERISA). The plaintiff also claimed that AETNA failed to comply with its own internal rules, guidelines, protocols, and other similar criteria relied upon in making the determination to deny his claim for disability benefits.
Relief Sought By The Plaintiff
The plaintiff in this case was seeking from the Court the following relief:
Richard Devlin Mcnamara vs. Aetna Life Insurance Company
The case of Richard Devlin Mcnamara vs. Aetna Life Insurance Company was filed at the District Court for the Western District of Texas by a Texas disability attorney. The plaintiff Richard Devlin became disabled in 2009. It was stated in the lawsuit that his claim for disability benefits was initially approved by AETNA. He received monthly disability benefits payments from AETNA until September 3rd 2010 when AETNA decided to terminate his disability benefits payment.
The plaintiff appealed AETNA's decision and had the denial of claim overturned after a review. AETNA issued to the plaintiff on May 24th 2011 its "Final Level Appeal Determination Letter" which stated that "...we have determined that sufficient documentation exists which supports Mr. McNamara's inability to perform the material duties of his occupation, effective 9/ 3/2010."
However, despite overturning its prior decision to deny the plaintiff his claim for disability benefits, the plaintiff stated that AETNA refused to reinstate his disability benefits payments due to him under the policy.
Relief sought by the Plaintiffs
In both legal actions filed by the Bank of America employees against AETNA, the plaintiffs were seeking the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Massachusetts Disability Attorney filed lawsuit against the Aetna Life Insurance Company on behalf of Biogen Idec, Inc’s IT Technical Ops Lead for denial long term disability benefits
In the disability lawsuit of Joseph Mcdonough Vs Aetna Life Insurance Company, HM Life Insurance Company, Biogen Idec, Inc. & Biogen Idec., Inc., Group Long Term Disability Plan filed at the District Court for the District of Massachusetts, the plaintiff filed a federal lawsuit against Aetna for violations of the Employment Retirement Income Security Act (ERISA.)
Disability Blog & Cases:
Registered nurse & her california disability lawyer sue Unum Life Insurance Company for failure to pay disability benefits
A California disability attorney recently filed a lawsuit in the District Court for the Central District of California against the Unum Life Insurance Company of America (Unum). In Marjorie McGill Vs Unum Life Insurance Company of America, Administrator of the HCA Management Services, L.P. On Behalf of HCA’s Affiliated Facilities (Los Robles Hospital and Medical Center) Long-term Disability Plan, the plaintiff brought the legal action under the Employment Retirement Income and Security Act (ERISA) to recover short and long term disability benefits that were wrongfully denied by Unum.
Disability Blog & Cases:
CIGNA denies disability insurance benefits to Engineering Manager with Stage 4 cancer
The plaintiff Bradley Erickson was employed as an engineering manager for BorgWarner. By virtue of his employment, he was entitled to coverage under an employee welfare benefits plan issued by LINA and administered by CIGNA. At the District Court for the Eastern District of Michigan recently, a Michigan disability attorney filed a lawsuit on behalf of a client against the Life Insurance Company of North America (LINA) and CIGNA for denial of disability insurance benefits and ERISA violations.
In the past week, The Liberty Life Assurance Company of Boston (Liberty Life) was recently sued for denying disability insurance benefits to claimants in the states of Florida, South Carolina and Michigan. The disability lawsuits were undertaken as a result of failure to comply with the provision of the Employee Retirement Income Security Act (ERISA). Let us examine the three separate Liberty Mutual cases in more detail.
Penny Menz Vs. Liberty Life Assurance Company Of Boston – Legal Action To Clarify Rights And Recover Disability Benefits Under Employee Welfare Benefit Plan
Filed at the District Court for the Middle District of Florida by a Florida disability attorney, the plaintiff Penny Menz was a covered participant of an employee welfare benefit plan sponsored by her employer, funded and administered by Liberty Life. Because Liberty Life was both underwritten and administered by Liberty Life, the plaintiff alleged that Liberty Life faces an inherent conflict of interest between its duties to the plaintiff as an ERISA fiduciary and its duties to its shareholders as a for-profit corporation.
According to the lawsuit filed by the plaintiff's Florida disability attorney, Liberty Life failed to:
The plaintiff in the lawsuit is seeking the disability benefits due to her under the plan in addition to prejudgment interest, costs, attorney's fees and such other relief as the Court may deem appropriate.
Dennis Johnson vs. Liberty Life Assurance Company Of Boston – Legal Action To Remedy Breach Of Fiduciary Duty And To Recover Full Disability Benefits
The case of Dennis Johnson vs. Liberty Life Assurance Company Of Boston was filed at the District Court for the Western District Of Michigan by the plaintiff's Michigan disability attorney regarding the breach of the terms of an employee benefit plan and breach of Fiduciary Duty. The plaintiff was a former employee of HI-Lex America, Inc and was a participant in a welfare benefit plan issued by Liberty Life
On July 12th 2008, the plaintiff became entitled to payment of partial disability monthly benefits under the Plan. However, the said disability benefits to the plaintiff were terminated by Liberty Life on June 17th 2010 because the plaintiff allegedly no longer met the definition of disability under the abovementioned plan.
Although the plaintiff made an appeal to Liberty Life's decision on March 30th 2011, the appeal was denied by Liberty Life on May 18th 2011. The plaintiff contended that the
discontinuation of the plaintiff`s disability benefits payments were in direct violation of the terms of the abovementioned plan. Hence, the plaintiff is seeking from the Court the following relief:
David Hill vs. Liberty Life Assurance Company Of Boston – Legal Action For Judicial Review Of Claim For Disability Benefits
In the case of David Hill vs. Liberty Life Assurance Company of Boston, the plaintiff was working for Mead Westvaco. He was provided with long term disability coverage under a plan that was fully insured by Liberty Life. In addition, Liberty Life was also the Claims Administrator of the Plan.
The plaintiff stated in the lawsuit that after being disabled, he filed a claim for disability benefits under the abovementioned plan. Liberty Life, however, denied his claim for the disability benefits.
The plaintiff alleged that liberty Life was operating under an inherent conflict of interest when it made its decision to deny his claim for disability benefits. The plaintiff also alleged that Liberty Life ignored relevant evidence pertaining to his claim.
In the lawsuit, the plaintiff is seeking judicial review of his claim and specifically seeks from the court the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Oregon Judge orders Standard Insurance Company to pay disability insurance benefits beyond the 24 month mental disorder limitation
In James F. Kitterman Vs Standard Insurance Company and Standard Select Trust Insurance Plans, the plaintiff, through his Oregon disability attorney, brought an ERISA action against the Standard Insurance Company (Standard) seeking to recover long term disability insurance benefits wrongfully denied under the terms of a group insurance plan (the Plan) issued by The Standard Insurance Company. This case is a victory for disability claimants and addresses an issue that is very common among thousands of claimants seeking disability benefits.
Disability Blog & Cases:
Bridgestone employee sues Liberty Life Assurance Company of Boston for long term disability benefits
Sandra Cotton-Lyons filed a lawsuit against Liberty Life Assurance Company of Boston (Liberty Mutual), Administrator of the Bridgestone Americas, Inc. Long Term Disability Plan in the United States District Court for the Eastern District of North Carolina. As an employee of Bridgestone Americas, Inc. (Bridgestone Firestone), Cotton-Lyons, a resident of Rocky Mount, North Carolina, is a qualified, vested member in her employer’s disability insurance plan with Liberty Life.
Disability Blog & Cases:
Cigna denies Herff Jones Inc. employee disability benefits after she is diagnosed with multiple sclerosis
Karen Kolesky has filed a lawsuit against Herff Jones Inc., Cigna Insurance, and Life Insurance Company of North America in the United States District Court of Utah, Northern Division in an effort to receive her long term disability benefits as promised in her employee insurance policy. In possession of an employee insurance policy from her employer Herff Jones, Inc., Kolesky applied for long term disability benefits when she became disabled in November 2009.
Disability Blog & Cases:
A phlebotomist employed by Quest Diagnostics and diagnosed with RSD sues Aetna for denial of long term disability insurance benefits
In Sheila Pannozzo v. AETNA Life Insurance Company, Quest Diagnostics, Inc., Quest Diagnostics Long Term Disability Benefits Plan, filed in the United States District Court of the Middle District of Pennsylvania, Pannozzo and her Pennsylvania disability attorney accuse AETNA of abruptly and improperly terminating her disability benefit payments in violation of the Employee Retirement Income Security Act (ERISA) and 29 U.S.C. § 1132(a)(1).
Disability Blog & Cases:
CIGNA entitled to recover social security disability benefit overpayment
The United States Court of Appeals for the Third Circuit recently reversed a district court’s decision denying CIGNA recoupment of overpaid benefits.
Disability Blog & Cases:
What is Liberty Life Assurance Company of Boston trying to hide in denial of disability benefits?
This disability insurance case against Liberty Life Assurance is an example of the type of fight that a disability insurance company will engage in once a disability lawsuit is filed. It is often surprising that disability insurance companies will claim they are acting fairly, yet when you ask them to provide claims handling information they will aggressively object.
Debra Letvinuck sued Aetna in District Court after Aetna denied her short-term and long-term disability benefits. After the District Court concluded that Aetna did not abuse its discretion in denying Letvinuck benefits, Letvinuck appealed to the 9th Circuit Court of Appeals.
Aetna both funds and administers the Plan's long-term disability benefits.
Aetna's dual role rendered it subject to a conflict of interest when making claims determinations. Because of the structural conflict of interest, Aetna's denial decision was reviewed while considering case-specific factors that may evidence a conflicted claim evaluation.
Failure to address a Social Security award of disability benefits offers support that the plan administrator's denial was arbitrary.
When reviewing Letvinuck's claim for benefits, Aetna gave no weight to the Social Security Administration's (SSA) decision that Letvinuck was disabled, nor did it provide an explanation. Although Aetna was not bound by the SSA's disability determination, the court noted that "not distinguishing the SSA's contrary conclusion may indicate a failure to consider relevant evidence."
During the ERISA appeal process, Aetna and its hired doctors acknowledged that Letvinuck had received an SSA award but no further explanation was provided. Only when Letvinuck called after Aetna had denied her appeal did Aetna offer an explanation by trying to distinguish its standard for disability from the SSA's.
Aetna failed to adequately tell Letvinuck what "additional material or information was necessary for her to perfect the claim, and to do so in a manner designed to be understood by the claimant.
Aetna based its denial of benefits substantially on the lack of recent neuropsychological testing that would objectively show Letvinuck's disability. However, Aetna did not ask Levinuck for more recent neuropsychological test results that showed her disability. More importantly, it failed to do so "at a time when she had a fair chance to present evidence on this point.
In essence, Aetna denied Levinuck's claim largely on account of the absence of objective medical evidence, yet failed to tell her what medical evidence it wanted.
Aetna's communications with Letvinuck's doctor asking for objective medical evidence was not sufficient.
Although Aetna presented evidence that it asked one of Levinuck's doctors for "clinically objective findings demonstrating… a further decline in her disability," the court found it inconsequential because the request was not specifically communicated to Levinuck.
Conclusion
The court ultimately concluded that Aetna had abused its discretion in denying Letvinuck benefits. Aetna had based its denial on the absence of specific medical evidence—evidence that Aetna did not tell Letvinuck she should obtain and send to Aetna to perfect her claim. Moreover, Aetna failed to meaningfully explain why it disagreed with the SSA's award of disability benefits.
The Court reversed Aetna's denial of long term disability benefits.
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. To request a free legal consultation call 800-411-9085.
Resolved Cases:
CIGNA denies benefits after paying for 10 years, but Disability Attorney Stephen Jessup wins benefits for 60 year old client with fibromyalgia
For ten years our client was receiving long term disability benefits from CIGNA under an ERISA governed Group Disability Policy (Jaycor) due to a litany of medical conditions, which included Adult Onset Still’s Disease, Chronic Pain, Fibromyalgia and Fatigue. During the course of his claim and well prior to CIGNA’s termination of benefits, he had already met and passed the own occupation to any occupation definition change, had been approved for disability benefits by the Social Security Administration, and had even been approached by CIGNA on several occasions for a lump sum buy out of his policy. For all intensive purposes it would seem that at the age of 60 and the decade long history of his claim that CIGNA would not challenge the claim. However, CIGNA proved the adage that disability benefits are never guaranteed benefits.
Disability Blog & Cases:
California Court orders CIGNA to disclose amount paid to MES Solutions for medical reviews
CIGNA Insurance Company can run but they can’t hide. Recently, the US District Court for the Central District of California granted Plaintiff Bradley Wojno’s Motion to Compel Defendant CIGNA Insurance to reveal the extent of it financial relationship with MES Solutions. Mr. Wojno’s California disability attorney sought information from CIGNA that could unveil potential conflicts and biases of CIGNA’s hired gun doctors relied upon to terminate Mr. Wojno’s disability benefits.
Disability Blog & Cases:
Federal Judge orders Sedgwick Claims Management to pay disability benefits to PNC Financial Services Group, Inc’s Collection/Recovery Team Manager
Disability claimants need to be extremely cautious when dealing with Sedgwick Claims Management Service Inc. (Sedgwick). From our law firms’ experience of handling thousands of disability insurance claims, Sedgwick is one of the top three most difficult companies to deal with. Unfortunately, Sedgwick will capitalize on any opportunity to deny a claimant their disability benefits. This case discusses the unreasonable conduct used by Sedgwick to wrongfully deny disability benefits.
Disability Blog & Cases:
Standard Insurance Company’s attempt to dismiss disability insurance lawsuit is denied in-part by Florida Federal Judge
Disability claimant challenges Standard Insurance Company’s attempt to limit disability benefits to 24 months under the “Other Limited Conditions” provision.
Disability Blog & Cases:
Life Insurance Company Of North America denies disability benefits and battles claimant for 4.5 years in Federal Court
LINA should be embarrassed and show some respect for a former payroll clerk that had no ability to work due to numerous medical conditions. After litigating for more 4.5 years since her wrongful denial of disability benefits, Ms. Dupree finally received a ruling in her favor from the United States Court of Appeal. LINA fought this disability claim until there were no more courts left for them to appeal to. While, Ms. Dupree eventually won her disability benefits, it is sad that she had to battle for 4.5 years without any payment from LINA. LINA essentially left Ms. Dupree out in the cold. Unfortunately, Dupree’s only remedy is payment of her benefits, interest and attorney fees. This case is a prime example of the wrongful conduct by LINA and the exact reason that punitive damages should be allowed.
Disability Blog & Cases:
California Judge grants disability claimant’s request to investigate Hartford Life And Accident Insurance Company’s relationship with hired doctors
In Mary Carten vs. Hartford Life and Accident Insurance Company, Group Long Term Disability Plan for Employees Of FMR Corporation, the plaintiff brought the civil lawsuit in a California Federal Court under the Employment Retirement Income Security Act (ERISA) to challenge a denial of disability benefits made by the Hartford Life and Accident Insurance Company (Harford). The plaintiff requested an opportunity to conduct discovery into Hartford’s claims handling practices in order to determine if Hartford’s wrongful denial her long term disability benefits was done with a conflict of interest. It is ironic that Harford denies disability benefits and then tries to do whatever they can to hide the existence of their financial relationship with the doctors they hire. Hartford is suppose to be the fiduciary of Ms. Carten. Hartford’s actions clearly suggest that they are not acting in the best interest of Ms. Carten.
Alleging that AETNA Life and Boeing have violated ERISA (Employee Retirement Security Act of 1974) by refusing to pay her earned disability insurance benefits, Deborah Rodriguez has filed a lawsuit in the United State District Court of Utah Central Division. Asking the Court to find in her favor against both AETNA and Boeing, Rodriguez and her Utah disability lawyer petitioned the United States District Court of Utah to order the defendants to:
Rodriguez and Her Utah Disability Lawyer Accuse AENTA of A Conflict of Interest
Rodriguez and her Utah disability lawyer allege that AENTA as the governing party for the payment of disability benefits as well as the denial of disability claims displays a conflict of interest when it comes to deciding who is awarded disability benefits under their policies and who is denied.
Aetna Denys Disability Benefits After Change of Definition from Own Occupation to Any Occupation
On May 25, 2008, Rodriguez ceased working at her job at Boeing as the result of a disability and was awarded disability benefits under her AETNA plan. Then, in October 2010, Rodriguez was informed that her benefits were terminated because AETNA's reviewers had determined that Rodriguez was capable of performing work other than her own occupation. Rodriquez appealed the termination, arguing that she did, indeed, still meet the criteria of her disability insurance plan to continue receiving disability benefits. Inevitably, AETNA didn't agree and in a letter dated March 10, 2011, informed Rodriguez that the decision to terminate her disability benefits would stand. With no other recourse, Rodriguez and her Utah disability attorney filed her complaint on June 13, 2011 claiming that AENTA was more concerned "over its own funds" and had allowed its decision-making to be influenced by that concern.
In her complaint, Rodriguez states her cause of action for plan benefits against Defendants AETNA and Boeing under 29 U.S.C. §§ 1132(a)(1)(B), pointing out that she qualifies to receive her disability benefits under her insurance plan until she reaches the age of retirement, that she remains disabled under her insurance plan requirements, and that AETNA and Boeing have breached their contractual agreement to provide her with those disability benefits.
Rodriguez and Her Utah Disability Lawyer Enumerate AETNA's Violations in the Administering of Her Disability Benefits Plan
Rodriquez and her Utah disability attorney allege that AETNA was "wrong under the terms of the Plan," that the "decision to terminate benefits and the decision-making process were arbitrary and capricious," that the "decision to terminate benefits was not supported by substantial evidence in the administrative record," and that Rodriguez has suffered damages as a "direct and proximate result of" the insurance company‘s conduct in the evaluation of her claim.
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
California disability attorney sues Standard Insurance Company for denial of long term disability benefits payments to paraplegic
In the case of D. Nielsen Pollock Vs Standard Insurance Company, filed at the District Court for the Southern District Of California, the plaintiff complained that the Standard Insurance Company (Standard Insurance) have breached the Employee Retirement Income And Security Act Of 1974 (ERISA) and suing for the recovery of disability benefits under the terms of an employee benefit plan for which Standard Life is the insurer of benefits under the “DILLINGHAM CONSTRUCTION HOLDINGS INC. GROUP LONG TERM DISABILITY INSURANCE POLICY.”
Disability Blog & Cases:
Hartford Life And Accident Insurance Company denies disability benefits and prevails in lawsuit filed by operator for Mohawk Inc.
When making a case for a claim of disability benefits, it is essential that a claimant has strong medical support from treating physicians. The disability insurance companies are not under any duty to help a claimant further his or her claim for disability benefits. It is the burden of the claimant to ensure that he or she had provided sufficient proof of his or her disability status. This case of Almetta T. Campbell Vs. Hartford Life And Accident Insurance Company is a good example of how a disability insurance company can easily win a disability denial if the administrative record does not have strong medical support. Disability claimants must anticipate and be prepared for a change of the policies definition of disability from own occupation to any occupation. ERISA governed policies can make it difficult for disability claimants to prevail.
Disability Blog & Cases:
Court Of Appeals agrees with Texas Judge that UNUM did not abuse its discretion in denying Accenture LLP’s employee’s claim for disability benefits
In the case of Gwendolyn Byrd vs. UNUM Life Insurance Company Of America, the plaintiff filed a lawsuit in Texas federal court to challenge the Unum Life Insurance Company’s (Unum) decision to terminate her long term disability benefits after paying for 5 years. In the review for the abuse of discretion, the District Court granted summary judgment to Unum. The plaintiff is appealing this decision by the District court.
Disability Blog & Cases:
Appellate Court denies Liberty Mutual’s attempt to recover $163,661.57 in disability benefits paid to disability claimant and business owner
After 5 years of receiving long term disability benefits, Robin Dolan suddenly receives a letter in 2006 from Disability Reinsurance Management Services stating that her disability benefits had been wrongfully calculated and she must repay $163,661.57. Approximately 5 years after receiving this dreadful letter and extensive litigation, Ms. Dolan has finally received an Appellate Court ruling stating that Liberty Mutual was wrong in their interpretation of the disability policy. Unfortunately Ms. Dolan has had to suffer through the unreasonable actions of Liberty Mutual and their third party administrator DRMS.
Connie White waited more than five years to file a lawsuit against MetLife for denial of her disability benefits. The law in Louisiana only provided Ms. White 5 years to file her legal action. The district court dismissed her disability claim and the 5th Circuit court of appeals affirmed the denial. Disability insurance claimants need to take timely action if a claim for disability benefits is denied. Failure to act within strict time lines can result in the inability to pursue a claim in court.
Failing to oppose Metropolitan's Motion for Summary Judgment, White alleges that her case was decided on the basis of her failure as opposed to the merits of her case. And even though the Court ruled to approve the insurer's motion, White was given a second chance to file her opposition. White had 10 days to file an opposing position to the original motion for summary judgment. Never filing anything acknowledging the motion, White, after the fact, claimed that the Court erred in its decision to uphold Metropolitan's decision to deny her long-term disability benefits.
The Fifth Circuit Court of Appeals Agrees to Review White's Case
As a result of her claim, the District Court of Appeals Fifth Circuit agreed to review the District Courts Summary Judgment de novo. White contended that the Court entered its ruling "solely because Metropolitan's motion was unopposed." And while the Court disputed this contention, it claimed that it granted the insurer's motion based on the evidence presented in Metropolitan's summary judgment motion.
The Fifth Circuit ruled that "the district court's ruling was correct on the merits." According to the terms of White's insurance plan, legal action cannot be filed "more than three years after proof of Disability," unless "the area where you live allows a longer period of time to file proof of Disability." In White's case, she let that time period expire. Consequently, her challenge to Metropolitan's benefit denial "was filed too late."
Finding of the Fifth Circuit Court in Connie D. White v. Metropolitan Life Insurance Company
The Circuit Court pointed out that since ERISA doesn't set a specific limitation period, state law applies. In Ms. White's case the law in Louisiana allows 5 years for a lawsuit to be filed. Unable to present a case that proves that Metropolitan did not materially misrepresent itself or its decision to deny White disability benefits or that "extraordinary circumstances" existed, White did not prevail in her appeal. Consequently, the Fifth Circuit Court allowed the District Court's ruling in White to stand. The lesson here is that timely filing of disability lawsuits and answers are imperative to a disability claimant's lawsuit being favourably ruled upon.
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. To request a free legal consultation call 800-698-9162.
Disability Blog & Cases:
Arkansas disability attorney filed lawsuit against Sun Life and Health Insurance Company on behalf of disabled Buford Media Group, LLC’s Office Manager for denial of disability benefits
In Kathryn McDaniel-Bowen vs Sun Life and Health Insurance Company F/K/A Genworth Life and Health Insurance Company, filed at the District Court for the Eastern District of Arkansas, the plaintiff Kathryn McDaniel-Bowen alleged that the Sun Life and Health Insurance Company (Sun Life) had breached its contractual obligations by denying long term disability benefits payments to her.
Disability Blog & Cases:
Disabled IKA Works, Inc. employee sues the Prudential Insurance Company of America to compel payment of disability benefits under an ERISA plan
A North Carolina disability attorney recently filed a lawsuit at the District Court for the Eastern District of North Carolina on behalf of a client against the Prudential Insurance Company of America (Prudential). In Cynthia Grimsley Vs the Prudential Insurance Company Of America, the plaintiff filed the complaint to seek the recovery of disability benefits under the Employee Retirement Security Act of 1974 (ERISA) from a Prudential issued Disability Plan.
Disability Blog & Cases:
Claimants under HSBC North America Holdings, Inc. Group Long Term Disability Benefits Plan sue Unum Life Insurance of America in Illinois and Nevada
Recently, two disabled employees of the HSBC Bank in Illinois and Nevada filed lawsuits against the Unum Life Insurance of America (Unum) for the wrongful denial of disability insurance benefits under the Employee Retirement Income Security Act (ERISA).
Disability Blog & Cases:
Tenet Healthcare Corporation employee sues UNUM Life Insurance Company Of America under ERISA for wrongfully denying disability benefits by disregarding attending physician’s medical opinion
An Alabama disability attorney recently filed a lawsuit at the District Court for the Northern District of Alabama against the Unum Life Insurance Company of America (Unum). In Joan Allred vs. Unum Life Insurance Company of America, the plaintiff Joan Allred sued Unum for the recovery of long term disability benefits due under her disability insurance plan sponsored by Tenet Healthcare Corporation.
Disability Blog & Cases:
Appellate Court upholds Prudential's decision denying disability benefits to insured when he refused to attend an IME Exam
Recently, the 8th Circuit Court of Appeals ruled that veteran career consultant, Anthony Polich, was not entitled to Long Term Disability (LTD) benefits after he refused to attend an Independent Medical Exam (IME) and to release relevant medical data requested by the LTD Plan administrator, Prudential Financial.
Disability Blog & Cases:
Office medical specialist suffering with fibromyalgia and CFS hires Arizona Disability Attorney to sue CIGNA for denial of disability benefits
Anita Barajas has taken her disability claim to the United States District Court of Arizona in an attempt to force University Physicians, Inc. (“UPI”), CIGNA Group Insurance, and Life Insurance Company of North America to provide her the disability benefits she is entitled to. An Office Medical Specialist 2 for UPI, Barajas became disabled on July 8, 2008 when “fibromyalgia and Chronic Fatigue Syndrome (“CFS”), Sjorgen’s syndrome, and depression with memory loss” prevented her from performing her duties as an office medical specialist or any other occupation.
Disability Blog & Cases:
Disabled engineer from Philips Electronics North America sue Sedgwick Claims Management Services Inc. for denial of long term benefits claim
In the case of Andrew Gary Sigai V Sedgwick Claims Management Services, Inc. and Philips Electronics North America Corporation, as Administrator of the Philips Electronics North America Long Term Disability Program, the plaintiff Gary Sigai, through a Kansas disability attorney, filed a lawsuit against Sedgwick Claims Management Services, Inc (Sedgwick CMS) at the District Court for the District of Kansas.
Disability Blog & Cases:
Disabled Goldman Sachs’s financial analyst filed lawsuit against Prudential Insurance Company Of America for denial of disability benefits following multiple seizures
Many disability insurance companies have developed a notorious reputation for the way they handle claims for long term disability (LTD) benefits. Regardless of the claimant’s background or medical conditions, the disability insurance companies will always try to have the last say in a claim application and reduce their obligation to pay out LTD benefits. A recent lawsuit filed by a New Jersey disability attorney at the District Court for the District of New Jersey is a very good example of how the Prudential Insurance Company of America (Prudential), as alleged in the lawsuit, “contrived a way to avoid paying those benefits…” Let us take a closer look at the case of Courtney A. Leone v Prudential Insurance Company of America.
Disability Blog & Cases:
New Jersey disability attorney filed lawsuit against Prudential Insurance Company of America to compel payment of long term disability benefits to disabled client
A lawsuit was filed recently at the District Court for the District Of New Jersey against the Prudential Insurance Company of America (Prudential) by a former employee of Horizon Blue Cross Blue Shield of New Jersey for unlawfully discontinuing benefit payments to the disabled plaintiff. In Denise Hodges V Prudential Insurance Company of America & Horizon Blue Cross Blue Shield of New Jersey (Horizon), the plaintiff Denise Hodges alleged that Prudential had contravened the provisions of the Employee Retirement Income Security Act of 1974 (ERISA) by failing to pay disability benefits to her.
Disability Blog & Cases:
Unum Life Insurance Company of America sued for claiming social security child benefits as part of the reimbursement for overpayment of long term disability benefits
Nowadays, it is standard practice for disability insurance companies to require claimants with long term disability (LTD) benefits to apply for Social Security disability benefits as well. Upon being approved for social disability benefits, the disability insurance companies will then deduct the amount of the monthly social security payment from the monthly benefit amount that was previously paid by the disability company. In most cases there are no disputes by the recipients as to this procedure by the disability insurance companies. However, problems arise when the disability insurance companies also try to claim those social security benefits like social security child benefits as offsets which are not meant for the claimants of LTD benefits. The case of William E. Sorrell V UNUM Life Insurance Company of America is an example of the above mentioned situation.
Disability Blog & Cases:
Disabled project manager for RTP Technology Corporation filed lawsuit against the Unum Life Insurance Company of America for refusal to pay disability benefits
A New Jersey disability attorney recently instituted a lawsuit against the UNUM Life Insurance Company of America (UNUM) at the District Court for the District of New Jersey of behalf of a disabled client. In Robert Garozzo v UNUM Life Insurance Company of America and RTP Technology Corporation long term disability plan, the plaintiff Robert Garozzo is seeking payment of disability income benefits from UNUM under the terms of a long term disability Benefit plan.
In the latter part of May, complaint after complaint was filed against Liberty Life Assurance Company of Boston from shore to shore.
Senior Administrative Analyst Sues Liberty Life Assurance Company of Boston For Disability Benefits And Seeks more than five million dollars in damages
In Margie Mauro v. Liberty Life Assurance Company of Boston, Mauro and her California disability lawyer filed her complaint against Liberty for damages as a result of Liberty's Breach of Contract and Breach of the Implied Covenant of Good Faith and Fair Dealing in the United States District Court Eastern District of California on May 26, 2011. A senior administrative analyst, Mauro became totally disabled in August 2009 and was unable to continue performing her job due to conditions of and related to "lumbar radiculopathy with left leg radicular pain, and bilateral sacroilitis. She filed her disability application under her employee disability plan with Liberty and was awarded long-term disability benefits until January 29, 2011, when her disability benefits were terminated because Liberty decided that she no long qualified for benefits as they determined that she was capable of engaging in "occupations other than her own." Needless to say, Mauro appealed the decision, but Liberty denied her appeal in February 2011.
Mauro's And Her California Disability Attorney File A Complaint
In her complaint Mauro and her California disability attorney allege that Liberty breached its contractual duties to pay Mauro's disability benefits and breached "its duties of good faith and fair dealing owed to [Mauro] by other acts or omissions as well." Mauro claims damages in the form of non-payment of disability benefits which has caused her to suffer "anxiety, worry, mental and emotional distress, and other incidental damages and out-of-pocket expenses" which she should be compensated for. Mauro's California disability lawyer states that Liberty's treatment of his client "was despicable" and conducted with a "wilful and conscious disregard of the rights of [Mauro]." He further states that Liberty's conduct "subjected [Mauro] to cruel and unjust hardship in conscious disregard of her rights, and was an intentional misrepresentation, deceit, or concealment of a material fact... with the intention to deprive [Mauro] of property and/or legal rights or to otherwise cause injury, such as to constitute malice, oppression, or fraud under California Code..." Thus, Mauro's disability attorney asks for punitive damages as well.
In her complaint, Mauro asks for:
Michelin Employee Sues Liberty Life Assurance Company of Boston For Disability Benefits
In Robert Weathers v. Liberty Life Assurance Company of Boston, Robert Weathers an employee of Michelin North America, Inc. was declared disabled and applied for his disability benefits through his disability plan at Michelin. Liberty acknowledged that Weathers is disabled and agreed to pay some of his disability benefits, but denied Weathers his 60% buy up claim. Weathers appealed with no satisfaction, and filed a lawsuit on May 27, 2011 in the United States District of South Carolina Greenville Division to see what the Court has to say about Liberty's decision.
Weathers Complaint
In his complaint, Weathers and his South Carolina disability attorney allege that Liberty made its decision about Weathers benefits claim under a conflict of interest in which the decision to deny Weathers his disability benefits "was not based upon substantial evidence or the result of a principled and reasoned decision-making process"; but instead, the insurer "ignored relevant evidence pertaining to [Weather's] claim... relying on biased information and flawed expert opinions."
Weathers and his South Carolina disability lawyer ask the Court to determine if Liberty "abused its discretion" in the decision to deny Weather's his disability benefits, and if so, to "remand [Weather's] claim for a ‘full and fair' review by the appropriate claim fiduciary," award Weathers attorney's fees, and court costs, and any other relief the Court sees fit.
Bridgestone Employee Sues Liberty Life Assurance Company of Boston For Disability Benefits
In Charles Horne v. Liberty Life Assurance Company of Boston, Horne petitions the United States District Court of the Northern District of Georgia, Atlanta Division to assist him in procuring his disability benefits. Horne's employer was Bridgestone Americas, Inc., where Horne worked as a machine technician and qualified under the company's insurance plan to receive disability benefits should he require them during his employ.
In March 2008, Horne ceased work due to "steroid dependent sarcoidosis," and suffers "fatigue, severe breathing problems, sleep difficulties due to sleep apnea, dyspnea, wheezing and coughing, blurred vision and headaches." In addition, the side effects of his many medications include "fatigue, drowsiness, difficulty with concentration, attention and focus," resulting in Horne needing "to rest or lie down at unpredictable intervals during the day."
After Liberty's six-month waiting period, Horne received long term disability benefits from September 18, 2008 until September 17, 2010, when Horne's disability benefits were terminated because Liberty believed that Horne was not disabled from "any occupation." The Social Security Administration had previously found Horne to be "totally disabled," but Liberty ignored this fact.
Horne's Complaint
At the time of the filing of Horne's complaint, Horne had exhausted his administrative appeals and needs the Georgia Court to determine his financial fate. Horne has substantial medical documentation to evidence his disability as well as "lengthy treatment records, supportive opinion from [Horne's] long-time treating physicians" and documentation of his declaration as being total disabled by the Social Security Administration.
Consequently Horne and his Georgia disability attorney ask the Northern District Court of Georgia for:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
30 year veteran employee of 3M Company sues company and Sedgwick Insurance for disability benefit denial
An employee of 3M Company as a Key Account Manager for 30 years, Dominic D. LaPorta was shocked to find out that his security net disability insurance plan was not so secure when Sedgwick Claims Management failed to meet its obligations to provide him disability benefits should he become disabled while working at 3M Company. With no other options available to resolve his issue with 3M Company and Sedgwick, LaPorta engaged the services of a disability attorney and filed a lawsuit against 3M and Sedgwick, alleging ERISA violations, on May 27, 2011 in the United States District Court of Minnesota.
Disability Blog & Cases:
Insurance sales agent files a disability insurance denial lawsuit against Liberty Life Assurance Company of Boston
Ricky C. Hampton, an insurance sales agent with Alfa Mutual Insurance Company (Alfa) has filed a lawsuit against his own disability insurance company, Liberty Life Assurance Company of Boston. A position described as light, Hampton was required to work forty hours per week, five days a week and was frequently asked to perform the following duties, all of which were documented in his job description.
Disability Blog & Cases:
Sun Life Insurance Company is sued for disability benefits in two separate cases for arbitrary and capricious denial of disability claims
With disability insurance lawsuits occurring up and down the eastern US coastline, Sun Life Insurance Company has a lot of litigation to settle. Just in May 2011, Sun Life was hit with two complaints from disability insurance benefits claimants, one in the United States District Court District of New Jersey (Kevin Giblin v. Sun Life and Health Insurance Company et. al) and the other in the United States District Court for the District of South Carolina, Spartanburg Division (Duane Easler v. Sun Life Assurance Co. et al.).
Disability Blog & Cases:
Xerox employee is denied her long term disability benefits and sues Sedgwick and Xerox
An employee of Xerox Corporation files a lawsuit against Sedgwick Claims Management Services, Inc., Sedgwick Claims management Services, Inc., and The Prudential Insurance Company of America for disability benefits. An employee with Xerox for 10 years, Andrea Calhoun brought a lawsuit against her employer and Sedgwick under the Employee Retirement Income Security Act of 1974 (ERISA) 29 U. S. C. § 1001, et seq. "seeking to overturn a denial by the Defendant" of her long term disability benefits.
Disability Blog & Cases:
CIGNA Group Insurance and Subsidiaries sued in Alabama, New York and Michigan for allegedly acting arbitrarily and capriciously in denying claims for long term disability benefits
Recently, the CIGNA Group Insurance and its subsidiaries (CIGNA) faced a barrage of disability insurance lawsuits filed against the company and its subsidiaries across the country allegedly for denying long term disability (LTD) benefits by ignoring overwhelming medical evidences that supported the plaintiffs' disabled condition.
Delicia Haynes, an employee of Commercial Metals Company has filed a lawsuit against Liberty Life Assurance Company of Boston to collect her long overdue disability benefits. A data entry clerical assistant at Commercial Metals Company, Haynes was denied her disability application for long term disability in a letter from Liberty Life Assurance, dated March 13, 2010. In the letter, Liberty Life denied Haynes claim but also failed to state "any material or information" that was necessary for Haynes to file an ERISA appeal. The insurer's letter did reference some of Haynes general documents, without stating why her claim was denied.
Baffled Employee Appeals Disability Claim Without Adequate Information
Without the necessary information to do so, Haynes appealed Liberty Life's denial of her disability claim on August 30, 2010 to no avail, as Liberty Life failed to respond to the appeal at all. Along with her appeal paperwork, Haynes provided Liberty Life with additional documentation to verify her disability and complied with all the requirements to file an ERISA administrative appeal under Liberty Life's Plan.
Haynes And Her Texas Disability Attorney File Her Lawsuit Against Liberty Life
As a result of Liberty Life Assurance's inaction to address Haynes administrative disability benefits appeal, Haynes engaged the services of a Texas disability lawyer and filed a lawsuit against Liberty Life Assurance in the United States District Court of the Northern District of Texas, Fort Worth Division to seek a judgment on her disability claim.
Haynes's Complaint
In her complaint, Haynes and her Texas disability attorney allege that 47-year-old Haynes "is entitled to LTD benefits under her Policy," has complied with proof of her disability claim according to the Policy and is entitled to receive long term disability benefits until age 65. Haynes's complaint also alleges that Liberty has violated several regulations of the Secretary of Labor by not giving Haynes adequate reason for its original denial of her disability benefits, failing to provide her with a full and fair review of her disability claim, failing to provide her with information to allow for an appeal of the denial, failing to administer Haynes's plan in a way that benefits participants, operating under a conflict of interest, failing to have Haynes's claim reviewed by a proper reviewer, and failing to act by responding to Hanes appeal.
In addition, Haynes and her Texas disability lawyer allege that Liberty Life violated ERISA regulations by failing to review her claim properly and being "arbitrary and capricious" in the handling of her claim. Haynes's Texas disability lawyer points out that Liberty Life didn't have Haynes's claim reviewed by an appropriate healthcare professional but used a biased consultant instead, gave inappropriate feedback to Haynes's claim making it virtually impossible for her to appeal, didn't follow their own guidelines in the evaluation of Haynes's claim, and in essence chastises the insurer for its handling of all claims.
What Haynes Asks The District Court To Do About Her Disability Benefits Claim
Haynes asked the District Court for the Northern District of Texas, Fort Worth Division to force Liberty Life to provide her with her entitled employee disability benefits, both past due and future, pre-judgment and post-judgment interest, Court costs, attorney's fees and any other further relief the Court thinks is proper under the circumstances.
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Disabled Unisys network design engineer sue Aetna Life Insurance Company seeking payment of long term disability benefits
Through a Utah disability insurance lawyer, a lawsuit was filed at the District Court for the District of Utah by a disabled Network Design Engineer formerly working at Unisys. In the lawsuit, it was claimed that the Aetna Life Insurance Company’s (Aetna Life) failure and refusal to pay the plaintiff long term disability (LTD) benefits under an employee welfare benefit plan underwritten and insured by Aetna Life constituted a breach of the terms and provisions of the Plan and of the Employee Retirement Income Security Act of 1974 (ERISA).
Disability Blog & Cases:
Former Charles Schwab Corporation employee sues Liberty Life Assurance Company of Boston for denial of long term disability benefits
A Kentucky disability lawyer recently filed a lawsuit against the Liberty Life Assurance Company of Boston (Liberty Life) at District Court for the Eastern District of Kentucky. In Rita Dirks Vs Liberty Life Assurance Company Of Boston, The Charles Schwab Corporation Long Term Disability Plan And The Charles Schwab Corporation, it was alleged by the plaintiff Rita Dirks that Liberty Life had violated the provisions of the Employee Retirement Income Security Act of 1974 (ERISA) in the handling of her claim for long term disability (LTD) benefits.
Disability Blog & Cases:
Cigna denies disability benefits to former Healthsouth Corporation nurse after paying for 11 years
In Susan Sheehan Vs Cigna Group, Life Insurance Company of North America, a Massachusetts disability attorney filed a lawsuit at the District Court District Of Massachusetts claiming that the giant disability insurance company Cigna Group (Cigna), had contravened the provisions of the Employment Retirement Income Security Act (ERISA) in its handling of a client’s claim for disability benefits.
Disability Blog & Cases:
Prudential terminates disability benefits of traumatic brain injury claimant in a case of mistaken identity
James H. White filed a lawsuit against Prudential Insurance of America in the United States District Court For The Eastern District of Pennsylvania for the insurer’s termination of White’s disability benefits after paying him disability benefits for twenty-four (24) months. Claiming that White’s disability was the product of a pre-existing metal illness, Prudential Insurance terminated White’s disability benefits because his policy with Prudential only allows 24 months of disability benefits when the disabling condition is related to a mental illness.
Disability Blog & Cases:
Sunlife denies disability benefits to Wise Foods employee disabled by cancer and shoulder surgeries
John McGinnis has filed a lawsuit against Sun Life Assurance Company of Canada because the insurer denied him his disability insurance benefits and life insurance coverage as dictated by ERISA 29 U.S.C. § 1001 et seq. According to the Complaint that McGinnis and his disability attorney filed in the United States District Court of New Jersey when the insurance company denied him his disability benefits and life insurance benefits the insurer was fully aware of McGinnis’s history of longstanding medical conditions that entitled him to disability benefits when it denied him disability benefits.
In Lamont Philip Richardson Vs Unum Group Corporation And First Horizon National Corporation, the disability insurance claimant alleged that he was improperly denied of his claim for long term disability (LTD) benefits by Unum. A lawsuit was filed for the recovery of disability benefits under an employee benefits plan and for enforcement of rights under the Employee Retirement Security Act of 1974 (ERISA) at the District Court for the Eastern District of Tennessee by a Tennessee disability attorney.
The Nature of the Lawsuit Against Unum Insurance
The plaintiff Lamont Philip Richardson was employed at the First Horizon National Corporation through the First Tennessee Bank at Memphis, Tennessee. By virtue of his employment, the plaintiff was a participant of an employee benefits plan maintained by the First Horizon National Corporation for the benefit of its employees and in which Unum was the Claims Administrator. The disability plan provides LTD coverage in the event of disability.
According to the disability lawsuit, the plaintiff became eligible to receive LTD benefits on May 31st 2008. The plaintiff stated that his UNUM disability application was approved and he began receiving LTD benefits from Unum beginning from May 31st 2008 until June 15th 2010. From the period of June 16th 2010 to September 15th 2010, the plaintiff was paid "extra-contractual benefits” by Unum.
Denial of Long Term Disability Benefits by Unum
On June 16th 2010, the plaintiff alleged that he was improperly denied his claim for LTD benefits. Subsequently, the plaintiff appealed Unum"s decision to deny him his claim for LTD benefits and submitted additional medical documentation to support his appeal. In the lawsuit, the plaintiff also stated that, on November 10th 2010, he was determined to be disabled by the Social Security Administration (SSA). Nevertheless, on March 8th 2011, Unum upheld its prior decision to deny the plaintiff his claim for LTD benefits.
The plaintiff argued that Unum had failed to accord proper consideration to SSA Administrative Law Judge"s determination of disability. The plaintiff also alleged that Unum had arbitrarily disregarded the medical opinions of his attending physicians and instead relied upon opinions of non-examining medical sources engaged by Unum in making its determination to deny the plaintiff"s claim for LTD benefits.
The plaintiff contended that the plaintiff"s treating physician(s) opinions/ restrictions/limitations as well as the SSA Administrative Law Judge"s determination of disability indicated that he was/is unable to perform any occupation. The plaintiff argued that Unum had failed to provide disability benefits that was due to the plaintiff under the terms of the Plan and that this denial of benefits was a breach of the plan as:
Relief Sought By the Plaintiff
As a result of Unum"s actions, the plaintiff argued that this have resulted in him suffering damages. In addition, the plaintiff has exhausted all his administrative remedies and is seeking from the Court the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Disabled project manager for RTP Technology Corporation filed lawsuit against the UNUM Life Insurance Company of America for refusal to pay disability benefits
A New Jersey disability attorney recently instituted a lawsuit against the UNUM Life Insurance Company of America (UNUM) at the District Court for the District of New Jersey of behalf of a disabled client. In Robert Garozzo v UNUM Life Insurance Company of America and RTP Technology Corporation long term disability plan, the plaintiff Robert Garozzo is seeking payment of disability income benefits from UNUM under the terms of a long term disability Benefit plan.
Disability Blog & Cases:
Disabled interventional radiologist with sleep apnea and cardiac limitations sues Unum Provident and Hartford Life for denial of long-term disability benefits payments
For a disability insurance contract, one of the most important clauses in the contract will be the “own occupation” definition of what constitutes disability. The implication of this clause is that if you become “disabled” due to sickness or injury and are unable to work in your specific line of work, the insurance policy will pay you disability benefits even if you decide to work in another line of employment.
Disability Blog & Cases:
AT&T employee with back injury sues Sedgwick Claim Management Services, Inc. for denial of short term disability benefits
Florida Disability Lawyer Sues Sedgwick Claim Management Services
In the case of Richard Shane Burnett Vs Sedgwick Claim Management Services, Inc. D/B/A AT&T Integrated Disability Service Center, filed at the District Court for the Middle District of Florida, the plaintiff Richard Shane Burnett alleged that he is eligible for short term disability (STD) benefits under an employee benefit plan provided by his employer.
Disability Blog & Cases:
Unum Insurance claims no object evidence exist and denies disability benefits to St. Anthony Central Hospital nurse suffering from fibromyalgia
Colorado disability lawyer files lawsuit against Unum Life Insurance Company Of America for denying long term disability benefits and wrongfully asserting no objective test exist to diagnose fibromyalgia
In Kelly Ann Curtis vs Unum Life Insurance Company of America, a Colorado disability attorney filed a lawsuit on behalf of a disability claimant against the Unum Life Insurance Company of America (Unum) at Denver County District Court. The case is quite interesting as it illustrates how disability insurance companies can, by applying certain limiting clauses in disability insurance contracts, avoid paying out disability benefits to the insured.
Disability Blog & Cases:
Fifth Circuit Court Of Appeal denied Estate Of Pepsiamericas, Inc.’s employee motion to recover accidental death and dismemberment benefits from group disability insurance plan issued by Unum
Recently the Court of Appeal Fifth circuit rendered their opinion in the case of Mary Ann LETTER, Individually and as Executrix Administratrix of the Estate of Timothy D. Letter vs. UNUM PROVIDENT CORPORATION; Unum Life Insurance Company of America. They ruled that the plaintiff Mary Ann Letter, individually and as acting as the estate of her husband Timothy D. Letter was not entitled to recover Accidental Death And Dismemberment (AD & D) benefits from her deceased husband’s group insurance plan due to non payment of premium.
Disability Lawyer Files Lawsuit Against Liberty Mutual
In the case of Georgia Lewis Vs Liberty Life Assurance Company Of Boston, Wachovia Corporation And Wachovia Corporation Long Term Disability Plan, the plaintiff filed a lawsuit against the Liberty Life Assurance Company Of Boston (Liberty Life) at the District Court For The District Of New Jersey. In the lawsuit, the plaintiff alleged that Liberty Life had violated the provisions of the Employee Retirement Income Security Act of 1974 (ERISA). The lawsuit was brought against Liberty Life to recover disability income benefits that were due under an employee welfare benefit plan in which Liberty Life was designated as the Claims Administrator and Claims Fiduciary of the Plan.
The Alleged Facts of The Case Against Liberty Life
The plaintiff Georgia Lewis was a former employee of Wachovia Corporation. While as an employee of Wachovia Corporation, she participated in the Wachovia Corporation Long Term Disability Plan in which the Wachovia Corporation acted as the sponsor and plan Administrator. Liberty Life was the Claims Administrator for this plan.
The Claim For Disability Benefits
On January 5th 2006, the plaintiff ceased working as a result of disabling impairments due to suffering from fibromyalgia, ulnar neuropathy of the left arm, and cubital tunnel syndrome. The plaintiff later filed a claim for benefits claiming that she had met the Plan's definition of "total disability" as she had been rendered unable to perform the material duties of a her occupation.
Initially her disability application for disability benefits was approved by Liberty Life and she received payment of benefits from Liberty Life until November 23rd 2009. On November 23rd 2009, Liberty Life terminated the plaintiff's benefits on the ground that she did not meet the plan definition of being disabled anymore.
The Appeals To The Termination Of Benefits
In the lawsuit, the plaintiff alleged that her medical condition had not changed and that she has been totally disabled until the present time. She later submitted an appeal to Liberty Life's decision to deny her disability benefits. Several medical documentations from her attending physicians attesting to her "total disability" condition were also submitted to support her appeal. Nevertheless, on July 14th 2010, Liberty Life informed the plaintiff of its decision to reaffirm the denial of benefits.
Another appeal was later submitted to the Wachovia Long Term Disability Appeal Committee which on November 9th 2010 informed the plaintiff of its final determination reaffirming the decision to deny benefits to the plaintiff.
Relief Sought By The Plaintiff In The Lawsuit
The plaintiff alleged that Liberty Life's determination that the plaintiff was not totally disabled was not based on evidence and is contrary to the welfare of the plan. The plaintiff further alleged that Liberty Life's actions in handling and determination of the Plaintiff‘s claim were arbitrary and capricious. Due to the final determination by Liberty Life, the plaintiff has exhausted all her administrative remedies and is asking the Court to review the matter and enter judgment in favor of her. The plaintiff is specifically asking the Court for the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Washington disability attorney filed lawsuit against the Hartford Insurance Company for denial of long term disability benefits to mentally disabled woman
A Washington disability attorney recently filed a lawsuit on behalf of his client at the District Court for the Eastern District of Washington against the Hartford Insurance Company (Hartford). In the case of Robin (Hunt) Hankel v The Hartford Insurance Company /The Hartford Financial services Group, the plaintiff was a woman employed in the health Safety and Environmental Management/ Engineering field for Harpers. While employed with Harpers, she contributed to a disability insurance plan which was issued by Hartford.
Disability Blog & Cases:
Fort Dearborn Life Insurance Company faces disability denial lawsuit from disabled account clerk of Katz Insurance Group diagnosed with PTSD
Recently, a former account clerk of the Katz Insurance Group filed a lawsuit against the Fort Dearborn Life Insurance Company (Fort Dearborn Life) through a Maryland disability attorney at the District Court for the District of Maryland. In the case of Tosha Pederson v Fort Dearborn Life Insurance Company, the plaintiff alleged that Fort Dearborn Life had acted arbitrarily and capriciously in its decision to deny the plaintiff's claim for long term disability (LTD) benefits.
Disability Blog & Cases:
Northwestern Mutual Life Insurance Company denies partial disability benefits to trial attorney resulting in lawsuit for violations of Washington Insurance Fair Conduct Act
The Northwestern Mutual Life Insurance Company (Northwestern Life) was recently sued by a Washington disability lawyer for the violations of the Washington Insurance Fair Conduct Act and Washington Consumer Protection laws. In Kurt D. Bennett v The Northwestern Mutual Life Insurance Company, the plaintiff alleged that Northwestern Life in denying the plaintiff's claims for disability benefits was in violation of the above mentioned laws and breached the terms of the disability insurance policy.
Disability Blog & Cases:
Disabled employee of University Of California Davis diagnosed with fibromyalgia sues Liberty Mutual for denial of disability benefits and seeks punitive damages
Recently a California disability attorney filed a lawsuit against the Liberty Life Assurance Company of Boston (Liberty Life) at the Superior Court of the state of California. In the case of Cassie Ray v Liberty Life Assurance Company of Boston, the plaintiff alleged that by denying the plaintiff's claim for disability benefits, Liberty Life, among other things, had caused the plaintiff to suffer damages. This disability policy is not governed by ERISA as the claimant is a government employee.
FAQ: General Questions
How can a claimant exclude their disability insurance benefit payments from Federal Income Tax?
In two recent separate cases, an employee of Wells Fargo & Company (Wells Fargo) and an employee of Filtrona Greensboro, Inc. filed lawsuits in California and North Carolina respectively, through their disability attorneys, against the Liberty Life Assurance Company of Boston (Liberty Life) for violations of the provisions of Employee Retirement Income Security Act (ERISA).
California disability Lawyer Sues Liberty Mutual
In the case of Melinda Martinez v Wells Fargo Long Term Disability Plan & Liberty Life Assurance Company of Boston, the plaintiff's California disability attorney filed the lawsuit at the District Court for the Southern District of California. The lawsuit alleged that Liberty Life contravened the provisions of ERISA and the plaintiff is seeking relief from the Court for the violations of her legal rights under an employee benefit plan issued by Liberty Life.
The Nature of the Complaint
The plaintiff Melinda Martinez was an employee of Wells Fargo and participated in a Long Term Disability (LTD) plan issued by Liberty Life. While employed with Wells Fargo, the plaintiff became disabled as defined by the LTD plan and hence was entitled to the benefits under the LTD plan. The plaintiff attempted to make a claim for LTD benefits under the LTD plan but was denied by Liberty Life on the grounds that the plaintiff was not disabled. Pursuant to the denial of the claim, the plaintiff made an appeal to Liberty Life's decision to deny her LTD benefits. However, despite overwhelming evidence indicating that the plaintiff was disabled, Liberty Life upheld its decision to deny LTD benefits to the plaintiff. At the same time, Liberty Life also informed the plaintiff that her rights to appeal under the LTD plan had been exhausted.
The plaintiff alleged that the Wells Fargo Long Term Disability Plan and Liberty Life had wrongfully denied her claim for LTD benefits by:
Request for Relief
Having exhausted her administrative remedies, the plaintiff is seeking the following relief from the Court:
North Carolina Disability Lawyer Sues Liberty Mutual
In the case of Barbara Newkirk-Davis v Liberty Life Assurance Company of Boston and FIL Holdings Corporation Group Disability Income Policy, the lawsuit was filed at the Superior Court for County of Guilford, North Carolina by a North Carolina disability attorney for the plaintiff Barbara Newkirk-Davis.
The Alleged Facts of the Case
The plaintiff Barbara Newkirk-Davis was employed as a Quality Assurance Auditor for Filtrona Greensboro, Inc. While employed with Filtrona Greensboro, Inc., the plaintiff participated in an employee welfare benefit policy known as "FIL HOLDINGS CORPORATION GROUP DISABILIY INCOME POLICY" (hereinafter "FIL Policy") that was sponsored by Filtrona Greensboro, Inc and issued by Liberty Life.
FIL Policy acted as the plan administrator while Liberty Life provided claims administration and services for the FIL POLICY and its beneficiaries. On November 11th 2009, due to severe depression, the plaintiff stopped working. She filed a claim for LTD benefits and was approved for payment of LTD benefits in the amount of $2318.00 per month until August 9, 2010.
On August 9th 2010, the plaintiff alleged that FIL Policy and Liberty Life, without any basis, and disregarding the conclusions of the plaintiff's doctors, terminated the plaintiff's LTD benefits effective from August 10th 2010. The plaintiff timely appealed the decision to terminate her LTD benefits but however was unsuccessful in her appeal on October 27th 2010.
The plaintiff argued that FIL Policy and Liberty Life had acted arbitrarily and capriciously and purposely ignored the qualified opinions, findings and conclusions of Plaintiff's doctors in their handling of Plaintiff's claim for LTD benefits. She further claimed in the lawsuit that that they had abused their discretion and acted with self interest whilst administrating her claim for LTD benefits. The plaintiff alleged that she remains disabled and based on her doctors' findings "is unable to perform the duties of any gainful occupation for which she is reasonably qualified by education, training or experience."
Relief sought by the Plaintiff
Having exhausted her administrative remedies, the plaintiff is bringing a "…civil action to recover benefits due to her under the terms of the Policy, to enforce her rights under the terms of the Policy and/or to clarify her right to benefits under the terms of the Policy" under ERISA. As such, the plaintiff is asking the Court for the following relief:
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. To request a free legal consultation call 800-411-9085.
June 22, 2011 - A recent opinion from the Ninth Circuit United States Court of Appeals has helped clarify the rules as to who you can sue in actions for benefits under a long term disability policy See Cyr v. Reliance Standard & Channel Technologies, 2011 WL 2464440, June 22, 2011. The Court concluded that under appropriate circumstances, an entity other than the plan itself or the plan administrator may be sued under 29 U.S.C. § 1132(a)(1)(B).
Laura Cyr was employed by Channel Technologies, Inc. ("CTI") as a vice president. CTI provided its employees with long term disability benefits under a program insured by defendant Reliance Standard Life Insurance Company ("Reliance"). CTI was the plan administrator, and Reliance effectively controlled the decision whether to honor or deny a claim for benefits. In October 2000, Cyr filed a claim for long term disability benefits based on a back condition. Reliance approved the benefits and based her monthly payment on her salary of $85,000/year.
Ms. Cyr later filed suit against her employer, CTI, alleging gender discrimination. A settlement agreement was eventually reached which awarded Cyr a retroactive salary of $155,000/year. When Cyr asked Reliance to increase her monthly benefit amount in accord with her adjustment in salary, Reliance declined. Cyr was forced to file suit to pursue her claim for the increased benefits.
Cyr filed suit against Reliance, the CTI Group Long Term Disability Benefit Program (the 'Plan'), and CTI as the plan administrator for the Plan. Reliance moved for summary judgment, arguing that only the plan or plan administrator could be held liable under the statute. Initially, the district court agreed with Reliance, but later the court changed its mind and ruled in favor of Cyr. Cyr was awarded fees, costs and interest on the money owed. In light of this ruling, Reliance appealed.
The issue for the Appellate Court was whether Reliance was a proper defendant in a suit for benefits under 29 U.S.C. § 1132(a)(1)(B) even though it was neither a plan or plan administrator. The Court first noted that neither 29 U.S.C. § 1132(a)(1)(B) nor 29 U.S.C. § 1132 stated any limits about who could be sued. Additionally, the Appellate Court looked to a United States Supreme Court ruling for guidance. In Harris Trust & Savings Bank v. Salomon Smith Barney, Inc., 530 U.S. 238 (2000), the Supreme Court addressed a similar question of who can be sued under a similar statute, 29 U.S.C. § 1132(a)(3). In that case, the Supreme Court noted that 29 U.S.C. § 1132(a)(3) makes no mention at all of which parties may be proper defendants. The Court then ruled that there was no limit in 29 U.S.C. § 1132(a)(3) as to who could be sued.
Similarly, in the case at hand, the Appellate Court felt that because 29 U.S.C. § 1132(a)(1)(B) contained no limitation as to who could be sued, the Court could not read a limitation into the statute. The Court concluded that parties other than plans can be sued for money damages as long as that party's individual liability is established. The Court looked to related section 29 U.S.C. § 1132(d)(2) which provides that 'any money judgment under this subsection against an employee benefit plan shall be enforceable only against the plan as an entity and shall not be enforceable against any other person unless liability against such person is established in his individual capacity under this subsection.'
In the case at hand, the Court determined that Reliance, as plan insurer who is responsible for paying legitimate benefits claims, is a logical and proper defendant for Cyr to recover benefits due, along with the plan and the plan administrator. The Court denied Reliance's appeal.
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Anesthesiologist files lawsuit against Paul Revere Life Insurance Company alleging wrongful deduction of social security retirement benefits
On April 29, 2011, Dr. Phillip W. Watson and his disability attorney filed a lawsuit in the United States District Court Southern District of Florida as a last resort to settle Watson's claim that in violation of ERISA, Title 29, United Stated Codes 1000-1461, Paul Revere Life Insurance Company arbitrarily decided to deduct part of his disability benefits payments when Watson applied for his early Social Security retirement benefits (SSR).
Disability Blog & Cases:
A former HCBS sales manager diagnosed with lyme disease sues UNUM Life Insurance for disability claim denial
Mark Linder filed a lawsuit against UNUM Life Insurance Company of America (UNUM) in the United States District Court for the Middle District of Pennsylvania under ERISA, 29 U.S.C. § 1132. Linder was forced to seek Court mandated relief when his disability claim was denied by UNUM even though he was classified as totally disabled by his medical provider.
Disability Blog & Cases:
UNUM denies disability insurance benefits to disabled nurse with fibromyalgia and osteoarthritis
Claiming four counts of misconduct by UNUM Life Insurance Company in the denial of her disability claim, Cynthia A. Keller filed a lawsuit on May 2, 2011 in the Eastern District of Michigan Southern Division. After exhausting all her administrative appeals to the insurance provider, Keller hired a Michigan disability lawyer who prepared her complaint stating that UNUM is guilty of breaching its obligations under ERISA, asking for injunctive and declaratory relief, requesting pre-judgment and post-judgment interest, and reimbursement for her attorneys' fees.
Disability Blog & Cases:
Former Zurich Insurance employee diagnosed with crohn's disease sues Liberty Life for denial of disability benefits
Carol Snyder and her Missouri disability lawyer filed a civil complaint against Liberty in United States District Court in the Western District of Missouri because Liberty denied her claim for short-term disability benefit payments.
Disability Blog & Cases:
Missouri disability lawyer files ERISA lawsuit against Lincoln National Life Insurance Company for denying LTD benefits
From 1997 to 2003, Bobby Nelson worked as a buyer for AMCOM until he became completely and totally disabled due to the displacement of a lumbar intervertebral disc in his lower back. Mr. Nelson's last day of working full-time at AMCOM was December 26, 2003. Three days later, he had posterior and anterior fusion of the L4 and L5 vertebrae performed on his lumbar spine. The surgeon also placed bilateral pedicle screws and a disc fixator device in Mr. Nelson's lumbar spine to maintain the integrity of the lumbar vertebrae. However, Mr. Nelson experienced chronic and continuing lower back and leg pain following surgery.
Disability Blog & Cases:
Podiatrist sues Northwestern Mutual seeking disability insurance benefits and bad faith damages
The case of Gaby Kafie v. Northwestern Mutual Life Insurance Company, commenced in the United States District Court of the Southern District of Florida on April 8, 2011 when Northwestern Mutual refused to pay Gaby Kafie's disability benefits as specified in a Northwestern Mutual Life (NML) disability insurance policy.
Disabled since March 12, 2008, Gayle Bennett initially received her disability benefits from Prudential Life Insurance until February 27, 2010, when Prudential ceased paying Bennett's disability benefits and refused to continue paying her disability benefits as required by her Plan. Consequently, Bennett and her disability attorney filed a six count lawsuit in the United States District Court in the Northern District of Texas, Dallas Division against the insurance company.
Bennett Alleges That Prudential Has Breached Its Contract With Her To Provide Her Rightful Disability Benefit Payments
In her complaint, Bennett and her disability attorney allege that Prudential breached its contract with her by denying her disability benefits even though Bennett had met all the requirements for receiving said benefits. Bennett also alleges that Prudential denied her benefits with malice, which caused Bennett mental anguish. Bennett's disability attorney enumerates several instances of misconduct by Prudential in its dealing with Bennett that includes:
Stating that Prudential's conduct was "unconscionable," Bennett's disability attorney seeks several remedies to compensate Bennett for her financial damages and her emotional damages and wants to present Bennett's case before a jury.
What Bennett Requests In Relief From Prudential
Bennett requests relief from Prudential according to the dictates of Teas Insurance Code for the following:
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. To request a free legal consultation call 800-411-9085.
Resolved Cases:
Hartford reverses disability benefit denial after previously paying 62 year old sales rep for 6 years
Our client, a 62 year old former pharmaceutical sales rep, had been receiving long term disability benefits with Hartford Insurance Company for nearly six years due to chronic back pain, which had resulted in six surgeries in a span of several years, when Hartford abruptly terminated his claim for long term disability benefits.
Disability Blog & Cases:
Guardian Life Insurance seeks overpayment of disability benefits for child social security disability benefits awarded to disabled claimant's daughter
A recent lawsuit filed against Guardian Life Insurance Company highlight an issue that comes up regularly for disability insurance claimants that have minor children and are approved for Social Security Disability Benefits. Monica Johnson has been receiving long-term disability benefit payments from Guardian Life (Guardian) since August, 2003 as result of her becoming completely and totally disabled in April, 2003. Under the terms of the group long-term disability benefit plan Monica purchased while working for EBE Office Source, Inc., Guardian is allowed to offset her monthly benefit payment according to the amount of Social Security disability income she receives.
Disability Blog & Cases:
CIGNA Life Insurance Company denies disability benefits yet social security disability benefits are approved
Lily Rubinstein filed suit against CIGNA Life Insurance Company of New York, Griffon Corporation Long Term Disability Plan, and Griffon Corporation Life Insurance Plan in the United States District Court of the Eastern District of New York when the insurance provider abruptly denied her disability benefits after approving short term benefits six previous times. The insurer took away Rubinstein's disability benefits even though her condition remains the same as when they approved her claim the last six times and even though medical opinion is that Rubinstein risks a stroke if she goes back to work.
Disability Blog & Cases:
Nevada disability lawyer and COX Enterprises Inc's customer service rep sue AETNA Life Insurance Company for denial of disability benefits
A former Customer Service Representative (CSR) for COX Enterprises Inc. (COX) recently filed a lawsuit through a Nevada disability attorney against the AETNA Life Insurance Company (AETNA Life) at the District Court for the District Court of Nevada. In Sandra Rada v Cox Enterprises Inc as Plan Administrator & AETNA Life Insurance Company as Claims Administrator, the plaintiff Sandra Rada alleged that AETNA Life had not provided the plaintiff with a full and fair review of her claim for long term disability (LTD) benefits and thus seek the Court to review Aetna Life's decision under a de novo standard.
Disability Blog & Cases:
Prudential Insurance sued by disabled HNI Corporation employee for denial of disability insurance benefits after 7 years
A 49 year old woman said to be suffering from degenerative disc disease and disabling pain recently filed a lawsuit at the District Court for the Southern District of Iowa against the Prudential Insurance Company of America (Prudential). In the case of Kimberly Maserang v The Prudential Insurance Company of America, the plaintiff's Iowa disability lawyer alleged that Prudential has wrongly denied payments after paying her disability benefits for 7 years. Despite a worsening of the plaintiff's medical condition, Prudential determined that the plaintiff is no longer disabled.
Recently a lawsuit was filed at the District Court for the District of New Jersey against the Prudential Insurance Company of America (Prudential) for failure to pay long term disability (LTD) benefits to a disabled teacher for West Orange Board of Education. In Janel Braun v The Prudential Insurance Company of America, the plaintiff Janel Braun alleged that Prudential had wrongfully denied the plaintiff her claim for LTD benefits.
The Nature of the Complaint
The plaintiff Janel Braun was a school teacher employed by the West Orange Board of Education. Whilst employed by the West Orange Board of Education, the plaintiff participated in a health and welfare plan that was offered by the New Jersey Education Association Member Fund, a plan underwritten and administered by Prudential. Under the plan, disability was defined as a person who is unable to perform the material and substantial duties of their regular occupation due to injury or sickness and suffered a 20% or more loss in monthly earnings as a result of that sickness or injury.
Due to severe pain relating to her sinus thrombosis, the plaintiff stopped working on April 29th 2005. The plaintiff's medical records were said to support the fact that she was unable to perform the material and substantial duties of her occupation. Subsequently, due to her disability, the plaintiff filed a claim for disability benefits with Prudential and was approved for LTD benefits on May 30th 2005. The LTD benefits were paid out to the plaintiff until May 29th 2007.
Disability Definition changes After 24 Months
Under the policy, the plaintiff was be subjected to a review of eligibility after receiving 24 months of LTD benefits. The review was to determine if the plaintiff satisfied the definition of disabled by not being able to perform the duties of any gainful employment for which she is reasonably suited by education, training or experience. To be considered gainfully employed, the plaintiff had to earn at least 66.33% of her pre-disability income. In the plaintiff's case, she had to earn at least $14.55 per hour to be considered gainfully employed. Upon conducting an employability assessment, Prudential determined that the plaintiff could be employed as an information clerk, a tutor, a telephone solicitor or as a routing clerk. It was asserted by Prudential that these occupations have an hourly wages of $15.00 to $18.00 which exceeded the plaintiff's minimum threshold to be considered gainfully employed.
Thus, on April 9th 2009, the plaintiff was informed that she did not meet the definition of disability under the plan and hence was not eligible for further payment of LTD benefits effective May 30th 2009. The plaintiff in response submitted an appeal to Prudential on November 16th 2009, together with further medical documentations supporting her claim. She also submitted details of her eligibility for Social Security Disability Benefits. Nevertheless, the plaintiff's appeal was rejected on March 18th 2010. Further to this rejection, another appeal was submitted to Prudential by the plaintiff on September 2nd 2010. This appeal was also denied by Prudential.
According to the lawsuit filed, the plaintiff contended that she had been disabled since 2005. In addition since November 2007, the plaintiff had been receiving Social Security Disability Benefits as the Social Security Administration had deemed her disabled and unable to be gainfully employed based on the same medical documentations provided to Prudential. The plaintiff further alleged that the chronic daily pain associated with her disability rendered it impossible for her to be gainfully employed as an information clerk, a tutor, a telephone solicitor or as a routing clerk. Due to Prudential's decision to terminate her LTD benefits, the plaintiff argued that Prudential had:
Claim for Relief
Due to the above mentioned breaches, the Plaintiff is seeking the following relief from the Court:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
Aetna fails to review Bank Of America employee’s ERISA disability benefit appeal timely resulting in lawsuit by an Illinois disability lawyer
Brian Woulfe of northern Illinois worked as a mortgage loan officer for Bank of America until he was no longer able to work with reasonable continuity because of complications that arose from being treated for non-Hodgkin’s lymphoma.
The exact nature of Mr. Woulfe’s non-Hodgkin’s lymphoma isn’t specifically stated within the civil complaint he and his Illinois disability attorney filed against Aetna Life Insurance Company (Aetna) and Bank of America Group Benefits Program...
Disability Blog & Cases:
Aetna Life Insurance Company denies disability benefits and claims physical therapist with back disorder can perform “reasonable occupation”
Sandy Brooks Scott filed a lawsuit against Aetna Life Insurance Company in the Circuit Court of the City of St. Louis, Missouri requesting that she be awarded long term disability benefits as well as attorneys’ fees and court costs.
Disability Blog & Cases:
Georgia disability lawyer sues Aetna for terminating disability benefits to Georgia woman with rectal cancer
Many long-term disability companies have a clause in their disability plans which change the definition of disability after 24 months. For the first 24 months of complete and total disability, a long-term disability insurance company pays the claimant if the claimant is unable to perform the material duties of his or her “own occupation.” Once the initial 24 months have elapsed under the “own occupation” standard, it’s not uncommon for long-term disability insurance companies to review and reevaluate cases in which they pay long-term disability benefits to find out whether or not the claimant meets the “any occupation” standard. Such is the case with Hellen Owens, a Business System Analyst at Fulton Paper Company.
Disability Blog & Cases:
Sun Life denies disability insurance benefits to Alabama man with heart problems
An Alabama disability lawyer recently filed a civil complaint on behalf of Philip Linville in United States District Court for the Northern District of Alabama in the Northeastern Division against Sun Life Assurance Company of Canada (Sun Life). Sun Life denied Mr. Linville’s claim for long-term disability benefit payments and is allegedly in violation of the terms of the group long-term disability plan held between Sun Life and Mr. Linville’s employer — Cherokee Nitrogen Company, a subsidiary of LSB, Inc. The long-term disability plan under which Mr. Linville was a participant is governed by the Employee Retirement Income Security Act of 1974 (ERISA).
Recently, the Prudential Insurance Company of America (Prudential) was sued by an SAIA truck driver for denial to pay long term disability benefits under the SAIA's 'Hourly Employees Long Term disability plan'. A Texas disability lawyer filed the lawsuit on behalf of the plaintiff Mitchell Stiles at the District court for the Northern District of Texas as an action under the Employee Retirement Income Security Act (ERISA).
Prudential Disability Claim Denial Background
In the case of Mitchell Stiles v Insurance Company of America, the plaintiff was a 53 year old man who was formerly employed as a truck driver for the LTL carrier, SAIA, Inc. "Truck Driver" is classified under the Dictionary of Occupational Titles (DOT) as unskilled work and medium occupation with a Specific Vocational Preparation (SVP) of 3. While under the employment of SAIA, Inc. the plaintiff participated under the SAIA's 'Hourly Employees Long Term disability plan'. The plan was underwritten and administered by Prudential.
Claim for Prudential Short Term disability Benefits
On July 6th 2007, due to the plaintiff suffering from degenerative and traumatic injuries, the plaintiff ceased working for SAIA, Inc. in the lawsuit filed, the plaintiff alleged that he is suffering from Cervical Stenosis and became disabled on July 9th 2007. As a result of his disability, the plaintiff filed for short term disability benefits with Prudential and was granted short term disability.
Filing for Prudential Long Term Disability Benefits
Subsequently, the plaintiff filed long term disability benefits with Prudential and his claim was approved on November 5th 2007. However, on October 7th 2009 through a letter sent to the plaintiff, Prudential denied further disability benefits to the plaintiff on the ground that the plaintiff did not meet the definition of disability in the plan for "Any Occupation". According to disability lawyer Gregory Dell, "the majority of disability insurance claim denials take place when the definition of disability changes from own occupation to any occupation".
According to the lawsuit filed, under the administrative remedies set forth in the plan, the plaintiff appealed Prudential's decision to deny him further disability benefits. Further medical records were submitted by the plaintiff to support his appeal. At the same time, the plaintiff was determined as being disabled by the Social Security Administration and issued a favorable decision on his claim for disability benefits.
Prudential on February 1st 2010 informed the plaintiff that it was reaffirming its original decision to deny the plaintiff his claim for long term disability benefits. A second appeal requesting administrative review of the decision to deny disability benefits was filed by the plaintiff with Prudential on July 31st 2010. Additional documentations were also submitted by the plaintiff to support the appeal. Nevertheless, a final denial was issued by Prudential on August 10th 2010.
The Medical Facts
It was stated in the lawsuit that the plaintiff suffered from several medical conditions. He has the following documented medical conditions:
It was alleged that the overall result of the plaintiff medical conditions was a severely limited range of motion, a restriction in activities and chronic pains. The plaintiff argued that he suffered from the above mentioned symptoms and they were not based merely on his own allegations. Because of these symptoms, the plaintiff argued that he was unable to maintain the concentration and the pace required to partake in competitive employment on full time basis hence satisfying the plan definition of being disabled for "any occupation". The plaintiff contended that despite his condition, Prudential persistently denied the plaintiff's claim for disability benefits.
Relief sought in the Legal Action
Having exhausted all his administrative remedies, the plaintiff therefore has no choice but to file an action under ERISA with the court to seek the following relief:
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. To request a free legal consultation call 800-411-9085.
Disability Blog & Cases:
20 years of receiving disability insurance benefits and CIGNA denies woman's benefits three separate times
A federal lawsuit recently filed in Pennsylvania against Cigna Insurance Company portrays a woman’s 21 year on and off battle with Cigna in order to maintain her long term disability benefits. When dealing with disability insurance companies, it is always a good move to have a disability attorney to handle your monthly disability payments. This is because the disability insurance companies are constantly reviewing your case and will try to look for a reason to terminate your long term disability (LTD) benefits. To them, you represent a “leak” in their bottom line, their profitability. So no matter how flimsy the reason maybe, disability insurance companies are not beneath their stations in trying cut off your long term disability payments. The case of Teann J. Scoggins v Life Insurance Company of America/CIGNA filed recently at the Distinct Court by the plaintiff’s Pennsylvania disability attorney alleges malicious behavior on the part of the disability insurance companies.
Disability Blog & Cases:
Pizzeria owner suffering from Celiac disease filed lawsuit against Berkshire Life Insurance Company of America for breach of contract in refusing to pay disability benefits
Recently a lawsuit was filed against the Berkshire life Insurance company of America at the Circuit Court for the County of Wayne in Michigan by an owner and operator of several pizzerias through his Michigan disability attorney. The disability lawsuit was filed after Berkshire evaluated the disability claim and made a determination that the claimant was not disabled.
Disability Blog & Cases:
Former security guard of the Children's Hospital of Philadelphia alleges CIGNA Insurance engaged in fraudulent and malicious disability claims practices
Recently, a CIGNA claim denial lawsuit was filed in District Court for the Eastern District of Pennsylvania by a disabled individual who was a former cop and ex security guard of the Children’s Hospital of Philadelphia through his Pennsylvania disability lawyer. The details of the lawsuit were somewhat disturbing as it alleges how, CIGNA also known as Life Insurance Company of America (LINA), fraudulently and willfully victimized the plaintiff in its quest to rid itself of an unprofitable policy account.
Disability Blog & Cases:
Former Aegon USA employee suffering with multiple sclerosis sues CIGNA for denial of disability insurance benefits
A recent disability insurance lawsuit filed at the District Court for the Eastern District of Wisconsin can serve as an eye opener to the kind of claims handling practices that CIGNA will employ in order to evaluate a CIGNA disability claim. In Laura McBrien v CIGNA Life & Health Insurance/Life Insurance Company of North America, the plaintiff Ms. McBrien filed a lawsuit under the Employee Retirement Income Security Act of 1974 (ERISA) through her Wisconsin disability lawyer to try and recover long term disability (LTD) benefits which she was and is legitimately entitled to. Allegedly, CIGNA Life had been relentless in denying the critically ill woman her claim despite the overwhelming medical evidence supporting her claim.
Disability Blog & Cases:
City University Of Medicine & Bioscience former employee disabled by back disorder sues Reliance Standard Life Insurance Company for denial of disability benefits
Back pain is one of the leading causes of claims for long term disability benefits against disability insurance companies. However, claimants of disability insurance benefits who are suffering from back disorders often have an uphill task in trying to claim their disability benefits from Disability Insurance Companies. This is because disability insurance companies can try to deny the claims of individuals who are suffering from back disorders by claiming there is no objective medical evidence to support a claimant’s subjective complaints of back pain. Hence, it is not surprising that we often see lawsuits filed against disability insurance companies from individuals disabled by chronic back pain...
It's not unusual for a long-term disability insurance company to ask a claimant to apply for Social Security Disability Income (SSDI) benefits. Why? When claimants receive SSDI benefit payments, the disability insurance company will offset the monthly benefit payment paid to the claimant by the amount of money the claimant receives from SSDI.
Most disability insurance companies hire a third-party to help the claimant obtain SSDI - especially if the claimant is experiencing difficulty obtaining Social Security disability income benefits alone.
In what appears the win–win–win situation for the claimant, the ultimate winner is the disability insurance company because they end up saving money in this well-calculated business decision.
Here is an example of what can happen.
Due to unspecified disabling conditions that precluded her from working on her own and, presumably, any occupation, Anita James of Kentucky was able to receive the maximum amount of short-term disability benefit payments from Prudential Insurance Company of America (Prudential). Ms. James also received long-term disability benefit payments during the first two years of her being completely and totally disabled. After that, however, Prudential terminated Ms. James' disability benefit payments.
With the help of a Kentucky disability lawyer, Ms. James filed a civil complaint against Prudential in United States District Court in the Western District of Kentucky, the Louisville Division for terminating her long-term disability benefits governed by ERISA.
Under the terms of the policy, if the claimant is approved for Social Security disability income, Prudential can subtract the amount the claimant receives as SSDI from the amount Prudential pays in disability benefit payments to the claimant. In Ms. James' case, Prudential hired and paid a company named Allsup, whose main focus is to assist disability claimants with SSDI claims, to obtain SSD I benefits for her stating, "[she] was totally disabled from any gainful occupation."
According to the civil complaint, "Prudential compensated Allsup for obtaining the SSDI benefit (which resulted in a reduction in Prudential's LTD benefit payments to Ms. James - the substantial financial savings) and for obtaining reimbursement of prior LTD payments (which resulted in an additional financial windfall to Prudential)."
Shortly after receiving SSDI Benefits, Prudential decided to terminate Ms. James' long-term disability benefit payments. This comes on the heels of Allsup successfully obtaining Social Security disability income payments for Ms. James at Prudential's request.
Prudential's decision to terminate Ms. James' LTD benefit payments, according to Ms. James and her disability lawyer, stemmed from "Prudential's internal policy of requiring claims personnel to follow the recommendations of its own physician recommendations, without regard to the participants treating physicians, precludes any participant from receiving a full and fair review."
In conjunction with that conclusion, Ms. James and her disability lawyer state that Prudential:
For her relief, Ms. James seeks the following:
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. To request a free legal consultation call 800-411-9085.
Resolved Cases:
Standard Insurance Company reverses disability insurance denial for a disabled lawyer
Disability Insurance Lawyers Dell & Schaefer prevailed in an ERISA appeal filed on behalf of their client when The Standard Insurance Company wrongfully denied her long term disability benefits. The client was suffering multiple gastro-intestinal conditions, chronic intractable abdominal pain, visceral hypersensitivity syndrome, nausea, vomiting secondary to a neuroma, migraines, fibromyalgia, severe weight loss, fatigue, syncope, and secondary diagnoses of anxiety, post traumatic stress disorder, major depressive disorder, panic disorder with agoraphobia, inability to concentrate and memory loss, all of which prevented her from performing the material duties of her occupation as an attorney...
Disability Blog & Cases:
Unum sued for denying disability benefits to florida woman with fibromyalgia, neuropathy, and hepatitis
Elaine Carr wasn’t getting anywhere with her claim with Unum Life Insurance Company of America (Unum) for long-term disability benefit payments for which she was eligible under the group plan she had while she was an employee of Ronald J. Mueller, Inc., d/b/a Volvo Village. Having exhausted her administrative remedies with Unum, Ms. Carr filed an ERISA lawsuit against Unum in United States District Court in the Middle District of Florida with the help of her Florida disability attorney.
Disability Blog & Cases:
Wisconsin man sues Liberty Life for termination of disability insurance benefits
Jeffrey Barr has not been able to work with any continuity and has been completely disabled since 2007. Hypertension and cerebral micro vascular disease of the brain have prevented Mr. Barr from working as an active employee of Danaher Corporation in Wisconsin. As result of his being completely and totally disabled, Mr. Barr was eligible to receive long-term disability insurance benefits from his long-term disability insurance company – Liberty Life and Mutual (Liberty). Mr. Barr was able to claim long-term disability benefit payments because he fit the definition of being disabled since he could not perform the material duties of his own occupation and, eventually, any occupation, according to his long-term disability plan.
Disability Blog & Cases:
Prudential Insurance pays disability benefits for 12 years to former Prudential employee then denies claim
Robert Bankston worked for Prudential Insurance Company of America from 1988 to December 1997 as an insurance and financial services agent. Mr. Bankston became completely and totally disabled as a result of severe mental illnesses in 1998 which included: bipolar disorder, major depressive disorder, panic disorder with agoraphobia, and obsessive-compulsive disorder.
Disability Blog & Cases:
Washington attorney sues CIGNA for denying disability benefits during any occupation stage and seeking to collect SSDI overpayment
Disability Insurance companies do not have a reputation for being sympathetic towards their clients. They will usually put themselves in the most favorable position that they can be at in order to minimize paying out to disability claims. The Employee Retirement Income Act of 1074 (ERISA) was enacted in an effort to limit the abuses and discrimination that insurance companies will impose on claimants for disability benefits. While ERISA has essentially become a pro-insurance company law, there are some protections in the law for disability claimants...
Disability Blog & Cases:
UNUM Life Insurance Company sued by California Disability Lawyer after denial of benefits for a school custodian
The UNUM Life Insurance Company of America (UNUM) is one of the largest providers of long term disability insurance in the United States; however, UNUM is not only well known for its size. This disability insurance company has a checkered history with regard to its handling of Unum disability Claims. In 2004, Unum was the subject of an investigation by state regulators which resulted in a reassessment of 200,000claims and a fine in excess of $15 million...
Disability Blog & Cases:
Former Aetna employee sues Aetna for denial of short-term disability benefits
It is not out of the ordinary to come across a case in which a former employee of an insurance company is denied disability insurance benefits by the same company that they were employed by. Aetna Insurance recently determined that one of their own employees was not disabled and therefore denied her claim for short term disability benefits.
Disability Insurance Law TV:
Beware of hired gun doctors in disability insurance claims
In this video former Montana Insurance Commissioner John Morrison discusses that the fact that disability insurance companies will use hired gun doctors to wrongfully deny disability insurance claims. Additionally, you will hear a view in defense of hired insurance company doctors from a representative of a pro-insurance lobby organization. As disability insurance attorneys that only represent claimants, we find it comical that the insurance company representative describes insurance company doctors as “compassionate”.
Disability Blog & Cases:
Provident Life & Accident Insurance Company sued for denying lifetime disability benefits to former attorney
Recently, in the case of Steven J. Kravitz v Provident Life & Accident Insurance Company (Provident Life), an action alleging breach of a disability insurance contract and promissory estoppel was filed at the District Court of the Southern district of Florida by a Florida disability attorney. This lawsuit deals with the issue of whether a disability was caused by an accident or sickness. In this case if the claimant can prove that his disability was caused by an accident, then he will be entitled to lifetime disability benefits.
Disability Blog & Cases:
UNUM Life Insurance Company of America sued by resident of Carroll County, Arkansas for denying disability benefits under ERISA plan
An action was filed recently at the District Court for the Western District of Arkansas by a resident of Carroll County, Arkansas through her Arkansas disability attorney against the UNUM Life Insurance Company of America (UNUM) for their failure to pay disability benefits under a group long term disability insurance plan issued by UNUM.
Disability Blog & Cases:
Epileptic auto technician sues Lincoln National Life Insurance Company (formerly Jefferson Pilot Financial Insurance Company) for denial of disability benefits
A lawsuit was recently filed against Lincoln National Life Insurance Company (formerly Jefferson Pilot Financial Insurance Company) by a husband and wife couple, Dale and Georgina Eckman, through their Arizona disability attorney to seek the recovery of disability benefits rightfully due to Mr. Eckman under a long term disability insurance policy. The plaintiffs alleged that the Jefferson Pilot Financial Insurance Company (Jefferson Pilot) had acted in bad faith in denying the plaintiff his claim for disability benefits.
Disability Blog & Cases:
Florida lawsuit filed against UNUM Life Insurance Company by disabled woman for failure to pay disability benefits and to clarify plan's benefits
A lawsuit was recently filed at the Tampa Florida District Court against UNUM Life Insurance Corporation by Ms Larriane Braun through her Florida disability attorney. The lawsuit alleged an action under the Employee Retirement Income Security Act (ERISA) and that UNUM was in breach of an employee benefits contract between UNUM and the plaintiff Ms Braun.
Disability Blog & Cases:
Insurance company relies on manipulative video surveillance techinique to challenge disabiling condition
Disability insurance companies are notorious for using video surveillance in order to evaluate a claimant’s restrictions and limitations. In more than 50% of the disability insurance claim denials that we review, the disability company relies on video surveillance. With today’s technological advances it is very easy to manipulate videos. It is rare for a disability company to manipulate a video, however the investigator filming the video can be manipulative in order to obtain further work form the insurance company. The following story is surprising and something that all claimants and disability attorneys should be aware of.
Disability Insurance Law TV:
Did UNUM insurance disability claims examiner understand physician's job duties?
This video is a small portion of the video-taped trial testimony of a Unum long term disability employee. The deposition was completed on behalf of our client by attorney Gregory Michael Dell.
Disability Blog & Cases:
UNUM sued by Ohio disability attorney for failure to pay disabiity insurance benefits to ex-nurse restricted to using a cane or motorized scooter to get around
Karen Russell has filed a lawsuit against her previous employer and UNUM Life Insurance Company of America in an attempt to collect her long term disability benefits in the United States District Court of the Southern District of Ohio Western Division. In her complaint, Russell asks the Court to order Defendant UMUM to pay her long term disability payments as is proper under her ERISA-controlled plan with her previous employer. In addition to disability benefits, Russell has petitioned the Court for attorneys’ fees and any other relief it deems appropriate.
Disability Blog & Cases:
Prudential Insurance Company sued for denial of disability benefits to former U.S. FoodService Inc. sales analyst with back disorder
Having exhausted all her disability insurance appeals and her patience, Torey Robinson filed a lawsuit in the United States District Court for the Southern District of Texas, Houston Division against Prudential Insurance Company in an effort to collect her back and future disability benefits as stipulated in her Prudential Insurance policy. With no more ERISA disability administrative remedies to pursue, Robinson felt she had no other choice but to file a lawsuit to collect her disability benefits and let the Court decide the merits of her claim for disability benefits.
Disability Blog & Cases:
Liberty Mutual Life Insurance denies disability benefits for depression despite two hospitalizations by claimant
Mary Denny and her Massachusetts disability attorney recently filed a civil complaint in United States District Court in the Eastern Division of the District of Massachusetts against Liberty Life Assurance Company of Boston (Liberty) for Liberty’s refusal to pay Ms. Denny long-term disability benefits.
Disability Blog & Cases:
Reliance Standard Life Insurance Company sued by occupational therapist for denial of disability insurance benefits
Occupational therapist Ernesto R. Campos has filed a lawsuit naming Reliance Standard Life Insurance Company, Rehab America, Inc., Group Long-Term Disability Insurance Plan and Rehab America, Inc. as the defendants. Campos and his Tennessee disability lawyer filed his complaint in the Western District of Tennessee Eastern Divisional Office at Jackson concerning a disability insurance plan under ERISA...
Disability Blog & Cases:
If you can afford it, then you should only buy an individual disability insurance policy
In the case of Fleisher v. The Standard Insurance Company filed in New Jersey Federal Court, the court recently rendered a decision which can have a negative impact for numerous physicians and other business professional that have Group Association Policies and also have an ERISA governed group policy from their employer. Numerous medical, dental, legal, accounting, nursing and other professional associations across the country offer a group disability insurance policy to all of their members...
Disability Insurance Law TV:
A Federal Judge's perspective on ERISA disability insurance claims
This video features Judge William Acker, Jr. testifying at Senate Finance Committee hearing discussing ERISA and long-term disability insurance claims. Disability insurance attorneys Gregory Dell & Stephen Jessup provide their thoughts on ERISA and the testimony of Judge Acker.
Disability Blog & Cases:
AETNA Life Insurance Company ordered by West Virginia Federal Judge to reevaluate denial of disability benefits to Bristol-Myers Squibb Manager
Routinely, disability insurance companies in their bid to reduce the amount of disability benefits to be awarded to disability benefits claimants will require the claimants to first apply for Social Security Disability benefits. If the claimant happened to be successful in his or her claim for Social Security Disability benefits, the insurance companies will then offset the amount of disability benefits awarded by the amount of disability benefits that the claimant received from the Social Security Administration (SSA). However, when it comes to losing out due to an SSA determination of the definition of “disability”, insurance companies will try their best to disregard the SSA determination as it is unfavorable for them financially to follow the SSA determination.
Disability Blog & Cases:
AETNA Life Insurance Company sued for failure to pay out disability benefits to ex senior nurse suffering from disabling mental conditions
On March 29th 2011, a lawsuit was filed against the AETNA Life Insurance Company (AETNA Life) at the District court for the Southern District of Florida. In the lawsuit, the plaintiff Jose Demello alleged that AETNA Life had refused to pay the disability benefits sought by the plaintiff under a group long term disability (LTD) benefits policy that was issued and administered by AETNA Life.
Disability Blog & Cases:
South Carolina disability attorneys sue Liberty Mutual three times in one week for denial of disability insurance benefits
Liberty Mutual finds itself back in court having to prove to a judge the validity of their reasons for denying yet another long-term disability insurance benefit claim. This time it isn’t just one lawsuit filed by a disability attorney on behalf of one plaintiff. As a matter of fact, the same disability attorney filed three separate Federal lawsuits against Liberty Mutual on behalf of three individual plaintiffs living in different jurisdictions.
Disability Insurance Law TV:
A Senator's view of ERISA disability insurance claims
This video features the testimony of Montana United States Senator Max Baucus at a Senate Finance Committee Meeting. Senator Baucus focuses his testimony on the problems with ERISA disability insurance laws and the unfair claims handling practices of disability insurance companies. Senator Baucus pays specific attention to two long term disability insurance claims that were wrongfully denied by The Standard Insurance Company and Hartford Financial Insurance Company.
Disability Blog & Cases:
Reliance Standard Insurance Company and Lincoln National Life Insurance Company attempt to avoid payment of disability benefits by ignoring claimant’s application
Eric Wilson has brought a lawsuit in the United States District Court of the Eastern District of Louisiana against Reliance Standard Insurance Company and Lincoln National Life Insurance Company because the companies have refused to reply either pro or con to his petition for disability benefits in compliance with his insurance policy contract.
Disability Blog & Cases:
Sun Life Assurance Company of Canada sued by gunshot victim for failure to pay long term disability benefits
A recent Sun Life disability claim by a gunshot victim ended up as a lawsuit in the Orange County Superior Court because of the reluctance of the disability insurance company to pay out any long term benefits to its plan’s participants. In Marilyn Ellis v Sun Life Assurance Company of Canada, the plaintiff Marilyn Ellis with her California disability attorney contended that she was at all times a participant to a group long term disability plan with the policy number 63311 that was provided by the Sun Life Assurance Company (Sun Life). As such, she argued that she was a beneficiary of the plan and is entitled to the long term disability benefits that were offered in the plan.
Disability Blog & Cases:
Federal Judge orders Union Security (Assurant) to re-evaluate disability denial due to failure to consider risk of substance abuse relapse as disabling condition
In any claim for any disability benefits, the deciding factor which disability insurance companies will decide on will be whether you are what they define as being “disabled” or not. Most insurance companies however, will try to define the scope of what constitutes “disabled” as narrowly as possible to their advantage. The situation is especially compounded when a claimant is disabled due to substance abuse. Substance abuse cases involved both physical disabilities and mental disabilities...
Disability Blog & Cases:
SunLife & Aetna Life Insurance Company sued for denial of disability benefits
Here are examples of two recent cases in which SunLife Insurance Company and Aetna Life Insurance Company had a structural conflict of interest and denied disability insurance benefits. In most long term disability insurance claims which are governed by ERISA there is an inherent structural conflict of interest. The conflict of interest exist because the disability insurance company not only pays the benefits, but has the ultimate authority to approve or deny benefits. How can a disability company act a fiduciary to the insured when at the same time a decision to pay benefits will reduce the net income of the company?
Disability Insurance Law TV:
UNUM employee deposition in a disability insurance claim denial lawsuit
This video is a portion of a video-taped testimony from a long term disability insurance claim denial lawsuit. The actual testimony in this video was presented to a jury in federal court.
Disability Blog & Cases:
CUNA Mutual terminates disability benefits to woman suffering from depression and lyme disease
A Federal Appellate Court upheld an insurance company's decision to terminate the long-term disability benefits of a woman who suffered from recurrent major depression. Although the woman claimed to now be suffering from Lyme disease, CUNA Mutual discontinued her benefits after two years due to the policy's 24 month mental illness limitation. The Court agreed with CUNA Mutual that there was insufficient evidence to support her claim of disability due to Lyme disease. Let's take a closer look to understand why the Court sided with CUNA Mutual.
Disability Blog & Cases:
Court of Appeals denies appeal for Business Executive claiming disability benefits due to lower back injury against Metropolitan Life Insurance Company
Participating in a disability insurance plan is always an excellent idea as a safeguard against unforeseen circumstances. Nevertheless, we tend to forget that when the time comes for us to try and claim our disability benefits, the disability insurance companies are always extremely reluctant to fork out what is due to us. Quite often, the language that is used in the plan issued by the disability insurance companies contains enough ambiguities and complexities for them to wriggle out of their contractual obligations. A recent opinion rendered by the Court of Appeal in the case of Michael Palmer v Metropolitan Life Insurance Company (MetLife) demonstrated just how this can happen. Although Michael Palmer's Wichita Kansas disability attorney did a commendable job in presenting this MetLife disability claim, they lost their case because there was enough leeway contained in the language of the plan which allowed MetLife to terminate Michael Palmer's disability benefits. Let us examine the case in more detail.
Disability Blog & Cases:
Prudential Insurance Company sued for denying claim for disability benefits to disabled individual suffering from chronic back and leg pain
A lawsuit seeking to recover monetary damages from Prudential Insurance Company (Prudential) was recently filed at the Supreme Court of the state of New York. In the lawsuit, the plaintiff Robert Hamil, through his New York disability attorney, alleged that Prudential's termination of his long term disability claim was in violation of his benefit rights that were protected under the Employee Retirement Income Security act of 1974 (ERISA).
Disability Insurance Law TV:
Deposition of medical consultant hired by MetLife for a disability insurance claim
It’s hard to imagine that a person that a person undergoes a 5 level surgical fusion procedure and does not have any restrictions or limitations. That was the position taken by a medical consultant hired by MetLife. The physician in this video deposition has reviewed hundreds of long term disability claims on behalf of MetLife. This video is an excerpt from the video-taped deposition of an orthopedic physician hired by Met Life to review medical records and determine if our client had any restrictions or limitations that prevented him from performing the duties of his occupation as a chiropractor. Despite never examining our client, the MetLife hired physician determined that our client had no restrictions or limitations and he could do any activities he wishes.
Disability Blog & Cases:
New York Court upholds Hartford Insurance Company's denial of disability benefits but denies $86,000 overpayment claim
A District Court ruling issued in New York’s Southern District Court illuminates the importance of understanding the meaning of an “occupation qualifier” and/or an “earnings qualifier” requirement in your long-term disability insurance policy. In general, to qualify for disability under a policy that requires these two prerequisites you must show...
Disability Insurance Law TV:
Who makes the final decison to approve or deny disability insurance benefits?
Is it the disability insurance claim representative or hired insurance company doctor that makes the decisional to approve or deny benefits?
FAQ | Overpayment Issues:
Can Veteran Disability Benefits be deducted from my monthly long term disability insurance check?
The answer to this question depends on the language contained within your long term disability insurance policy. In most disability claims that are governed by ERISA there is an offset provision for other disability related benefits such as SSDI, Worker Compensation or Veteran Benefits.
Disability Blog & Cases:
Pennsylvania class action disability insurance suit against Reassure and Swiss Re dismissed due to lack of subject matter jurisdiction
A federal district court in Pennsylvania recently dismissed Claimant Barry Sunshine's complaint for lack of subject matter jurisdiction. Alleging that Reassure America Life Insurance and Swiss Re Life & Health America, Incorporated prematurely terminated his and other similarly-insured individual's disability insurance benefits, Sunshine and his disability attorneys were attempting to right a wrong for not only Sunshine but for others in a similar situation. Unfortunately, the Eastern District Court of Pennsylvania dismissed Sunshine's disability insurance class action lawsuit because the suit lacked federal subject matter jurisdiction. Fortunately, the dismissal was filed as a dismissal without prejudice, making it possible for Sunshine to file an amended complaint when his disability attorneys establish proper subject matter jurisdiction.
Disability Blog & Cases:
LINA and CIGNA need to listen to the Federal Courts and stop denying disability insurance claims for people disabled by fibromyalgia
An affirming opinion from the Fourth Circuit United States Court of Appeals shows how Administrators of ERISA long term disability benefits can't abuse their power of discretion in North Carolina. This case against LINA also known as CIGNA, is a great victory for claimants suffering from fibromyalgia. In the appeal of Rebecca DuPerry v. Life Insurance Company of North America, Appellee Rebecca DuPerry prevailed in her quest to receive long-term disability benefits from her group long term disability insurance provider, Life Insurance Company of North America (LINA).
Disability Blog & Cases:
Lincoln Nebraska man suffering from fibromyalgia and chronic fatigue syndrome sues UNUM when he is denied disability benefits
UNUM Life Insurance Company of America has refused to honor its obligation to provide Scott A. Boles with his disability insurance benefit income even though Mr. Boles qualifies for benefits stipulated in two UNUM Life Insurance Company disability insurance policies. UNUM denied Mr. Bole's disability insurance benefits on both his individual disability policy, on which he has paid all premiums on time and in full since 1994, as well as an employee group disability policy from his employer that has been in effect since 2006.
Disability Blog & Cases:
Sun Life deducts veteran disability benefits from claimant’s monthly long term disability check
Most long term disability insurance policies allow the insurance company to offset the monthly disability payments to an insured if the insured is receiving “other income” from certain sources. Often, these other sources include any Social Security disability or retirement benefits, workers’ compensation benefits, retirement plan benefits from the employer, or even earnings the insured receives from any other occupation or form of employment. The specific policy language governs exactly what the insurance carrier can consider an “offset” to reduce the claimant’s monthly benefit. Sometimes, however, the insurance policy is not crystal clear on what specifically may be used as an offset. Such a situation occurred in the case of James Riley v. Sun Life Insurance Company. In this case, the issue was whether Sun Life was allowed to reduce Riley’s monthly benefit because of veteran disability benefits he received from Veterans Affairs. The Court ultimately upholds Sun Life’s decision to reduce Riley’s monthly long-term disability benefits. Let’s take a closer look to see why the Court ruled the way it did.
Disability Blog & Cases:
Disability benefits lawsuit against Fortis Benefits Insurance Company dismissed by West Virginia Federal Court
Failing to comply with administrative requirements in a timely manner as specified by Fortis Benefits Insurance Company resulted in Elizabeth A. Bailey being denied benefits from her deceased husband’s short-term disability benefits, long-term disability benefits and life insurance policies. Having neglected to follow proper ERISA procedures in pursuing long-term disability and life insurance benefits from Fortis Benefits Insurance Company (a wholly owned subsidiary of Assurant) as specified in Fortis’s policy requirements, Elizabeth Bailey forfeited her opportunity to present her case to a federal court when her complaint was dismissed by the Court’s ruling on two motions for summary judgment filed by Fortis’s disability defense attorneys.
FAQ: Attorney Fees & Representation:
Can a disability attorney manage all aspects of my long-term disability insurance claim?
What amounts to a business decision for your disability insurance company is a life decision for you as a disability benefit recipient. Your disability insurance company views you as a piece of paper, some medical documents, a persistent headache, and a drain on their bottom line. Your monthly disability payment is your home, your groceries, your health care—your livelihood; and you don’t trust your disability insurance provider to make sure that your interests are being taken care off. Consequently, much of your precious time may be spent dealing with your disability insurance provider to make sure you receive your monthly disability payment.
Disability Blog & Cases:
Disability lawsuit against MetLife alleges insurance company refuses to pay disabled claimant
The Metropolitan Life Insurance Company, known as MetLife (NYSE: MET), is being sued in United States District Court, Southern District of Florida, for refusing to honor its contractual obligation to pay long term disability insurance benefits to a psychologically impaired woman.
Disability Blog & Cases:
Liberty Mutual sued in Tampa Federal Court for denying long term disability insurance benefits
An ERISA disability lawsuit was filed against the Liberty Life Assurance Company, this time in Federal Court in the Middle District of Florida. Andrea Medders was forced to file suit after her administrative appeals were denied and Liberty Life, also known as Liberty Mutual refused to pay her long term disability benefits.
Disability Blog & Cases:
CIGNA/LINA sued for denying waiver of life insurance premium to caretaker of disabled and mentally challenged adults
After repeated appeals asking CIGNA / LINA to change their decision regarding denial of waiver of life insurance premiums due to total disability, Wendy Magee was recently forced to hire Michigan disability attorneys and file an ERISA disability lawsuit in the Federal Court of the Western District of Michigan.
Disability Blog & Cases:
Federal Court provides 5 reasons CIGNA wrongfully denied disability benefits to man suffering from chronic fatigue syndromes
Citing a financial incentive to cheat, the United States Court of Appeals for the Ninth Circuit recently overruled the decision of CIGNA (CI) to deny disability benefits to a man suffering from chronic fatigue syndrome. For anyone disabled by chronic fatigue or fibromyalgia this is a very supportive case and great law. The court provided five reasons that Cigna abused its discretion by denying disability insurance benefits. Let’s take a close at the case history and the court’s reasoning.
Disability Blog & Cases:
Hartford Financial’s mental nervous disorder limitation clause in disability insurance policy held ambiguous
The United States Court of Appeals for the Ninth Circuit recently ordered a lower court to reconsider its decision that had affirmed Hartford Financial Insurance Company‘s denial of a woman’s claim for disability benefits. Although the claimant has not yet been awarded her requested disability benefits, the Appeals Court’s decision leaves her one step closer to achieving this goal.
Disability Blog & Cases:
Life Insurance Company of North America, part of CIGNA Corporation, sued for refusing disability insurance benefits for mentally ill teacher
Disability Insurance Attorneys Dell and Schaefer filed a Federal Lawsuit against Life Insurance Company of North America (LINA), which is part of CIGNA Corp (CI.N). The lawsuit was filed after Cigna refused to pay disability benefits to a Florida teacher forced to stop working due to mental health issues such as depression, bipolar disorder and schizophrenia.
Disability Blog & Cases:
Federal lawsuit against Hartford Insurance alleges company refuses to pay disabled Patriot Act analyst
A Federal lawsuit filed in United States District Court Southern District of Florida accuses the Hartford Life and Accident Insurance Company of breaching its contract with Branch Banking and Trust (BB&T) and a BB&T employee. Filed by noted disability insurance law firm of Dell & Schafer, the suit states that Hartford is refusing to pay benefits to the employee, a U.S. Patriot Act/Anti-Money Laundering Analyst. The refusal by The Hartford violates the Employee Retirement Income Security Act of 1974, commonly referred to as ERISA.
Disability Blog & Cases:
Disability insurance lawsuit against Guardian Life Insurance serves as warning to doctors
A lawsuit filed in the United States Southern District Court of New York reveals that The Guardian Life Insurance Company of America is refusing to pay long term disability insurance benefits to a New Jersey OB/GYN critically injured in a car accident.
Disability Blog & Cases:
Disability insurance benefits lawsuit against Prudential Insurance Company is dismissed by Pennsylvania Judge
A Federal District Court in Pennsylvania recently dismissed the case of a long-term disability claimant who claimed damages resulting from Prudential Insurance Company‘s delay in the approval of her claim for long-term disability insurance benefits. Although the claimant was eventually awarded disability benefits by Prudential Insurance Company, she still filed a lawsuit for the damages she allegedly suffered due to the carrier’s delay in approving her disability benefits. The Court ultimately dismissed all of her claims against the carrier for the delay. As a disability insurance law firm that handles cases nationwide, it appears that the lawyer who filed this lawsuit was not a Pennsylvania disability insurance attorney. This case provides a good summary of how restrictive and unfair ERISA can be, but an experienced disability insurance lawyer would not have filed this disability lawsuit against Prudential. Check out our video on why ERISA is an unfair law. To understand the Court’s ruling, let’s take a look at the case of Carolyn Jobe v. Prudential.
Disability Blog & Cases:
Michigan Court determines Sedgwick wrongly terminated woman’s disability benefits and awards Michigan disability attorney his fees
A recent opinion from the United States District Court in the Eastern District of Michigan shows how difficult it can be get a court to award disability benefits instead of just remanding a wrongful termination decision back to the plan administrator. Although the Court in this action remanded the case back to the plan administrator for a new review, it did award the claimant’s Michigan disability attorney partial attorney’s fees. To understand the Court’s decision, lets take a closer look at the case of Luda Blajei.
Disability Blog & Cases:
Ohio National Life Insurance loves to tell disabled doctor “no”
As disability attorneys we deal with long term disability insurance carriers such as Ohio National Life Insurance Company on daily basis. Most insurance companies do not have good reputations for fair claim handling so it is not unusual for our attorneys to encounter some opposition while handling a disability insurance claim. The conduct of Ohio National in a long term disability claim our lawyers are handling on behalf of a family medicine physician is disturbing. The conduct is even more disturbing because Ohio National’s most recent letter states, “Ohio National has acted reasonably and fairly in the handling of [Dr. X's] claim.” While our client continues to be paid disability insurance benefits each month, Ohio seems to thinks that by paying disability benefits they are acting reasonably.
Disability Blog & Cases:
UNUM class action filed by New York disability insurance attorneys is dismissed by Federal Judge
A Federal District Court in New York recently dismissed the class action lawsuit of four individuals whose disability insurance claims were denied or terminated by the Unum Provident Corporation. The individuals filed the lawsuit because they believed that Unum denied or terminated their claims to meet expectations as to revenue and profit for the corporation. To understand the Court’s decision, we must look at the underlying facts of the case. It is unfortunate that after several years of litigation, the New York disability insurance lawyers and their clients were unsuccessful in obtaining long term disability insurance benefits. The court did not dispute Unum’s unreasonable claims handling tactics, rather the court dismissed the case because the Judge felt that any further action against UNUM in light of the RSA agreement would be moot. Let’s take a closer look at the facts.
Disability Blog & Cases:
Disability insurance claimant’s allegation of bad faith against Unum Provident is disallowed due to ERISA regulations
A federal district court in California recently ruled that a disability claimant could not recover on his state-law claim for breach of implied covenant of good faith and fair dealing. This specific count is also known as “Bad Faith”. The court found that the disability plan at issue fell under the federal ERISA statute, and, as such, his state-law claim was preempted by ERISA. ERISA prohibits bad faith claims, which is why every insurer always wants a claim to be governed by ERISA. Check out our video on why ERISA is an unfair law. This case is a good summary of the law in California regarding when a disability policy may be exempt from ERISA. The California disability insurance attorneys that filed this ERISA disability lawsuit did a good job in trying to make this case exempt from ERISA. Let’s take a closer look to understand why the court found that the disability plan fell under the ERISA statute and why they ruled that his bad faith allegation was dismissed. .
FAQ | ERISA Information:
Can my disability insurance policy be exempt from ERISA?
One of the first things our disability insurance attorneys will do with every disability claim is to determine whether or not the disability insurance policy is governed by ERISA. The analysis to determine if a disability plan is exempt from ERISA is complicated when a disability claimant received their policy through their employer. If you purchased your disability policy from an insurance agent or through an organization that is not your employer, then your disability policy is Exempt. If you are a government or church employee, then your disability plan is exempt from ERISA.
Disability Blog & Cases:
Disability insurance companies challenge heart disease disability insurance claims
According to the American Heart Association, one out of three, or approximately 81 million Americans have heart disease. In 1963 Congress proclaimed February as “American Heart Month” in order to raise awareness and fight the battle against heart disease. Millions of Americans each year are unable to work as a result of heart disease and are forced to file for either disability insurance benefits or social security disability benefits. Heart disease, also known as cardiovascular disease, includes high blood pressure, coronary heart disease, stroke, heart failure, and congenital heart defects. More than 5.8 million Americans have heart failure. Disability lawyer firm Dell & Schaefer participates each year in multiple events to help raise funds to battle heart disease.
Disability Blog & Cases:
Principal Life denies disability benefits to a physician and then seeks attorney fees after physician’s disability denial is affirmed by Texas Judge
Dr. Bruce Leipzig had been denied long-term disability benefits by Principal Life Insurance Company, and brought his ERISA case before the District Court covering the northern part of Texas. After hearing the case, the Court issued summary judgment in favor of the disability insurance company.
Disability Blog & Cases:
CIGNA destroys copy of accidental disability insurance policy but claimant is able to prove existence of policy and obtain benefits
An interesting disability claim arose in 2008 that highlights the challenges a disabled individual can face when a span of time exists between the time of a covered event and the manifestation of an injury associated with that event. This case against CIGNA is rare because it is an accident and sickness policy rather than a traditional disability insurance policy. It is also rare, because most disability insurance companies will not lose a copy of your policy. A disability claimant should make every effort to keep the original copy of their disability insurance policy. A New York ambulance volunteer, George Glew, discovered this when he sought to claim disability benefits under a CIGNA Life Insurance Company of New York (CIGNA) policy that covered accidents and sickness for employees and volunteers in the Shirley Community Ambulance Company. This case is rare because it is an accident and sickness policy rather than a traditional disability insurance policy.
Disability Blog & Cases:
Sun Life Insurance Co. wrongfully denies disability insurance benefits following disability claimant's failure to respond timely
It isn’t always the claimant who appeals a District Court decision. The District Court may rule in favor of the claimant and have its decision challenged by the disability insurance provider. Wenner v. Sun Life Assurance Company of Canada is just such a case. Arguments were heard in the U.S. Court of Appeals, Sixth Circuit, located in Cincinnati, Ohio. The case arose from Nashville, Tennessee. This entire disability claim could probably been avoided had the claimant hired a disability insurance attorney to manage his disability claim on a monthly basis. The denial of this claimant’s claim resulted in more than 4 years of delay before the claimant was able begin receiving monthly benefits again.
Disability Blog & Cases:
Missouri Court reverses Prudential Insurance Company’s wrongful denial of disability insurance benefits for former pharmacy technician
A Missouri Federal Court determined that Prudential was wrong to terminate a man’s disability insurance benefits by relying on a vocational expert who was not given enough information and a doctor who failed to explain why he disagreed with the claimant’s treating physicians. Let’s take a detailed look at the Court’s opinion to understand its ruling.
Disability Blog & Cases:
Liberty Mutual ordered to pay interest & attorney fees following disability insurance claim denial
A recent Federal Court decision from New Jersey sided with a disability claimant who filed an ERISA suit after her disability insurance benefits were wrongfully denied by Liberty Mutual Life Insurance Company. The Court held that the claimant was both entitled to a fair and equitable rate of interest as well as reasonable attorney’s fees under the circumstances of the case. The issue that I find frustrating about this case is that after the claimant proved that Liberty was wrong in denying disability benefits, they continued to battle the claimant by refusing to pay attorney fees and the interest on the money that Liberty saved over a 5 year period. Liberty probably spent more in battling against paying attorney fees than they could have paid the claimant by agreeing to pay her attorney fees and interest.
Disability Blog & Cases:
Pennsylvania Court rules that CIGNA disability insurance policy allows for offset of lost wages from auto insurance policy
A District Court ruling issued in Scranton, Pennsylvania highlights the importance of understanding the terms of a long-term disability insurance policy. It is common for these disability insurance policies to reduce monthly disability benefits by other benefits or income a claimant receives. This case is a good example of the complex language in disability insurance policies which can be subject to multiple interpretations.
Disability Disability Insurance Law TV:
10 things to expect when your disability insurance company asks for an IME exam
Almost all disability insurance policies provide a disability insurance company with the right to have the insured examined by a physician of their choice. The disability insurance companies can select any physician and a claimant must attend. These exams are commonly referred to as Independent Medical Exams (IME EXAM); however many courts refer to them as Compulsory Medical Exams (CME EXAM) since the claimant’s benefits will be denied if they fail to appear. Disability Insurance attorneys Gregory Dell and Stephen Jessup discuss what a claimant should expect if asked to attend a CME exam.
Disability Blog & Cases:
CIGNA / LINA wrongfully relies upon surveillance video to deny long term disability insurance benefits
CIGNA Insurance Company, the parent company of Life Insurance Company of North America (LINA) has relied on video surveillance to deny thousands of claims for disability insurance benefits. This case is another classic example of CIGNA wrongfully relying upon video surveillance to justify its disregard of the claimant’s medical evidence. A Federal Court in California found that CIGNA / LINA abused its discretion when it denied Todd Nash’s claim. Let’s take a closer look at the Court’s reasoning.
This short term disability insurance case originated from North Carolina and involved a claim that was denied under the TYCO short term disability plan. This North Carolina disability claim was not governed by ERISA as the TYCO short term disability plan is self-funded. The theory for filing a lawsuit in this claim was breach of contract, but in an unusual argument the North Carolina disability insurance attorney attempted to argue that ERISA should apply to the case. This case is an unusual disability insurance claim.
A federal court of appeals upheld Guardian Insurance Company’s denial of disability benefits. The claimant in this case was paid disability insurance benefits for several years, but when he returned to work for more than 40 hours a week, Guardian was convinced he was no longer eligible for benefits. The disability claimant disagreed as he did not think he was capable of working and earning the same amount of money he earned pre-disability. The court disagreed with the claimant’s argument.
This disability insurance case was a short term disability insurance claim that was denied by Broadspire. The disability claimant was denied on multiple occasions and was finally forced to file an ERISA disability lawsuit against Broadspire Services and Cytec.
ReliaStar reduces monthly disability insurance benefits to veteran due to VA benefits
FAQ (ERISA Information):
What is the discretionary clause in a disability insurance policy?
Mass Mutual, an insurance company that sells long term disability insurance products, recently hired the international law firm of Shutts & Bowen in an effort to prohibit Disability Insurance Attorneys Dell & Schaefer from displaying blank Mass Mutual long term disability insurance claim forms on their website. More specifically, Mass Mutual hired attorney Jeffrey Landau, one of the leading insurance defense attorneys in the United States. Mass Mutual claims that by displaying their logo and claim forms that Attorneys Dell & Schaefer is “conducting an unfair and deceptive trade practice.” The forms are posted by Attorneys Dell & Schaefer in order to inform potential claimants of the requirements necessary to prove disability. Mass Mutual has over 300 billion dollars in assets under management and it is interesting that they are concerned about Attorneys Dell & Schaefer providing access to a set of blank claim forms that must be submitted in order for disability applicant to complete their claim for benefits. Instead of blank claim forms, we could have provided copies of claim forms that were submitted as public records in one of the many lawsuits against Mass Mutual.
I always try to give disability insurance companies the benefit of the doubt that they want to do the right thing for their insured’s, but it is actions like requesting a law firm to remove blank claim forms which reaffirms my belief that insurance companies are committed to making the disability benefit claims process as difficult as possible.
Disability Attorneys Dell & Schaefer do not have the time to dispute Mass Mutual’s request to remove the disability claim forms from their website, therefore we have agreed to remove the forms from our website. Claim forms and information regarding Mass Mutual are available upon request. A copy of the cease and desist letter sent by Mass Mutual’s hired lawyer can be viewed below.
Re: Infringement of MassMutual Intellectual Property
Dear Greg:
We represent Massachusetts Mutual Life Insurance Comapny and its affiliated entities (collectively, “MassMutual”) in connection with the enforcement of its intellectual property rights and pursuit of those who may infringe those rights. Your website, http://www.diattorney.com/, and more particularly the page located at http://www.diattorney.com/mass-mutual/ (collectively, the “Dell Website”) have come to the attention of MassMutual, which has asked us to contact you regarding your unauthorized use and display of MassMutual’s registered marks, proprietary information, and forms that also contain those marks. This includes, but is not limited to, the use of the MassMutual Financial Group logo and MassMutual long term disability claim forms. It also appears that some of these copyrighted and/or trademarked materials may have improperly, and without authorization, been misappropriated from MassMutual’s own website.
We assume you are aware that unauthorized duplication of MassMutual’s proprietary marks and forms violates federal law, including the Lanham Act. Furthermore, while we understand that competition in the marketplace is allowed, this conduct is unfair and deceptive trade practice under Florida law and en example of sanctionable unfair competition. These act violate section 501 et. seq., Florida Statutes and Florida common law. The potential remedies available under Florida law and for infringement actions are significant.
MassMutual is prepared to pursue its civil remedies in this matter. As a plaintiff, we may not only enjoin the unlawful infringement of MassMutual’s marks and proprietary documents, but may also obtain damages for such infringement and unfair competition, including, but not limited to, the defendant’s profits, any damages sustained by the plaintiff, and the cost of the action. In egregious cases, such as where knowing and willful infringement is found, the damages may be multiplied.
However, MassMutual wishes to resolve this matter amicably and without filing suit – but is fully prepared to enforce it’s rights in court if necessary. Accordingly, we demand, on behalf of MassMutual, that you and your law firm immediately:
- Take down all infringing content at all websites under your control, including, but not limited to those pages located at http://www.diattorney.com/ and http://www.diattorney.com/mass-mutual/
- Cease and recall all advertising and promotional materals bearing MassMutual’s marks and other proprietary forms
- Discontinue all use of the text, images, and forms taken from our MassMutual’s website (of from a website of an authorized used of the materials and marks); and
- Commit in writing to cease all use of such marks or materials.
We ask you to confirm your agreement and comply with our request by signing and returning a copy of this letter to us by the close of business on October 20, 2010. MassMutual’s course of action in this matter will be determined based upon your degree of cooperation. If we do not hear from you we will be forced to move ahead promptly.
This offer of compromise is without prejudice to any claim for copyright or trademark infringement or unfair competition, or damages that may be asserted on behalf of MassMutual should this matter not be resolved promptly to its satisfaction.
If you have any questions about this, please don’t hesitate to contact me.
Very truly yours,
SHUTTS & BOWEN LLP
Jeffrey M. Landau
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. To request a free legal consultation call 800-411-9085.
Ms. Kathleen M. Hackett brought suit in the U.S. District Court of South Dakota’s Western Division against Standard Insurance Company (Standard), alleging that Standard had wrongfully denied her long-term disability benefits claim. In the first round, in 2007, both parties moved for summary judgment. The District Court granted summary judgment to Standard on August 15, 2007. Court held that although Standard operated under a conflict of interest, under Woo, Hackett’s disability attorney had failed to prove that a serious breach of fiduciary duty had occurred.
On appeal against the order of the District Court, the Eighth Circuit Court of Appeals reversed and remanded the matter back to the District Court for its reconsideration of the conflict of interest issue. This was ordered in the light of Glenn v. Metropolitan Life Insurance Company decision.
In remand, Hackett’s disability attorney served a set of interrogatories and request for production of documents upon Standard. The answers Standard gave prompted a second motion to compel discovery.
Standard raised objections on those interrogatories and pointed out that discovery was already closed and the Court on remand was only allowed to consider the administrative records in light of Glenn, a decision that had taken place after the District Court’s first ruling.
Standard argued that the Eighth Circuit Court did not mentione anywhere in its order to remand that the District Court could allow additional discovery. Therefore, as far as Standard was concerned, the Judge had erred by allowing further discovery.
But in raising these objections, Standard failed to acknowledge the issuance of a Court order setting the deadline to file a rebuttal against the order within 10 days. The Eighth Circuit Court remanded the case which clearly showed that additional discovery had to be considered. After a careful analysis as to whether Glenn made this appropriate, the Court determined that additional discovery should be allowed. This decision was affirmed, and the objection raised by Standard was denied.
Standard then went on to argue that the requested discovery was cumulative and irrelevant to the present conflict. The Court disagreed. Hackett’s attorneys efforts to enquire into Standard’s efforts to assure accurate claims assessment was consistent with the clear language of Glenn.
Prior to Glenn, Hackett’s discovery would have been limited to the business relationship between Standard and Dr. Zivin and Dr. Dickerman. But post Glenn, the main question was whether the Court should allow discovery to extend into the other related areas not requested by Hackett’s ERISA attorney in his interrogatories. After consideration of cited authorities and the logic expressed by both sides for and against discovery, the Court held that the more appropriate step was to allow limited discovery. The Court determined that it should allow Hackett to make inquiry into any incentives paid by Standard for denial of claims. The same thing remained true with respect to relationship between Standard and the outside medical advisors it hired, who might have received incentives to inappropriately deny claims.
ThereforetheCourt held that Hackett’s disability attorney must be allowed to make inquiry into the conflict of interest so the Court could make a reasonable analysis. This objection was also denied. Limited discovery would be allowed.
Standard’s last objection was that the burden of the requested discovery outweighed the potential benefits. The disability insurance company claimed that the cost to produce the requested documents would outweigh the benefits which Hackett’s attorney would gain in presenting the case.
The Court found that this argument was not convincing. Standard had not raised this point when the Court was first considering whether discovery should be allowed. In Howell, the Court had already found that when the discovery requested is relevant to the dispute, expensiveness and burdensome of production of such discovery is not be a proper reason to deny the discovery. I always find it comical when a multi billion dollar insurance company says that it will be a financial burden for them to obtain requested information.
The Court had already found that the six questions Hackett’s ERISA attorney asked regarding how Standard shielded decision makers from financial concerns addressed the main reason behind the Glenn decision. Her attorney had limited the scope of his questions from 2000 onward, which fell within a reasonable time scope, considering that Hackett’s first claim occurring in 2002.
Based on Burns v. Imagine Films Entm’t, Inc., the fact that answering these interrogatories would require Standard to “expend considerable time, effort, and expense consulting, reviewing, and analyzing huge volumes of documents and information” was not a sufficient reason for the Court to uphold Standard’s objections. The order to supply answers to these questions was once again affirmed, with stipulation that Standard use the time frame of 2000 through 2006.
The next objection was related to Hackett’s interrogatories 9 to 12. The first round of discovery revealed that Dr. Zivin had reviewed 398 files for the consideration of $115,228 during 2003 to 2005. Dr. Dickerman had reviewed 1,939 files for a fee of $577,00. This suggested to the Court that Standard had paid $289.94 to Dr. Zivin and $297.58 to Dr. Dickerman for each review done by them.
Standard argued that this was not the case. Rather some of the reviews had included multiple reviews of a single claimant’s file. Standard claimed that some reviews only involved comments on a single chart, while others included a claimant’s entire medical history.
The Court found that this argument supported Hackett’s attorney’s supposition that discovery into the billings presented to Standard would be useful in proving or disproving a conflict of interest. The Court found that the requested information was relevant to the matter in dispute. The information would help the Court to determine the percentage of time Dr. Zivin and Dr. Dickerman denied claims. And it would help to prove whether or not Standard was engaged in a history of biased claims administration with the help of both physicians. Without this information, Hackett’s disability attorney would not be able to prove a biased claims approval history. Therefore Hackett’s disability attorney was entitled to the discovery, as had been approved by the Court earlier, in order to shore up the evidence required to prove his case. For this reason Standard’s objection to interrogatories 9-12 was denied.
Hackett’s attorney succeeded in securing the Court’s support of his discovery requests, although Standard raised objections to them. Hackett’s disability attorney argued competently against each and every objection. Because Standard still maintains that it made the right decision regarding Hackett’s disability claim, this is a case that will be seen again. It will be interesting to see whether discovery has an impact on the District Court’s decision when it reviews this case again on remand.
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. To request a free legal consultation call 800-411-9085.
Disability Insurance Attorneys Dell & Schaefer are excited to report that Senate Finance Committee Chairman Max Baucus (D-Mont.) will convene a hearing on Tuesday to examine the difficulties workers face in securing benefits they are entitled to from private long-term disability insurance plans. The hearing, entitled “Do Private Long-Term Disability Policies Provide the Protection They Promise?” will take place at 10:00 a.m. on Tuesday, September 28 in Room 215 of the Dirksen Senate Office Building.
At the hearing, Baucus will focus on whether private-sector long-term insurance claims are being unfairly denied or terminated by the companies providing long-term disability insurance covered under the Employee Retirement Income Security Act (ERISA). The hearing will also examine how these private insurance companies have handled workers’ appeals of denials and terminations. Baucus will raise questions about possible improvements that can be made to ensure claimants and beneficiaries of long-term disability insurance plans covered under ERISA are treated fairly.
The hearing can be watched by going to http://finance.senate.gov/hearings/. Any individual or organization wanting to present their views for inclusion in the hearing record should submit a typewritten, single-spaced statement, not exceeding 10 pages in length. Title and date of the hearing, and the full name and address of the individual or organization must appear on the first page of the statement. Statements must be received no later than two weeks following the conclusion of the hearing.
Statements should be mailed (not faxed) to:
Senate Committee on Finance
Attn. Editorial and Document Section
Rm. SD-219
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
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. To request a free legal consultation call 800-411-9085.
After successfully winning her claim against Liberty Life Assurance Company of Boston (Liberty Life) at both district and appeals court levels, Theresa Willcox’s disability attorney sought compensation for the attorney’s fees charged Willcox to bring her claim before the Courts. When the District Court denied the application, Willcox’s disability attorney appealed the decision.
The primary reason given by the District Court for denying the disability attorney compensation hung on the reality that despite the fact that the Court found Liberty Life had abused its discretion, there had been enough contradictory evidence in the record to clear the disability insurance company of charges it had acted maliciously.
The Court also found that the fees Willcox’s disability attorney was seeking to collect were “clearly excessive.” The Court noted that Willcox’s disability insurance attorney had engaged in a “pattern of inflammatory and vitriolic arguments.” The District Court concluded that his charges it was Liberty Life’s fault that so much time and resources had gone into the disability lawsuit were unfounded.
In order to determine whether the District Court had made the correct decision, the Court of Appeals considered whether the District Court had applied the following five factors to reach the decision.
These five factors are known as the Westerhaus factors—named after the 1984 Lawrence v. Westerhaus opinion in which the factors first appeared. The Court has been using these five factors to evaluate when to award attorney fees under ERISA.
The Court of Appeals found that the District Court had applied these five factors properly. While it is unnecessary for all five factors to apply, the Court has generally found more than one factor necessary before it will award attorney fees. In Willcox’s case, only one factor clearly weighed in favor of awarding attorney’s fees—Liberty Life’s ability to pay.
The District Court did not find the disability insurance plan culpable or guilty of bad faith. In his appeal of this finding, Willcox’s long-term disability attorney argued that Liberty Life should have been found culpable for its abuse of discretion. By conducting a cursory review of her benefits claim, the disability attorney argued that Liberty Life had acted in bad faith.
The Court of Appeals disagreed. Based on Fletcher-Merrit v. NorAm Energy Corp. and Eisenrich v. Minneapolis Retail Meat Cutters & Food Handlers Pension Plan, Liberty Life could not be held culpable when there was enough evidence to suggest that Liberty Life’s denial was not without some merit.
Willcox’s claim only sought personal benefits, notwithstanding her disability attorney’s claim that her lawsuit was filed to indirectly motivate Liberty Life to conduct more thorough investigations in the future. The Court of Appeals sided with the District Court’s evaluation of this matter as well. Wilcox was not directly seeking to benefit other participants in the disability insurance plan, thus this factor weighed against approving compensation for attorney’s fees.
While her disability attorney argued that awarding disability attorney’s fees would discourage long-term disability insurance plans from performing surface claims review, both Courts felt that it would not have much impact, if any, on other disability insurance plans. Siding with the District Court, the Court of Appeals found that the disability attorney had exacerbated the situation by his handling of the lawsuit.
After reviewing all the evidence the Court of Appeals upheld the finding of the District Court that Willcox’s disability attorney had “done more to unreasonably” prolong the ERISA litigation “than any litigating position Liberty Life took.” The Court found that it preferred to deter long-term disability attorneys from clogging the Court system with drawn out ERISA claims.
Willcox’s disability attorney argued that the merits of her case were so strongly on her side, that attorney’s fees should be paid on this one factor alone. The Court of Appeals found otherwise. The merits of Willcox’s position was only slightly stronger than Liberty Life’s, but not enough to tip the scales toward payment of her disability attorney’s fees. Liberty Life had made a decision on evidence that did present some merit.
After considering Willcox’s case carefully, the Court of Appeals reached a conclusion. The District Court had not made a “clear error in judgment” as Willcox’s disability attorney claimed. Rather, because the only factor that weighed clearly for awarding attorney’s fees was Liberty Life’s ability to pay, the Court of Appeals upheld the District Court’s decision.
This case highlights one vital factor that a disability attorney must consider when representing a client in an ERISA claim. The Court felt this disability attorney had caused the whole litigation process to linger in the Courts. The decision to deny attorney’s fees fails to give specific details, but it may be inferred from reading the decision that the disability attorney “unreasonably multiplied” the proceedings in some way. As I have stated in numerous articles, attorney fees are discretionary with the court and it appears that the disability attorney in this case must have pissed off the judge.
It is important that a disability attorney expend time and resources efficiently. The Court is well aware of what is necessary to prepare a proper litigation, yet is also sensitive to things that lawyers may do that are unnecessary and take up more time than needed. If it appears that an attorney is “milking” a claim for everything he/she can get, the Court is less favorable to awarding attorney’s fees, even if it has sided with the claimant, as it did in Willcox’s case.
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. To request a free legal consultation call 800-411-9085.
Willcox v Liberty Life Assurance Company of Boston (Liberty) is an interesting disability insurance case. Theresa Willcox originally brought her disability claim before the U.S. District Court in Minnesota. When Liberty Life determined that she did not qualify to have her short-term disability benefits extended into long-term disability benefits, she made the usual appeals to the decision. Liberty Life made its final decision in May 2006, which led to her disability attorney filing a law suit pursuant to ERISA § 502, 29 U.S.C. § 1132.
Prior to trial her long-term disability attorney presented the Court with fifteen exhibits, all drawn from publicly available resources. This presented a problem for the Court as ERISA generally does not allow the Court to consider evidence outside the administrative record. Evidence outside the administrative record means any additional information that was not submitted with the ERISA appeal. At the same time, the exhibits contained material designed to help the Court evaluate whether Willcox had been given a fair hearing—anatomical charts, medical dictionary definitions, journal articles. One exhibit was provided to demonstrate the possibility that a conflict of interest existed. It addressed the qualifications of the neurologist Liberty Life hired to evaluate Willcox’s medical files.
The exhibits presented by her disability attorney did not include any medical data or diagnostic test results that weren’t already present in Willcox’s administrative record. He asked the Court to consider this information. Liberty Life argued that the District Court should allow Liberty Life to offer rebuttal exhibits and remand the case back to the disability plan for administrative review if the Court felt that the exhibits should be accepted into evidence. The court granted Liberty’s request and the administrative record was essentially reopened. This is a very rare occurrence in ERISA disability Cases.
So what were these medical exhibits about? They included generic anatomical charts, medical dictionary entries, journal articles, and similar material that would help a claims handler or judge understand what the test results in the medical record revealed.
What were the test results that needed to be understood? There were a series of medical exams designed to evaluate the presence of a condition known as L5 radiculopathy. There were also MRIs and CT scans. This condition causes weakness in the leg, impaired sensation, foot drop and pain. It is caused by compression of the nerve that comes from the L5-S1 segment of the spine.
Why would L5 radiculopathy cause Willcox’s disability? Because of the debilitating pain in her lower left leg that did not respond to surgical options, she could no longer work full-time. Her job was sedentary, but the long hours of sitting caused excruciating pain. Because of the involvement of her spine, walking to relieve her pain was not an option. She was no longer able to fulfill her duties as a claims adjuster for Blue Cross Blue Shield.
What precipitated her disability? She was injured in a car accident in March 2003. She tried the chiropractic route first but had to undergo a spinal diskectomy and fusion in November 2004. After this surgery, she began working part-time from home. The pain in her back resolved, but the L5 radiculopathy did not improve.
The District Court chose to order Liberty Life to conduct an initial review of the information that Willcox’s disability attorney had presented to the Court. The disability insurance plan was also ordered to consider more than the 15 exhibits. If Willcox presented more information regarding her disability, Liberty was to consider it.
Willcox added medical records from treatments she underwent in 2006 and 2007, two questionnaires filled out by two of her treating physicians and two witness statements regarding her physical limitations (one statement was her own).
Liberty Life retained a different neurologist to review her medical records. This physician concluded that despite the restrictions her condition created in her ability to walk, stand or lift objects, there was no reason to conclude that Willcox was barred from a position as sedentary as an insurance claims adjuster. Liberty Life reaffirmed its decision to deny Willcox’s long-term disability claim.
Willcox took her claim before the District Court once again. After reviewing Liberty Life’s disability determination using the abuse of discretion standard of review, this Minnesota District Court determined that Liberty Life had abused its discretion because it failed to evaluate Willcox’s medical record in its entirety and relied entirely on the shallow medical overview of the neurologist it hired. The court revered Liberty’s disability denial.
Liberty Life appealed the lower courts reversal of the claim denial. Liberty Life chose to challenge both the District Court order to reopen Willcox’s claim and its conclusion that Liberty Life had abused its discretion.
When Willcox’s disability attorney and Liberty Life argued before the Court of Appeals, both sides were fully agreed that ERISA governed the disability insurance policy. They also agreed that the proper standard for reviewing Liberty Life’s decision was abuse of discretion, a review that is deferential to Liberty Life.
Liberty Life acknowledged that it had invited remand for consideration of the new evidence presented by Willcox’s disability attorney. Yet, Liberty Life was now arguing that the evidence should not have been considered. Willcox’s disability insurance attorney pointed to the significant difference between the exhibits he had presented to the Court for consideration and other cases where the reviewing courts had refused to consider extra material. In Rittenhouse v. UnitedHealth Group Long Term Disability Ins. Plan and Brown v. Seitz Foods, Inc. Disability Benefit Plan, the evidence had been specific to the plaintiff’s symptoms or diagnosis.
Willcox’s disability attorney pointed to the fact that each exhibit served only one purpose—to assist the court in its ability to interpret complex medical evidence. Each exhibit had been culled from medical publications and websites without thought of its effect on litigation. Considering that in Barnhart v. Unum Life Ins. Co. of Am. the Court had itself gone to public medical sources to establish a fair context for a decision and Vega v. Nat’l Life Ins. Servs., Inc. held that generic materials that assist “the district Court in understanding medical terminology or practice related to a claim would be … admissible.”
The Court of Appeals found that the District Court’s decision to remand review of the new evidence to Liberty Life, instead of taking this upon itself, expressed the appropriate deference due to Liberty Life as the plan administrator. For Liberty Life to then complain that the District Court had abused its discretion by remanding consideration back to the disability insurance plan hinted at the capricious and arbitrary manner in which Liberty Life had handled the claim.
The Court of Appeals looked for any evidence that the District Court had used the additional medical evidence Willcox supplied for the remand to reach its conclusion that Liberty Life had abused its discretion, as this would have been problematic. No such evidence appeared in the District Court’s decision. Rather Liberty Life had clearly abused its discretion during its first review.
Liberty Life had originally sent Willcox’s file for review by an internist. This physician recommended that a neurologist or specialist in physical medicine review the file. Liberty Life then sent the file to a neurologist who listed all the medical records he reviewed. This neurologist’s report was full of errors. He stated that there was “no objective evidence” of radiculopathy, when in fact there were multiple tests demonstrating the symptoms of radiculopathy. He also stated that a nerve block that had provided relief for 24 hours had provided no relief at all.
Based on this faulty report, Liberty Life had denied Willcox’s application for long-term disability benefits. While Liberty Life had no obligation to give more value to the opinions of physicians who had treated her, it was under obligation to weigh the evidence she provided fairly. The neurologist Liberty Mutual hired failed to do this.
When the District Court remanded Willcox’s case back to the disability insurance plan, Liberty Life had a second opportunity to get it right. The second neurologist had the same materials as the first neurologist, yet also stated that there was no evidence to support her claim. This physician also ignored the tests that supported her claim and only considered the tests that were inconclusive. It would appear that both physicians hired by Liberty Life had failed their fiduciary duty by combing the record for evidence to deny Willcox’s claim. The decision reached by Liberty Mutual could be nothing but arbitrary and capricious and an abuse of discretion when it depended upon these doctor’s opinions.
Liberty Life wasted the premiums paid into its disability insurance pool pursuing this appeal. The Court of Appeals affirmed the decision of the District Court. The District Court had neither abused its discretion by doing as Liberty Life suggested by remanding Willcox’s claim for further administrative review, nor had the Court made an error in concluding that Liberty Life had abused its discretion when it relied on medical reviews that ignored medical evidence or misread findings that confirmed Willcox’s disability.
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. To request a free legal consultation call 800-411-9085.
Our law firm was recently contacted by an individual that was receiving long term disability income payments from Prudential. This disability claimant has been on long term disability for approximately 12 months. His disability is the result of a disabling knee condition. His Prudential long term disability policy defines "disability" for the first 24 months as the inability to perform the substantial and material duties of his occupation. After 24 months the definition of disability changes to the inability to perform the material duties of any gainful occupation. Gainful occupation is an occupation that will pay at least 60% of the claimants pre-disability earnings. This is known as the "any occupation" definition.
→ Click to continue reading Beware of unreasonable Prudential Disability Insurance lump sum buyout offer.
The Prudential Insurance Company of America (PRU), one of the world’s largest long term disability insurance companies, recently issued a press release regarding their return to work strategies. In my opinion, when Prudential or any long term disability insurance company discuss “return to work strategy”, this is tantamount to saying how quick can we stop paying a long term disability income claim. It’s no secret that Prudential can make a lot more money if less people are paid long term disability. No employer wants to see their employee miss work due to a disabling condition, but it is is scary when a long term disability company thinks they are qualified to make decisions about when a disabled person can return to work. Unfortunately, many long term disability insurance companies rely on computer programs to tell them how long a person should be out of work based upon a specific medical condition. Prudential and many other long term disability insurance carriers attended a national conference to discuss “effective return to work strategies”.
For more information about the meeting check out dmec.org.
Prudential’s August 26, 2010 Press Release states as follows:
NEWARK, N.J., Aug 26, 2010 (BUSINESS WIRE) — Kimberly Mashburn, vice president of Strategic Partnerships for Prudential’s Group Insurance business, a unit of Prudential discussed the critical role of managers and effective return to work strategies at the annual Disability Management Employer Coalition (DMEC) conference, August 1- 4, 2010 in San Diego, Calif.
Workplace absence can be very expensive. Costs and consequences of absence can include direct costs like disability premiums, benefits paid to disabled employees, continuing employee benefits, and wages to replacement workers. Also, indirect costs like reduced productivity, increased overtime, increased supervisory time, increased stress & pressure, recruitment and training of replacement workers, increased medical costs, and administrative cost all add up. While many disability absences are out of a manager’s control, some may not be.
“Some disability absences are driven by subjective feelings about work, so managers should make sure they are building an environment that breeds commitment,” said Mashburn. During her August 1 workshop, she provided the following actionable steps that managers can take to enhance prompt return to work and boost productivity:
“New laws, escalating costs, fewer employees, and health and productivity issues are the challenges of the post-recession economy,” said Joe Wozniak, Certified Professional in Disability Management and Chief Financial Officer of DMEC. “This year’s conference allowed attendees to learn best practices and proven solutions that help employers return workers to productive employment from peers and thought leaders like Prudential.”
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. To request a free legal consultation call 800-411-9085.
Certain Underwriters at Lloyd's London insurance company took almost two years to make a decision regarding a doctor's disability application for benefits. When he sued, the Court stayed the suit until an arbitration panel could review his claim. This article discusses the how the final disability benefit award was finally settled.
Most people don't think of cardiologists developing heart conditions. It is far more common than most people realize.
Dr. Zev Lagstein held a disability policy with Certain Underwriters at Lloyd's, London. The policy required Lloyd's to pay him $15,000 per month for up to 60 months if he lost his ability to practice medicine due to a disability.
When he developed complications from heart disease, including severe migraine headaches and other neurological problems he applied for benefits. He supported his claim with the opinions of several physicians who concluded after examination that he was permanently disabled from practicing not only as a cardiologist but as a physician.
Months passed without Lloyd's reaching a decision. Lagstein went back to work against his doctor's advice, which only complicated matters. Finally after almost two years had passed since he filed his long term disability claim, Lagstein sued. The policy mandated binding arbitration, so Lloyd's moved that the case be stayed until a three - member arbitration panel issued its decision. A arbitration panel found Lloyd's in the wrong and awarded Lagstein more than $6 million to cover policy benefits, emotional distress damages and punitive damages. Lloyd's responded to this decision by filing a motion to vacate the arbitration award.
The motion was heard before the U.S. District Court, District of Nevada. The judge sitting on the bench was shocked by the size of the award and used this as his primary reason for vacating the decision of the arbitration panel. He also vacated the punitive damages the arbitrators entered as being outside its jurisdiction. Lagstein appealed.
The Ninth Circuit Court of Appeals found that the District Court did not have the authority to vacate an arbitration award just because it disagreed with the size of the award. See Collins v. D.R. Horton, Inc. Rather proof that the arbitration panel had exceeded its powers, was necessary. The Court found that § 10 of the Federal Arbitration Act does not sanction judicial review of the merits behind an arbitration award. The District Court had stepped outside the scope the law gives the Court in these matters.
Lloyds argued that the arbitration board had manifestly disregarded the law, yet could produce no evidence to demonstrate this. In Kyocera, the Court had found that an award is completely irrational "only where the arbitration decision fails to draw its essence from the agreement." Lloyd's claimed the issue was the fact that Lagstein was not disabled because he had returned to work. Thus the panel's findings were irrational.
The Court of Appeals did not find the arbitration panel's findings irrational. The majority of the panel had found that Lloyd's violated the policy's "referee provision" by hiring a physician of its own choosing while failing to inform him of the import of this action. The majority also found that he was disabled thus Lanstein was entitled to benefits, whether Lloyd's agreed with these conclusions or not.
The Court of Appeals also found fault with the District Court's finding vacating the punitive damages which were awarded by the panel after they had issued their initial arbitration award. The panel had requested an extension of an additional 15 days in which to submit its initial award. Both parties agreed. The filing occurred before the deadline with punitive damages set to be determined at a later date. Nothing in Lagstein's policy expressly withdrew determination of procedural issues from the panel, so the panel was within its rights to set another hearing for determining what punitive damages, if any, would be awarded.
Both rulings by the District Court were vacated and Lloyd was ordered to pay over 6 million dollars to Dr. Lagstein.
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. To request a free legal consultation call 800-411-9085.
There seems to be a trend recently in which the Hartford disability insurance company is closely scrutinizing long term disability claims regardless of how long a claimant has been on claim. In the past 7 days I have been contacted by two separate claimants that have been on claim with Hartford for over 20 years and are having issues with Hartford. We usually see problems develop with long term disability claims when a new claims adjuster is assigned to a disability benefit claim. In my opinion, Hartford is one of the most difficult and unreasonable long-term disability insurance companies to deal with. I based my opinions on long-term disability claims my firm has handled and the numerous lawsuits around the country that discuss the conduct of Hartford.
A woman recently contacted me and she asked that I share her experience with Hartford so that other disability claimants can be aware of Hartford's claim handling tactics. This woman stated the following:
"The Hartford sent us a letter demanding that we sign a bunch of papers allowing them access to ALL doctors previously seen, All bank accounts, several questionnaires or they would cut off all benefits (which they did). I spoke to a paralegal at a local law firm that told me to sign all papers unless I had something to hide. We reluctantly signed the papers (I didn't feel that they needed our bank account info amongst other info not pertaining to this claim). My wife has been on disability with Hartford for 13 years and she has seen many doctors. Her primary doctor has recently filled out a letter stating that there was no time table for her return to work ( she just had an epidural in her spine last week). The Hartford has just sent us a letter stating that they have basically annoyed several other doctors that my wife has seen recently (she has renal issues also) trying to get them to give information but they are blackmailing us as they did at the beginning by saying you MUST tell your doctors to send them the information within 21 days or we will shut off your benefits. They have continually tried every angle to cut off my wife's benefits with these harassment techniques. We didn't want to sign any of these papers but we did. We think we should tell them that we are revoking their right to contact everyone. (My wife also gets social security because of this injury and we fear The Hartford will destroy that also leaving us in ruins). Now the doctors that my wife sees are being tormented which will have an effect on the care my wife receives AND now they are resorting to another type of blackmail as they expect us to do their work contacting these doctors to force them to give in to their demands or they will cut us off. I don't believe we signed up for that duty. I originally thought that they were going to negotiate a payoff settlement but instead it appears that they are trying the bullying tactic so they can stop paying."
This woman's experience and frustration with Hartford is consistent with the hundreds of Hartford disability claim emails we receive each year. In this scenario, a claimant should never revoke Hartford's ability to contact a treating doctor, however Hartford does not have a right to receive whatever information they feel like asking for.
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. To request a free legal consultation call 800-411-9085.
Disability Insurance Attorneys Gregory Michael Dell and Rachel Alters of Dell and Schaefer have filed a lawsuit in the United States District Court for the Southern District of Florida against Liberty Life Assurance Company of Boston "Liberty Mutual" for failure to pay long-term disability benefits owed to a disability claimant in violation of The Employee Retirement Income Security Act of 1974 (ERISA). The Plaintiff suffers from Fibromyalgia Syndrome which causes her unrelenting pain in her arms, legs, wrists, neck, shoulders and feet. Additionally, she suffers from severe fatigue and cognitive impairment as a result of her Fibromyalgia Syndrome. All of which prevents her from being able to perform the material and substantial duties of her occupation as a Benefits Coordinator, for Bridgestone Americas, Inc., an occupation that requires her to sit at a desk and type on a computer 6-8 hours a day.
The Plaintiff's treating physicians all concur that she is disabled and unable to work due to severe pain, fatigue and cognitive impairment. She underwent a functional capacity examination which revealed that she was only able to sit or stand for a maximum of 2-4 hours in an 8 hour day. Her pain was so severe on the first day of testing she was unable to complete the exam. A neuropsychological examination revealed that she was impaired in her high order thinking which was likely due to her fibromyalgia syndrome.
Liberty failed to provide a "full and fair review" of the Plaintiff's claim in violation of ERISA. Liberty ignored her treating physicians' opinions, with whom she has treated with for over 15 years, who opined that she was clearly disabled and unable to work. Liberty disregarded the neuropsychological test results as well as the functional capacity exam results. Instead Liberty determined that the Plaintiff was not disabled, could work 40 hours a week in her regular occupation and should not limit her activity when she is in severe pain, but should be as active as possible in order to prevent her joints from stiffening. According to Liberty and the physician they paid to review our client's medical records, working 40 hours a week would actually be beneficial to her condition. Liberty provided these opinions without ever examining the Plaintiff. They based their denial solely on a paper review of her medical records ignoring the medical opinions given by her treating physicians that she should not and could not work.
In our opinion, Liberty has really bent over backwards to wrongfully deny this claim. It is shocking that Liberty has relied on the opinion of a doctor that says 40 hours of work each week will make our client recover from her 15 years of suffering from fibromyalgia.
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. To request a free legal consultation call 800-411-9085.
In a recent long-term disability case against The Standard Insurance Company the court granted specific discovery request in order to further explore The Standard's potential conflict of interest. The Standard objected to all questions that the claimant's disability attorney had asked with regard to The Standard's potential bias and conflict of interest. Prior to granting the disability claimant's specific interrogatories sent to The Standard, the federal judge noted previous information which showed a bias in the working relationship between the Standard and the physicians that they hired to review long-term disability claims.
→ Continue reading The Standard Disability Insurance Company paid one doctor $577,000 to review 1,939 files over 2 years
Unum Provident Reviews Approved Benefits to Assure Continuing Qualification
When Nancy Perryman stopped working on February 28, 1997 she was the Western Farm Bureau Insurance Company's agency manager for metropolitan Phoenix and Northern Arizona. She supervised between 18 and 21 insurance agents who worked out of Western Farm Bureau's various insurance offices. She's earned around $300,000 each year in commissions, with average monthly earnings of almost $19,000 for the two years before she stopped working.
→ Continue reading Unum Provident terminates disability benefits to woman with chronic fatigue syndrome (CFS) (Part I)
When Nancy Perryman stopped working, she was the Western Farm Bureau Insurance Company's agency manager for metropolitan Phoenix and Northern Arizona. It was a complex job, in which she supervised between 18 and 21 insurance agents at Western Farm Bureau's various insurance offices. She's earned around $300,000 each year in commissions, with average monthly earnings of almost $19,000 for the two years before she stopped working.
→ Continue reading Arizona Court rules Provident wrongfully terminated disability benefits to insurance manager with CFS (Part II)
Rosemary McGahey's long-term disability attorney did an excellent job of representing her in U.S. District Court's Massachusetts district in December of 2009. McGahey's disability attorney carefully demonstrated that the administrators of the Harvard University Flexible Benefits Plan had wrongfully terminated McGahey's long-term disability benefits. As part of the court's decision to award McGahey compensation for the expense of pursuing her claim in court, her disability attorney was given instructions to put together the appropriate documentation to demonstrate what the attorney fee award should be.
→ Continue reading Harvard University ordered to pay $53,817.50 in attorney fees to disability insurance claimant
Lisa Pakovich and her former employer's long-term disability plan had been in and out of court for almost five years when Judge Michael Reagan listened to arguments between Pakovich's disability attorneys and Verizon Long-term Disability Plan on March 24, 2010. It was the third time he had considered this case in less than a year. He's not the first judge to consider Pakovich's claim. Three U.S. Court of Appeals, Seventh Circuit judges heard arguments in Pakovich v. Broadspire Services, Inc., 535 F. 3d 601 in April 2008. The decision rendered on July 25, 2008 has been cited in a number of decisions that have involved disability insurance claims since then.
The matter before Judge Reagan this time was which side's motion for summary judgment should be granted by the Court. In order to prepare a fair memorandum and order, a review of the history of Pakovich's claim, while redundant to the Judge, remained important to a decision that could stand as a separate document.
→ Continue reading Disability battle against Verizon and Broadspire long-term disability plan lingers in courts for years
If Judge Michael J. Reagan is beginning to tire of considering the case between Lisa Pakovich and her former employer's long-term disability plan, he may have good reason to. He has had to listen to arguments from both Pakovich's long-term disability attorneys and the Verizon Long-Term Disability Plan (Plan) attorneys at least four times in less than a year. He's not the first judge to consider Pakovich's claim. Pakovich v. Broadspire Services, Inc., 535 F. 3d has been cited in a number of Seventh Circuit decisions.
On March 24, 2010, Judge Reagan entered his ruling granting Pakovich's motion for summary judgment. In response, Packovich's disability attorneys filed a motion for attorney's fees. Judge Reagan considered the motion to collect these fees on April 22, 2010. In his decision, he first breaks down the legal standard that guided his decision. Then he compares Pakovich's motion against that standard.
→ Continue reading Broadspire ordered to pay disability insurance benefits but not attorney fees
Physician's Failure to Fill Out Functional Limitations Paperwork Costs Man Rightful Benefits
A supporting physician is essential for any claimant to receive long-term disability benefits. However, a treating physician must do far more than just diagnosis a disabling medical condition. The decision rendered by the U.S. Court of Appeals, Seventh Circuit in Williams v. Aetna Life Insurance Company continues to have an impact on long-term disability decisions in U.S. Courts even though it has been over two years since Lee K. Williams lost his appeal against Aetna Life Insurance Company (Aetna) and The Sysco Corporation Group Benefit Plan (Plan). Williams' unsuccessful attempt to secure a Court reversal of his long-term disability denial for chronic fatigue syndrome (CFS) continues to shape the strategies of disability attorneys as they help their clients perfect their claims for this non-objective ailment.
→ Continue reading Aetna denial of long-term disability benefits for chronic fatigue syndrome upheld by Court
Frequently, a disability attorney finds that additional information is needed before he or she can demonstrate that a conflict of interest has motivated the denial of benefits by an ERISA governed disability insurance company. In order to secure this information, the disability insurance attorney files a Motion to Compel Discovery. In response, the disability insurance company inevitably contests the need to provide this information.
→ Continue reading Court orders Citigroup and MetLife to answer discovery request exposing conflict of interest in long-term disability benefit denial
When Barbara Sterio's disability attorney presented arguments on February 11, 2010 before the Ninth Circuit United States Court of Appeals, he was unsuccessful in convincing the court to review her denial of benefits under the de novo standard of review. But the three judges reviewing Sterio's claim, found that even though the District Court had been correct in choosing to use the abuse of discretion standard of review, that standard had not been applied correctly. A review of the background behind Sterio's disability benefits application will demonstrate why the Court of Appeals reversed the decision of the District Court.
→ Continue reading HM Life and Broadspire wrongfully deny disability insurance benefits to a receptionist and 9th Circuit Court of Appeals reverses claim denial
The case we are going to look at here highlights the importance of involving a disability insurance attorney in your disability insurance policy purchasing decision. The language in disability insurance policies is complex and can often be turned against you when you most need the benefits. It is never safe to trust the assurances of the disability insurance company that a policy meets your requirements. The following case clearly demonstrates this reality.
→ Continue reading Was Boston Mutual's decision to terminate long-term disability insurance correct? (Part I)
On September 2, 2009, District Judge William E. Smith of the Rhode Island U.S. District Court filed a Memorandum and Order, delaying his final judgment on the case of D & H Therapy Associates v. Boston Mutual Life Insurance Co. until all of the matters which were not under the jurisdiction of the Employee Retirement Income Security Act (ERISA) could be resolved (you may find the arguments presented to Judge Smith of interest; we discussed them in an earlier article titled Was Boston Mutual's Decision to Terminate Long-Term Disability Insurance Correct?). On March 8, 2010, both sides asked Judge Smith to reconsider his earlier order.
→ Continue reading Boston Mutual can not recover $163,000 overpayment to long-term disability claimant (Part II)
On May 24, 2010, the United States Supreme Court rendered an opinion in the case of Hardt V. Reliance Standard, which is a major victory for disability insurance claimants that have a long-term disability policy governed by ERISA. Reliance Standard, a disability insurance carrier attempted to argue that a disability claimant was not entitled to attorney fees because she was not a "prevailing party" after her case was remanded back to Reliance
→ Continue reading ERISA disability claimants can receive attorney fees with "some degree of success"
A case heard recently before the U.S. District Court in the District of Massachusetts highlights the fact that a long-term disability plan administrator can choose to deny a claim even though the person making the claim may not be able to find employment. The plan administrator does not claim to offer unemployment benefits, so if the long-term disability plan finds that the claimant can work, the plan may refuse to extend benefits.
This is what happened to Andrew Gross, an employee of Federal Express Corporation (FedEx) until he suffered a heart attack in October 2003. He had been a full-time checker/sorter since 1989. In order to fulfill the duties of his job, he had to be able to lift up to 75 lbs. When his doctor checked him out of the hospital, it was with clear instructions to lift no more than 25 lbs. His doctor also ordered a leave from work.
→ Continue reading FedEx employee disability plan wrongfully denies LTD benefits without proving job exists for man to fill
Our disability insurance law firm was recently contacted by a woman that has been denied long-term disability benefits by Hartford. The claim is currently pending, but I asked if I could share her story so that others could learn about the real actions taken by disability companies such as Hartford. I strongly advise all disability claimants to never submit for a field interview without the presence of an attorney.
→ Continue reading Hartford pays disability benefits for 12 years and then uses video surveillance to deny benefits
Imagine a disability claimant has their long-term disability claim denied, files an appeal which is denied, then files a lawsuit to recover disability insurance benefits. After 2 years since the first denial and hundreds of hours of litigation, the court says the disability carrier needs to reconsider their claim denial. The disability carriers argues that the court sending the claim back for another review is not a victory by the claimant and the claimant's attorney is not entitled to collect attorney fees.
This is the exact argument that Reliance Standard has made in a further effort to make it more difficult for claimants with ERISA governed long-term disability policies to collect benefits. Most disability case victories result in the court remanding the case back to the company for an additional review. If a court's remand of the case back to the disability company is not considered to be a victory, then there will be very few cases in which the disability carriers will be responsible for attorney fees.
→ Continue reading Are attorney fees payable in long term disability insurance cases governed by ERISA?
The Standard Insurance Company sells multiple different long-term disability policies to dentist and other medical professionals. The difference in each policy is usually the definition of disability. In my opinion, the following definition of Own Occupation Disability sold by Standard is called an Own Occupation definition, but it is not a true Own Occupation policy. The following definition of Own Occupation is misleading and essentially requires the policy holder to be unable to work in any occupation.
Our law firm has represented numerous claimants that have purchased a long-term disability policy from Standard with the following definition of Own Occupation...
→ Continue reading Dentist and doctors: beware of the Standard Insurance Company Group's long-term disability policy
Once again, long-term disability insurance provider Metropolitan Life Insurance Company (MetLife) has been ordered by the court to reverse a long-term disability denial because the Court found the grounds for denying the benefits were arbitrary and capricious. This is a far too common occurrence, and one that disability insurance attorneys see frequently.
We are going to look at how Lanier's disability insurance attorney represented him before Judge David M. Lawson of the U.S. District Court, Eastern District of Michigan, Southern division.
→ Continue reading MetLife ordered to reverse denial of long-term disability insurance benefits
In the case we are going to look at, a disability insurance attorney found himself representing a client who believed that Metropolitan Life Insurance Company (MetLife) had wrongfully denied the extension of his long-term disability benefits. This is a far too common occurrence, and one that disability insurance attorneys see frequently. As we look at this case, you will see that without the representation of a disability attorney, John Lanier would not have received his rightful benefits.
→ Continue reading MetLife denies long-term disability benefits to a consultant after approving them
This is a case in which Unum's decisions to deny benefits was consistent with the policy language. Employer-provided group disability insurance plans are different from individual plans. An employer-provided disability plan depends upon the employer/employee relationship. If something happens to interrupt this employer/employee connection it can have consequences, as Carol Jones discovered.
→ Continue reading Unum denies disability benefits to a Minnesota legal secretary with pre-existing condition
Attorneys Seek Information In Order to Prove Conflict of Interest Impacted Claim Denial
Another case appeared recently before the United States District Court, Northern District of Indiana, Hammond Division. It sheds light on motions to compel. We will look at the background behind the motion before looking at how the Court evaluated the need for discovery into a disability insurance company's claims decision process. This case is another example of how a disability insurance company will fight with great effort to hide their potentially unreasonable claims handling activities.
BP Corporation of North America employed Clifford Hall for 27 years as a process operator. On December 1, 2007 he was involved in the motor vehicle accident that caused serious neck and back injuries and a traumatic brain injury as well. He worked his last day at BP the next day.
→ Continue reading Life Insurance Company of North America (CIGNA) ordered to supply information to disability insurance attorneys
The case we will look at here demonstrates once again how reviewing a disability denial under the abuse of discretion standard can favor an insurance company's disability denial. All the insurance company must prove is that the process used to come to a claims decision was logical and reasonable. As you read the following case, it might seem that Jerry Darvell and his disability insurance attorney had good reason to believe he had been denied benefits wrongfully. You will discover why two federal courts decided otherwise.
This case is a sad example of how a disability claimant can battle a disability insurance company in an ERISA lawsuit for several years and then have a Judge give the insurance company another opportunity to wrongfully deny disability benefits.
As an employee of Philips Lighting Company, 55-year-old Ronald E. Cox had been a repairman and tradesworker for nearly 24 years. While he had earned his GED, he had never graduated from high school. His job's duties included installing, repairing, constructing and maintaining plant facilities and equipment. He fabricated and installed frames and supports for the tanks, kilns and other equipment in the plant facilities.
Dalit Waissman took sued Life Insurance Company of North America (LINA) when the company terminated her long-term disability payments in May 2006. In arguments presented before District Judge Jeremy Fogel of the U.S. District Court’s Northern District of California, San Jose Division on January 20, 2010, Waissman’s disability attorney did his best to show that the material in Waissman’s claim’s file demonstrated beyond doubt that Waissman was disabled according to the definitions laid out within her former employer’s long-term disability plan.
→ Click here to continue reading Did LINA wrongfully deny disability payments to claimant with multiple sclerosis? (Part II)
Dalit Waissman, a 53 year old who immigrated to the United States from Israel in 1984, came to her position at SAP, Inc. in 1997 with considerable experience in computer programming and educational consultation and resource coaching. She had spent the previous two years working as an independent contractor providing technical writing services.
SAP hired Waissman as one of their Senior Technical writers. The primary duties of her job according to SAP were to provide “excellent research, interviewing and writing skills: information mapping skills; instructional design skills; knowledge of the business cycles; knowledge of computer software, Windows applications and authoring tools; and HTML/Internet knowledge.”
→ Click here to continue reading CIGNA (LINA) terminates disability payments to woman with multiple sclerosis
A recent article written by Evan George of the Los Angeles Daily Journal, documents a new bill that would be a great thing for long-term disability claims that are governed by ERISA. If this bill passess, we can only hope that other states across the country would adopt similar legislation. Discretionary clauses do nothing other than tie the hands of judges and increase the profits of disability isnurance companies. A special thanks to Evan for sharing this article with our law firm and for his efforts in independently reporting the actions of long-term disability insurance companies.
→ Click here to continue reading California lawmakers want to assist disability insurance claimants
On April 7, 2010, the ABC Good Morning America (“GMA”) show once again presented a story exposing the desperate actions of the Hartford Insurance Company. Disability insurance companies are notorious for using video surveillance. Hartford is one of the country’s largest long-term disability carriers.
An order granting discovery of Unum employee performance reviews was issued out of the U. S. District Court, Southern District of California that highlights how important it is for a disability insurance attorney to couch discovery requests carefully.
On January 19, 2010, the United States Court of Appeals, First Circuit handed down a decision based on arguments heard between the disability attorney of Edward F. Richards and Prudential Insurance Company of America on October 7, 2009. This is another case that highlights the difficulties faced by disability claimants suffering with fibromyalgia. It demonstrates how important it is to hire an attorney who pays attention to the fine details and has a clear understanding of what his or her clients need to do in order to win their case.
Another case heard on October 7, 2009 before the United States Court of Appeals First Circuit highlights the challenges of obtaining benefits when a claimant suffers from fibromyalgia. This case also highlights how one court can find a successful application for Social Security disability benefits as compelling evidence that a person deserves their long-term disability benefits and how another court will side with the insurance company’s argument that the plan criteria is different from Social Security's disability criteria.
A case that took over 10 years to move through the federal judicial system, finally ended with the court agreeing that Unum must pay attorney's fees and costs. However when the bill was delivered, Unum sought the court's intervention because Unum claimed that the attorney fees and costs were excessive.
Jane Fitts' long term disability battle with Unum had been a long one. The final bill that her attorneys delivered came to $1,384,127.79 in fees and costs. She supplied supporting records of the time spent by her attorneys. Unum contended that it should only have to pay half of this, and Fitts found herself in court once again.
When Donna Cusson took her long-term disability case to the U.S. Court of Appeals, First Circuit on September 15, 2009, she hoped for a reversal of the U.S. District Court of Massachusetts' decision in favor of Liberty Life Assurance Company of Boston (Liberty Mutual). We have already shared the background to this case in Liberty Mutual wins long-term disability case because of video surveillance—backdrop for an unsuccessful LTD claim (Part 1). Now, we will look at both the District Court and Appeals Court decisions because the District Court's decision is what the Appeals Court would be considering.
Donna Cusson went into Appeals Court challenging the First District Court's decision issuing summary judgment to Liberty Life Assurance Company of Boston (Liberty Mutual) and thereby upholding the disability denial. Cusson believed that the material facts in her case should have gone in her favor, not the disability insurance company's.
In this article, we will look at the background for this case. Hints as to why her appeal proved unsuccessful are found in her history.
As of the time of this writing, Beverly Barker doesn't know the answer to that question. Court proceedings are complicated and seeking compensation for long-term disability benefits is no exception. A case heard in December 2009 in U. S. District Court for the Southern District of Indiana, Indianapolis Division demonstrates this yet again.
When an insurance company uses a deliberate, principled reasoning process, supported by enough evidence, the United States court system will stand behind them. This fact is highlighted by a case that was argued before the United States Court of Appeals, Sixth Circuit, which covers the states of Kentucky, Michigan, Ohio and Tennessee. Arguments were heard by the judges on December 1, 2009 and a decision was filed on February 5, 2010.
A long-term disability case brought before Lincoln D. Almond, U.S. Magistrate Judge in the District of Rhode Island, brings to light how important it is for a long-term disability attorney to prepare a discovery request carefully and to make every effort to resolve discovery issues without involving the court system. The case we are going to discuss could have gone more favorably for Lorene Roccon Thompson, if her attorneys had paid more attention to the details. Discovery in ERISA disability cases is extremely limited and generally is only allowed to determine the extent of a conflict of interest.
→ Click here to continue reading Discovery requests in ERISA disability cases are found to be limited
A recent short-term disability case before the United States Court of Appeals, Seventh Circuit, Chicago, Ill., demonstrates that insurance companies are no friendlier to their own employees than anyone else. Kirsten Majeski worked for Metropolitan Life Insurance Company (MetLife) as a nurse consultant until June 2006 when she began complaining of pain and numbness in her shoulders, arms and hands. She was diagnosed with cervical radiculitis, a disorder of the spinal nerve roots.
In this article, I want to highlight, once again, the importance of rendering timely responses to correspondence from your long-term disability insurance company. I also want to highlight the importance of paying attention to statutes of limitations. A long-term disability case that came before the United States Court of Appeals 11th circuit recently highlights these issues.
The foundation of this case began back in 1999. Stuart S. Johnson, a participant in a group disability policy issued by Unum Life Insurance Company of America (Unum), applied for long-term disability benefits. Unum denied his application. The administrative appeals process allowed him to request review of the decision three times. Johnson appealed three times and was denied each time.
Shirley Graham, an employee with the U.S. Postal Service (USPS) who participated in a long-term disability plan administered by Hartford Life and Accident Insurance Co. (Hartford), brought her case recently before the United States Court of Appeals, Tenth Circuit. Her appeal raised three issues: 1) Did the District Court rule correctly that her disability benefits plan did not qualify as a governmental plan? 2) Was the District Court's determination that her claim did not qualify for a jury trial correct? 3) Did the District Court made the right determination when it failed to find Hartford's denial of benefits arbitrary and capricious.
To understand Graham's claim we will look at the background of her claim.
When Laurie Cooper walked into the U.S. Court of Appeals, 5th Circuit, in New Orleans, she had to demonstrate before the court that she had been denied a full and fair review of her claim and that the denial of her benefits abused the discretion given the benefit provider, Hewlett Packard Company Disability Plan. Two out of three judges found that she had failed to do this. In a two-to-one decision, the ruling from the U.S. District Court for the Southern District of Texas was affirmed.
The end result? Ms. Cooper will not receive long-term disability benefits. Let's look at this case and see how the circuit judges reached their conclusions.
Another case highlights the importance of making timely appeals when your long-term disability benefits are denied. Richard MacLennan discovered this when he took his case to court against Provident Life And Accident Insurance Company (Provident).
MacLennan filed his case in the U.S. District Court, District of Connecticut. In his claim, MacLennan sought to take advantage of tolling, a legal doctrine that allows for a statute of limitation to be extended. "Equitable tolling" can delay the initiation of a statute of limitations or it can halt the countdown of time after it has started.
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.
→ Continue reading MetLife abused its discretion when it terminated long-term disability benefits
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.
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.
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.
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.
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.
On February 18, 2010, Disability 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.
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. To request a free legal consultation call 800-411-9085.
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.
→ Click here to continue reading US court of appeals upholds denial of disability benefits by Metlife
When Rosemary McGahey was denied long-term disability benefits after 24 months, she appealed Harvard University’s decision. She had been approved by Social Security for disability coverage. But Harvard claimed that their standards were different than Social Security’s. At Harvard’s request, she had seen numerous physicians and psychologists, physical therapists and occupational therapists. Did the evidence from these visits validate Harvard’s decision?
The case we are going to discuss here highlights one of the ways an insurance company attempts to justify discontinuance of benefits after they have begun paying them.
George Nevitt, a practicing attorney fell down a flight of stairs on June 19, 2001. His injuries were so severe, that The Standard Insurance Company (Standard), the company that provided his company’s employee welfare benefit plan, initially approved Nevitt’s claim for disability benefits. In April 2007, Standard terminated Nevitt's coverage claiming that he no longer qualified because of the mental disorder limitation of the plan.