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

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:

• Create a positive work environment that employees want to come back to;
• Prepare for planned absences by discussing how to cover the work with the employee going on leave;
• Keep personal and professional connections when employees are out of work;
• Plan for the return to work using all the options available at your company; and
• Monitor the return to work to help ensure additional absence is mitigated.

“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.”

If you have questions about a long term disability claim please call 800-828-7583 for a free consultation or use our contact page.

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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.

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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. If you have questions regarding a long-term disability claim, contact us for a free consultation.

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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.

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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

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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)

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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)

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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

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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

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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

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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

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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

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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

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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)

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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)

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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. For a background summary of this case see Can I recover attorney fees if my long-term disability claim is governed by ERISA?

→ Continue reading ERISA disability claimants can receive attorney fees with "some degree of success"

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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

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Our 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

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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?

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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

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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. In MetLife denies long-term disability benefits to a consultant after approving them, we looked at background behind John Lanier's claim.

Now, 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

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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

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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

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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

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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.

→ Click here to continue reading LINA (CIGNA) denies long-term disability benefits to yellowbook Account Executive

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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.

→ Click here to continue reading Life Insurance Company Of North America (CIGNA) wrongfully denies disability benefits to a Kentucky repairman

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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)

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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

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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

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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.

→ Click here to continue reading Hartford continues to use video surveillance to wrongfully deny long-term disability claims

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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.

→ Click here to continue reading Unum attempts to hide California disability insurance attorney's attempt to obtain Unum employee reviews

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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.

→ Click here to continue reading Man with fibromyalgia faces Prudential Insurance in appeals court (Part II)

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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.

→ Click here to continue reading Prudential denies disability benefits to man with fibromyalgia after paying benefits for 10 years

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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.

→ Click here to continue Court Orders UNUM to pay over one million dollars in attorney fees for long-term disability denial

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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.

→ Click here to continue reading Liberty Mutual wins long-term disability case because of video surveillance—how District and Appeals Courts drew conclusions (Part II)

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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.

→ Click here to continue reading Liberty Mutual wins long-term disability case because of video surveillance—backdrop for an unsuccessful LTD claim (Part 1)

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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.

→ Click here to continue reading Will Life Insurance Company of America have to pay long-term disability benefits?

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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.

→ Click here to continue reading Reliance Standard long-term disability benefits decision affirmed by Circuit Court

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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

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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.

→ Click here to continue reading MetLife must reconsider denial of benefits for former MetLife employee

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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.

→ Click here to continue reading Unum's denial of disability claim is upheld after court finds claimant failed to respond in a timely manner

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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.

→ Click here to continue reading Postal worker loses long-term disability claim against Hartford Insurance

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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.

→ Click here to continue reading Hewlett Packard's denial of disability benefits is upheld by appeals court

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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.

→ Click here to continue reading Long-term disability claim against Provident almost lost because of untimely appeals

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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

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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.

→ Click here to continue reading MetLife terminates long-term disability benefits to woman with fibromyalagia

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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.

→ Click here to continue reading 10th Circuit Court of Appeals validates MetLife's accidental death and dismemberment denial

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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.

→ Click here to continue reading Unum's claim handling exposes them to a multi-million dollar bad faith disability lawsuit

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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.

→ Click here to continue reading Standard Insurance denies disability claim to a wheelchair bound woman

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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.

→ Click here to continue reading Accidental death & disability dismemberment; AIG reversed by Colorado Court

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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.

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

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

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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

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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?

→ Click here to continue reading Harvard University Ordered By Massachusetts Federal Court To Pay Long-Term Disability Benefits To A Former Employee

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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.

→ Click here to continue reading Federal Court Reverses Standard Insurance Company's Denial Of Long-Term Disability Benefits To An Attorney

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When Richard Geroux brought a long-term disability insurance underpayment complaint before the Tribal Court of the Keweenaw Bay Indian Community, L’Anse Reservation, Mich., the insurance companies involved, Assurant, Inc (Assurant) and Union Security Insurance Company (Union Security) immediately sought to remove his case to the United States District Court for the Western District of Michigan, Northern Division. The insurance companies claimed that Geroux’s case fell under ERISA jurisdiction and should be considered in Federal Court.

What is at stake here? Whether the tribal court had jurisdiction. Geroux moved on August 8, 2008 to have his case sent back to tribal court, arguing that his complaint should be decided in tribal court. The Assurant and Union Security filed a counterclaim on August 21, 2008 seeking to move action to Federal Court. They also opposed Geroux’s motion to review the case at tribal council on August 25. In response, Geroux moved to dismiss Union Security’s counterclaim.

→ Click here to continue reading Tribal Court Retains Jurisdiction For Tribal Member's Disability Insurance Lawsuit Against Assurant And Union Security

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Many long-term disability cases revolve around the issue of what constitutes the ability or inability to work in any gainful employment for which you “are reasonably fitted by education, training or experience.” The following case is another example.

In July of 2001, Linda Gardner stopped working as an operating room nurse. She had been diagnosed with avascular necrosis (AVN) in both of her knees, explaining the severe pain she had been suffering from. One of the symptoms of AV is its progressive nature. Temporary or permanent loss of blood supply to affected bones destroys the bone tissue and causes collapse. The resulting pain in an affected joint can limit movement severely.

→ Click here to continue reading Appellat Court Reverses Unum's Denial Of Disability Benefits To A Registered Nurse ("RN") And Trial Court Victory

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A ruling in U.S. District Court for the Southern District of New York found Reliance Standard Life Insurance Company (“Reliance”) acted in an arbitrary and capricious manner when it denied Elizabeth Diamond long-term disability benefits. Here is her story.

Ms. Diamond worked for Paine Webber as a desktop publisher. Coverage from Reliance through a Group Long Term Disability (LTD) Insurance Policy paid for by her employer was included in her benefits package. Ms. Diamond fell ill and ceased working on September 9, 2000. She first applied for long-term disability benefits in early March of 2001.

→ Click here to continue reading Disability Claimant Takes Reliance Standard To Court Twice Within 5 Years

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An opinion issued by the United States District Court for the Middle District of Pennsylvania in November 2009 highlights the challenges an attorney faces when a complaint for denial of disability insurance benefits involves parties from different jurisdictions. An attorney must be very knowledgeable regarding insurance contract law in their state, because the laws of the state in which the contract is signed are the laws that will apply unless preempted by ERISA.

The case we are going to consider involves Edward J. Zaloga, a doctor of osteopathy. He filed his complaint originally in the Court of Common Pleas for Lackawanna County, Penn. in December 24, 2008. Because the claim exceeded the value of $75,000 and neither Provident Life & Accident Insurance Company (Provident Life) nor Unum Group (Unum) had corporate offices in Pennsylvania, jurisdiction over the case resided with the U.S. District Court.

→ Click here to continue reading Unum's Attempts To Dismiss A Physician's Bad Faith Disability Lawsuit Are Denied By Pennsylvania Federal Court

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After 18 years of work as a management assistant at Raytheon Company, Dorothy Whitehouse suffered a psychotic episode in the workplace triggered by an experience with her boss and co-workers. The severity of the attack prompted her to immediately schedule an emergency appointment with her therapist, a licensed social worker on August 23, 2007.

→ Click here to continue reading Court Finds MetLife's Denial Of Short-Term Disability Benefits Arbitrary And Capricious

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Linda Chavis filed a complaint against Cigna Group Insurance and Life Insurance Company of North America (LINA) on June 24, 2009, alleging that the insurance company had breached two disability insurance contracts by refusing to pay her claims for short-term disability (STD) insurance and for long-term disability (LTD) insurance. While Cigna filed a motion to dismiss the complaint, Chavis stated in her complaint that she and her employer had paid all the required premiums for both policies, but she had been wrongfully denied benefits for both policies.

→ Click here to continue reading Court Finds CIGNA Failed To Follow Proper Claim Denial Procedure, Nurse's Right To Pursue Disability Law Suit Under ERISA Supported

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In a ruling filed on November 17, 2009, the United States Court of Appeals for the Eighth Circuit found that Prudential Insurance Company of America (Prudential) had failed to provide Barbara Brown adequate information with which to appeal their decision to deny her long term disability (LTD) benefits. As a result, the court did not apply a common court-approved practice which demands that all administrative options must be exhausted before filing suit.

→ Click here to continue reading Prudential's Failure To Produce Documents Weighs In Long Term Disability Claimant's Favor

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The Third Circuit Court of Appeals recently rendered a very difficult decision in favor of Hartford Insurance Company dealing with the interpretation of pre-existing condition clauses in long-term disability income policies. The three judge panel ruled 2-1 in favor of upholding Hartford’s denial of disability benefits. The law in each state is different for pre-existing conditions, therefore a disability claimant should consult with a disability insurance attorney prior to filing a claim for benefits.

In the case we are going to consider here, Jay Doroshow v. Hartford Life and Accident Insurance Company, two judges found Hartford had been neither capricious nor arbitrary when the insurance company denied Doroshow’s claim for long-term unemployment. The third judge disagreed, arguing in his dissent that Doroshow had not received treatment for the condition that precipitated his claim with Hartford. We will have to look at the backdrop against which this case developed.

→ Click here to continue reading Third Circuit Court of Appeals Upholds Hartford's Denial Of Long-Term Disability Claim Based on Pre-Existing Condition Defense

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Once again the Ninth Circuit U.S. Court of Appeals has upheld a state’s rights to protect employees that have long-term disability insurance policies issued by their employers. In an opinion filed on October 27, 2009, three circuit judges on the ninth circuit reached a unanimous decision that a state’s practice of disapproving insurance policies that contain clauses that vest insurers with discretion in how they process long-term disability claims and who they issue these claims to is legal and does not conflict with Federal law. The court agreed that a discretionary clause in a long-term disability plans is not valid. This is a major victory for disability claimants; however this ruling is only binding in the following states: Washington, Oregon, Montana, California, Arizona, Idaho and Nevada.

→ Click here to continue reading The Standard Insurance Company Loses Court  Battle To Enforce Discretionary Clauses In Long-Term Disability Insurance Policies

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On November 4, 2009, a ruling was handed down in the Sixth Circuit Court of Appeals that will surely have insurance companies looking at how they define ”pre-existing condition”. Ruth Mitzel is certainly happy that the court affirmed the lower court’s decision that Anthem Life Insurance Company, her employer and insurer, had wrongfully denied her long-term life insurance benefits.

When Mitzel was diagnosed on June 18, 2004 with Wegener’s granulomatosis (WG), an auto-immune disease that is life-threatening. Her diagnosis came just five days after she qualified for her employer’s long-term disability plan. She continued working until her condition required hospitalization on June 3, 2005, just shy of a year later.

→ Click here to continue reading Court Rules That An Undiagnosed Pre-Existing Condition Will Not Result In Denial Of Long-Term Disability Benefits

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After receiving disability benefits for more than 10 years, the Reliance Standard denied disability benefits. After a 4 year legal battle, the Arizona district court determined that Melisa Gemmel was disabled by fibromyalgia. Melissa Gemmel was employed at Systemhouse, Inc. and covered under her employer’s long-term disability plan, issued by Reliance Standard (NYSE:DFG). In 1989, it was discovered that Gemmel suffered from osteophytes in the neural canal at C5-6, a posterior osteophyte at C5-6, and a C7-T1 abnormality.

→ Click here to continue reading Arizona Court Reverses Reliance Standard And Awards Disability Benefits to Woman Suffering From Fibromyalgia

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It is vital that you hire the right long-term disability firm to represent you. Debra Swanson had to learn this the hard way, as a recent ruling in the Fifth Circuit court of Appeals in the Southern District of Texas demonstrates. How did Swanson’s attorney fail her? Her counsel failed to file a proper appeal.

Swanson’s story begins in January of 2002, when she was approved for long-term disability benefits through her employer’s plan with Hartford Life Insurance Co. (“Hartford”). The following year, on April 4, 2003, Hartford notified Swanson that her benefits would be terminated because she had been cleared to return to full-time work. She had 180 days to appeal this determination.

→ Click here to continue reading Texas Court Rules That Hartford Wins Long-term Disability Case, Claimant Failed To Exhaust Administrative Remedies

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Aside from the fact that many disability insurance companies already have a conflict of interest for being both the administrator of benefits and the entity that decides whether or not an employee qualifies for disability insurance, there are some cases in which it appears that insurance companies simply decide they don’t want to pay disability benefits.

→ Click here to continue reading Texas Court Reverses Hartford's Unreasonable Denial Of Disability Benefits To A Hospital Employee

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Alvin Hintz was an employee of CCL Custom Manufacturing, Inc. as Director of Information Systems for more than a decade. The company was purchased prior to Hintz’s termination, by KIK Custom Products, Inc. On August 8, 2005, Hintz was terminated along with eight other employees. In the separation agreement, there was a ‘general release of claims’ that Hintz signed. The long term disability plan was administrated by Prudential.

→ Click here to continue reading After Denial Of Long-Term Disability Benefits, Director Disabled By Heart Disease Takes Prudential To Illinois Court

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Donna Blake was an employee of Express Scripts, covered under both a long term disability plan and a short term disability plan, when she applied and was denied for short term disability coverage. After internal appeals, Mrs. Blake brought her claim to the United States District Court, Missouri Eastern Division. Upon the settlement of Mrs. Blake’s claim for short term disability, she claimed that she would be prevented from filing for long term benefits, because the denial of her short term disability claim, “prevented her from applying for LTD benefits from the LTD Plan, as she was required to satisfy the applicable period of STD before becoming eligible for LTD benefits.”

→ Click here to continue reading MetLife's Motion To Dismiss Long-Term Disability Claim For Failure to Exhaust Administrative Remedies Is Denied By Missouri Court

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When you apply for a disability policy, it is very important to answer all questions as truthfully as you can. The courts generally will not render a summary judgment in favor of the disability insurance company if the company can’t prove that you answered a question with the intent to defraud. If you don’t have a solid explanation for why you answered a question falsely, you may find yourself losing your coverage or facing a jury trial to determine whether you should receive your long-term disability benefits or not.

This is what happened to Richard Koch. Northwestern Mutual Life Insurance Company filed a motion in the U.S. District Court for the Western District of Washington for a summary judgment against Mr. Koch and rescission of his disability policies.. At issue? Three disability insurance policies that Koch had purchased from Northwestern Mutual.

→ Click here to continue reading After Claimant Paid Premiums For 15 Years, Northwestern Mutual Rescinds Disability Policy

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When Vickie Costello left work on May 19, 2006, after a stressful encounter with one of her co-workers, she had no idea that her problems were going to get even worse. In order to return to her job at Logan Aluminum, Inc., her employer required her to sign a “last chance agreement.” Already suffering from debilitating pain for which she had been under a physician’s care since 1999, Ms. Costello felt that this event marked the time to claim disability through her employer’s long-term disability plan with Sun Life Assurance Company.

Sun Life’s policy stated that if Costello became disabled and could not perform the “material and substantial duties of her occupation” that she would be entitled to disability benefits for 24 months. At the end of 24 months, she would have to prove that she was “unable to perform the material and substantial duties of ‘any gainful occupation” in order to remain eligible for disability benefits.

→ Click here to continue reading Sun Life Ordered To Re-Evaluate Long-Term Disability Benefit Denial By Federal Judge

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When Dr. Beatriz Martinez received a letter from MetLife denying her claim for long-term disability insurance, her only remaining option was to file a lawsuit. Unfortunately for her, the court upheld Met Life’s denial for one primary reason, she filed her claim for disability benefits four months too late. No arguments put forth by her attorneys could change that fact, and in the end, her appeal was denied, and she lost her lawsuit.

This issue arises far too frequently. Let’s look at Dr. Martinez’ story. There are important lessons for all of us.

→ Click here to continue reading Late Application Filing Results In MetLife Denying A Physician's Long-Term Disability Claim

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Mrs. Pettigrew was an employee of Pioneer Automotive Technologies, Inc from December 8, 2003 until May 15, 2006. Her most recent position was that of a senior engineer. Mrs. Pettigrew had been experiencing increasing pain and symptoms of Chronic Fatigue Syndrome (CFS), Fibromyalgia and Radiculopathy. Because of the increasing problems Mrs. Pettigrew was facing, she was finally forced to stop working. On May 25, 2006 Mrs. Pettigrew submitted a claim for short-term disability benefits, claiming that she was unable to work due to fatigue, severe pain causing lack of concentration, difficulty sitting as well as standing.

→ Click here to continue reading Prudential Ordered To Re-evaluate Long-Term Disability Claim of Engineer Suffering From Chronic Fatigue Syndrome and Fibromyalgia By Court

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For several years, Elizabeth Black was the executive director of Milwaukee World Festival, Inc. (MWF), the organization that governs Summerfest, a music festival in Milwaukee. Black was covered under the company’s disability insurance plan, underwritten and administered by Standard Insurance Company. Black was diagnosed with multiple aortic aneurysms bulging and weak areas in the aorta. In 2001, Black had surgery to repair the aneurysms and was recommended by her doctor to medically manage a third aneurysm in the descending aorta.

→ Click here to continue reading Standard Insurance Company's Denial Of Disability Benefits Is Upheld By Court, Despite Claimant's Approval Of Social Security Disability Benefits

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Mrs. Kaufmann was employed as a senior project manager by Siemens Corporation. Mrs. Kaufmann was a member of the long term disability plan through MetLife who was both the administrator and payor of disability benefits. On May 26, 2006, Mrs. Kaufmann stopped working on advice from her treating physician, Dr. Daniel T. Rubino. Because of an unsuccessful diskectomy and laminectomy, Mrs. Kaufman suffered from severe chronic pain. Mrs. Kaufman suffered from progressive back pain, disc protrusion and herniation, stenosis and radiculopathy which led her to seek help from those unsuccessful surgeries.

→ Click here to continue reading MetLife's Denial Of Long-Term Disability Benefits to a Senior Project Manager Suffering From Back Pain Is Reveresed By A Federal Judge

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Annette Engel was employed with Harborcreek Youth Services as a Clinical Director, where she performed duties such as providing leadership and vision, developing proposals, overseeing interviews and recruits of other clinicians, consultation and more. On September 5, 2007, Mrs. Engel applied for long term disability benefits under her employer’s plan with Jefferson Pilot (aka Lincoln National), claiming fibromyalgia, chronic fatigue, stress, and depression resulting from working long hours.

→ Click here to continue reading Disability Benefits Ordered To Paid By Jefferson Pilot To A Clinical Director Suffering From Fibromyalgia, Chronic Fatigue And Depression

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Mrs. Rebecca Duperry worked as payroll benefits HR administrator for Railroad Friction Products Corporation (RFPC) until April 7, 2006. Mrs. Duperry suffered from rheumatism, and stopped working in April pursuant to the advice of her rheumatologist. The rheumatologist told Duperry to ‘slow her work down’ and that cutting hours was a good idea, although working from home would be an even better idea.

October 16, 2006, Duperry claimed disability from three conditions,  rheumatoid arthritis, osteoarthritis and fibromyalgia. Among the documents Mrs. Duperry submitted to CIGNA Life Insurance Company of North America were two attending physician statements completed by Duperry’s primary care physicians, Dr. Glenn Harris, and her rheumatologist, Dr. Supen Patel. In his statement, Dr. Harris stated that “plaintiff was limited to zero hours per day of climbing, balancing, stooping, kneeling, crouching, crawling, reaching, walking, sitting, or standing, and that plaintiff would "never" be able to return to work.” A statement was made also by Dr. Patel that Duperry was ‘permanently disabled’ and therefore could not return to work.

→ Click here to continue reading Disability Benefits Ordered To Be Paid By CIGNA To HR Administrator Diagnosed Fibromyalgia

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Walter Pettway was employed with ADP (NASDAQ: ADP), as a principal consultant, beginning in 1994.  Mr. Pettway’s job required him to travel the United States helping large corporations with computer processes.  In the 1970’s, Mr. Pettway had undergone a cervical fusion at the C6-7 level and at the C5-6 level in 1999.  In the summer of 2002, Mr. Pettway suffered a fall which aggravated his condition, so that he experienced issues with his neck, lower back, left arm, right and left leg weakness and numbness in his fingers.  In October 2002, Mr. Pettway began treating with and orthopedic surgeon, Dr. Ragab.

Mr. Pettway underwent a cervical discectomy and fusion from C3 to C5 with an allograft and placement of anterior instrumentation on January 21, 2003.  Because of continued finger numbness and neck pain, Mr. Pettway underwent another surgical procedure to remove the hardware on June 24, 2003.  Continued pain led Mr.Pettway’s orthopedic surgeon to suggest his pain and numbness was a result of scarring from past surgeries.

On January 20, 2003, Mr. Pettway applied for long-term disability benefits with Prudential as outlined in the plan he was part of with his workplace.  He claimed disability for the recent cervical issues, pain and numbness as well as a history of diabetes and high blood pressure. Submitted with the disability claim was a statement of Dr. Ragab, indicating that the patient had been diagnosed with cervical spondylosis and herniated nucleus pulposus.  Prudential initially approved Pettaway’s claim for disability benefits.

Disability benefits were received until December 1, 2003 because Prudential stated that Mr. Pettway was no longer qualified to receive them.  At this point with the policy, Mr. Pettway could only be considered disabled if he were not able to perform the duties of any job as opposed to only the duties of his job.  Along with an appeal on November 25, 2003 Mr. Pettway submitted a statement from Dr. Ragab on December 5, 2003, stating that Mr. Pettway was, “unable to perform the duties of any gainful occupation which he is reasonably fitted by education, training and experience.”

A Prudential-initiated independent medical exam by Dr. Thomas Cullom, a neurological surgery specialist, was scheduled on January 7, 2004.  Dr. Cullom concluded that Pettway was unable to perform the duties of his own current occupation.  Prudential reinstated benefits on January 22, 2004.  Multiple attempts to perform surveillance on Mr. Pettway happened between February 2004 and November 2007.  At one point, Prudential had video of a man they thought was Mr. Pettway.  However, it was proven not to be and those videos were disregarded.  There was one video of Mr. Pettway driving to a car rental location, placing two bags in the car and driving for an hour.

Another independent medical examination was scheduled with Dr. Jo Lynn Polk, on November 16, 2007.  After examining Pettway, reviewing his medical records, and watching the surveillance video of Mr. Pettway, Dr. Polk concluded that the patient’s, “self-reported functionality is not consistent with the activities noted on the surveillance.”

Other claims by Dr. Polk include, "(1) although he claims his left hand is weak, there was no atrophy of his left hand muscles; (2) although he says he has numbness in his left hand, there was only a slight sensory deficit which would impart minimal impaired function of the left hand; (3) although he says he can sit for only 30 minutes at a time, he sat on the examining room table for one hour during my interview; and (4) although he says he needs assistance standing and wiping himself after bowel movements, during my evaluation he demonstrated independence with standing after sitting and had adequate right shoulder internal rotation to wipe himself after bowel elimination."

As far as standing without assistance, Dr. Polk repeated only what a nurse relayed to her – these observations were not made firsthand.

Prudential had an in-house physician, Dr. Day, review Dr. Polk’s report and he concluded, “I would agree with the conclusion Dr. Polk noted that the claimant has sustainable work capacity at least at a sedentary level. There were several inconsistencies in the physical examination by Dr. Polk.”

In another appeal, Mr. Pettway submitted letters from three physicians (Dr. Ragab, Dr. Cullom and Dr. Bouldin), which disagreed with Prudential’s findings.  Prudential denied benefits and stated in a letter sent June 11, 2008 that Mr. Pettway has the functional ability to perform duties of jobs other than his own, which he is well-trained and qualified for.

In the United States District Court for the Southern District of Mississippi, Hattiesburg Division, it was found that Prudential completely ignored irrefutable evidence of Mr. Pettway’s condition by his treating physicians.  Instead they relied on Dr. Polk’s assessment, a physician who saw him for less than an hour.  The video evidence was disregarded, both because Prudential had been unsuccessful at surveying Mr. Pettway most of the time and had blundered in their attempts to do so and because nothing in the videos suggested that Mr. Pettway was able to perform the duties of any job with reasonably continuity.  Because of this, the court ordered Prudential to reinstate Mr. Pettway’s 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 disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability insurance attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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In February of 2006, Mrs. Lanoue was a table games floor person for the Mohegan Tribal Gaming Authority and had been since October of 1997. She was covered under the long-term disability plan issued and funded by Prudential Insurance Company of America (NYSE:PRU). In April of 2006, Mrs. Lanoue filed for long-term disability, claiming to have chronic pain, fatigue and fibromyalgia. Her claim included an employee statement and an attending physician’s statement (APS) from rheumatologist, Dr. Sandeep Varma.

→ Click here to continue reading Conneticut Court Rules Against Prudential After They Fail To Recognize Pain Caused By Fibromyalgia As A Long Term Disability

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Individuals who pay for disability insurance premiums hope to be able to rely on the disability benefits if they are ever unable to work for any extended period of time. However, many times these employees’ claims are denied without any reasonable basis for denial. As in the case below, it is often abusive claims handling tactics by disability insurance companies that leads to disabled individuals being denied their benefits and forced to try and support their families in any way that they can.

→ Click here to continue reading New York Federal Court Exposes Unum's Disability Claims Handling Tactics

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Karen Bloom was a partner and doctor specializing in physical medicine and rehabilitation at Rehabilitation Associates in Louisville, Kentucky. In 1999, she was diagnosed with Multiple Sclerosis (MS). In 2002, she decided to perform most of her work on an outpatient, rather than inpatient basis.

At the beginning of 2004, Dr. Bloom became unable to continue working full-time for Rehabilitation Associates because of her MS. She subsequently transitioned into part-time work and filed a claim in March 2004 for long-term disability benefits under the group policy provided by Hartford through her employer since 2002.

On September 21, 2004, Harford denied Dr. Bloom’s claim. In its denial, Hartford claimed that Dr. Bloom had a pre-existing condition, based on a date of disability of December 1, 2002. Through her attorney, Dr. Bloom appealed the denial. While admitting that she had a condition that existed prior to the effective date of the policy (October 2, 2002), Dr. Bloom’s position was that she became disabled after the 365-day elimination period had run, since she had claimed a date of disability in 2004, and thus was still entitled to coverage under the policy. Hartford’s position was that when Dr. Bloom transitioned from inpatient to outpatient work, she did so because of her MS, and thus had reduced hours in 2002 because of her condition.

Hartford contacted Dr. Bloom’s doctors, who agreed that she was disabled, but not until 2004. Despite the full support of her doctors, Hartford denied her appeal on July 8, 2005. In its denial letter it recited the same incorrect information it had relied upon in its previous denial. In response, Dr. Bloom filed suit in Federal Court. The federal court granted summary judgment in favor of Dr. Bloom after concluding that Hartford’s decision was arbitrary and capricious because it had relied on circumstantial evidence of her disability – work records and salary reports – rather than the medical records that existed between Hartford’s determined date of disability and Dr. Bloom’s claimed date of disability. Hartford appealed the trial court’s decision to the Sixth Circuit Court of Appeals.

On appeal, the decision to award benefits to Dr. Bloom was upheld. However, the court ordered that Hartford conduct the appropriate evaluation as to the true date of disability and to determine the amount of benefits owed to her.

From a practical standpoint, this case highlights two important points. One, it is vitally important to have an attorney involved in filing a claim as soon as possible. Had an attorney been involved at the outset at the filing of the claim, Dr. Bloom could perhaps have avoided leaving the door open for Hartford to deny her based on a pre-existing condition. Two, while Dr. Bloom won her case, because of the decision on appeal she is still subject to the whims of Hartford in picking a date of disability and determining the benefits that she is owed. Ultimately, she may have won the battle for entitlement to benefits, but lost the war, since Hartford still controls her date of disability and how much money she will receive under the disability policy.

See Bloom v. Hartford Ins. Co., No. 07-6374 (6th Cir. Jul. 21, 2009).

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

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Our client, an Engineer Manager specializing in Fluid Power Engineering, suffers from severe Coronary Artery Disease. Despite the fact multiple diagnostic tests performed indicated there were no abnormalities with his heart, he suffered two heart attacks in the span of six months. Following his second heart attack in July 2006, he applied for long-term disability benefits under his employer’s long term disability plan through Prudential. Prudential initially approved his claim for disability benefits, and following his elimination period he began receiving long term disability benefits in September 2006.

→ Click here to continue reading Denial Of Long-Term Disability Benefits To Engineering Manager Is Reversed By Prudential

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Many companies offer short and long-term disability insurance coverage to protect a portion of an employee’s monthly income in the event the employee is unable to work as a result of a sickness or injury. Employees pay the premiums for this insurance on a monthly basis so they’ll have something to fall back on if they ever become sick or injured. Of course, many individuals have a sense of security because of this. However, most employees are unaware that once a claim for disability benefits is submitted, the disability insurance company has a “structural conflict of interest”, as it is usually the long-term disability insurance company that both administers and pays any approved claim. This structural conflict is significant as a claim denial allows the insurance company to keep the money for itself and increase its profits. Fortunately for disability claimants, the courts are required to consider this structural conflict of interest as one of many potentially bias factors that inappropriately motivate a disability insurance company to deny disability benefits.

As a disability insurance attorney that has handled thousands of claims against every major disability insurance company, I am constantly trying to educate potential claimants about the tactics of disability insurers. A recent case is a victory for disability policyholders as it exposed the “signs of bias” exhibited by Hartford Life and Accident Insurance Company throughout its decision making process.

→ Click here to continue reading California Court Orders Hartford To Pay Long-Term Disability Benefits To A Telecommunications Manager

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As a disability attorney for clients who go up against disability insurance companies all over the country, I can tell you that the insurance contracts are often full of legalese and gibberish that most individuals don’t understand. Unfortunately, most individuals don’t understand even the communication they receive from the disability insurance companies, such as why their claim has been denied. According to the outcome of the case below, even a judge may find communication from the insurance company difficult to understand.

→ Click here to continue reading Appellate Court Reverses Liberty Mutual's Denial of Disability Benefits To A Bank Employee

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Many employees rely on disability insurance benefits if they have been injured or have developed a sickness which prevents them from working. Disability insurance provides individuals with a percentage of his or her typical salary until the employee is able to return to work or turns age 65. However, what employees aren’t usually aware of is that as soon as disability benefits start, the disability insurance company wants them to stop and they will use a wide range of tactics to make that happen.

As a disability attorney who has worked on thousands of long-term disability claims against major insurance companies around the country, I can tell you that insurance company tactics can involve undercover investigations, fact-twisting, and even having bias doctors subjectively determine that you are not disabled as in a recent disability insurance case.

→ Click here to continue reading Metlife's Wrongful Denial Of Long-Term Disability Benefits To A Wells Fargo Employee Is Reversed

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Recently, the California Department of Insurance settled with LINA, a daughter company of CIGNA to the tune of $600,000. What was this penalty for? According to California Insurance Commissioner Steve Poizner, LINA was apparently ignoring certain claims that might have been valid disability claims.

Between January 1, 2005 and December 31, 2007 LINA improperly handled insurance claims. It seems that not only did LINA deny many cases before ever receiving the medical proof those clients were entitled to their insurance payouts but LINA ignored important information that may have reversed the denied claim on a number of accounts.

→ Click here to continue reading CIGNA/LINA Penalized By The California Department Of Insurance

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Disability Insurance Policies are complicated legal documents that are unfortunately difficult for most individuals to properly understand. While a disability policy is intended to be drafted so that a claimant will clearly understand all of the terms and conditions, a claimant’s misunderstanding can jeopardize a claimant’s right to disability benefits. A recent disability case reveals the importance of complying with a disability policy’s statute of limitations provisions. A statute of limitations is the period of time in which a lawsuit may be filed. Failure to file a lawsuit within the statue of limitations will result in dismissal of a lawsuit. The steps that must be taken in order to obtain disability benefits are not always contained within the disability policy.

→ Click here to continue reading Claimant's Statute of Limitation Non-Compliance Allows MetLife's Denial Of Disability Benefits To Go Unchallenged

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After several month of attempting to handle his long-term disability claims on his own, our client contacted Attorneys Dell & Schaefer. Mutual of New York Life Insurance Company claimed to be conducting an evaluation of his claim, but had not yet paid any benefits. Disability Management Services (“DMS”), a third party administrator, was retained by Mutual Life to administer and process our client’s claim for disability benefits.

→ Click here to continue reading The Mutual Of New York Life Insurance Company Approves Long-Term Disability Benefits For Cameraman

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Our client, a pharmaceutical sales representative, was recently denied benefits by her carrier, Cigna, despite clear medical documentation of several severe medical problems that prevent her from performing the duties of her occupation.

→ Click here to continue reading Attorneys Dell & Schaefer Files Lawsuit Against Cigna In Hawaii On Behalf Of Pharmaceutical Sales Representative

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Our client, a financial advisor, was first diagnosed with fascioscapulohumeral muscular dystrophy (FSHD) in 2002. FSHD is a neuromuscular disease which causes progressive skeletal muscle loss and weakness, defects in the biochemical, physical and structural components of muscle and the death of muscle cells and tissue. FSHD is a severely disabling condition and is the second most prevalent muscular dystrophy affecting adults. Despite our client’s diagnose he continued work with his illness for several years. Beginning in 2003 and 2004, our client began experiencing noticeable symptoms of aches, pains, difficulty speaking, discomfort and limitations in doing some normal everyday tasks and activities. Over the past two years our client’s symptoms rapidly increased and intensified, to the point it was becoming impossible to perform his occupation as a financial advisor.

Our client contacted Attorneys Dell & Schaefer to assist with the filing of application for long-term disability benefits with Mass Mutual and other long-term disability insurance companies. Attorneys Gregory Dell and Cesar Gavidia worked with our client to gather all of his medical records, financial and occupational information. Our client’s disability policy stated that he would be eligible for long-term disability benefits if he was unable to perform the duties of his occupation. Attorneys Dell & Schaefer submitted our client’s application with extensive addendums attached and the claim for long-term disability benefits was approved within 45 days. As long as our client remains eligible for long-term disability benefits, he will receive approximately $12,000 a month until her turns age 65. Disability Attorneys Dell & Schaefer continue to assist our client with the monthly maintenance of his claim with MassMutual.

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During the week of July 13, 2009, Attorney Gregory Dell spent several days in Portland, Oregon deposing multiple employees of The Standard Disability Insurance Company. Prior to taking the depositions, The Standard refused to make their employees available for deposition and instructed their attorney to file a motion preventing Attorney Gregory Dell from taking the depositions. The court received multiple motions and entered an opinion stating that our client has the right to take the depositions and The Standard must produce their witnesses. The Standard’s motion for attorney fees against our client was denied. It is obvious that the Standard did not want their claims handling practices exposed through deposition testimony.

→ Click here to continue reading Attorneys Dell & Schaefer Win Motion Against The Standard Disability Insurance Company

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Since late 2004, our client, Sumiko Besser has been battling Prudential Insurance Company in an effort to secure her long-term disability benefits. Prudential currently owes her in excess of $900,000 in unpaid long-term disability benefits. Our client became disabled on May 10, 2004, as a result of chronic neck pain caused by multi-level degenerative disk disease. Attorneys Dell & Schaefer submitted two administrative appeals to Prudential and in early 2008 filed a lawsuit in United States District Court of Hawaii. On May 19, 2009, Attorneys Gregory Dell and Leonard Feuer presented our client’s case at trial and on July 14, 2009 the Federal Judge issued a 20 page opinion reversing Prudential’s denial of benefits. Motions are currently pending for calculations of past due disability benefits, interest, and attorney fees. A copy of the court’s opinion is available upon request.

→ Click here to continue reading Attorneys Dell & Schaefer Wins Case Against Prudential Insurance Company Of America On Behalf Of Time-Share Salesperson Suffering From Cervical Disc Disease

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Our client, a dentist working in the capacity of a director of clinical technology for a well known company, began experiencing problems with his balance in March of 2009. In his role as director of clinical technology he was required to give lengthy presentations and speaking engagements, as well as be on the cutting edge in dental procedures. His initial balance problem quickly progressed leading to the cancelation of scheduled presentations, and our client seeing his doctors for testing. Test results indicated that he had a life-threatening brain tumor. Within a month and a half of first being seeing for the brain tumor he was undergoing brain surgery to remove the cancerous mass. The surgery was successful in removing the majority of the tumor, but resulted in loss of hearing in his left ear, cognitive dysfunction, and the exacerbation of a cervical neck condition brought on by years of dentistry. In the aftermath of the surgery his balance and equilibrium problems worsened, he began to experience severe headaches when working at the computer, and the surgery exacerbated his cervical neck condition. Hopes of returning to work after a short rest period from the surgery quickly vanished and he contacted Dell and Schaefer to assist in the filing of his disability claims.

Attorneys Gregory Dell and Stephen Jessup gathered all of the medical, financial and occupational information necessary to submit our client’s claim for disability benefits. Attorneys Dell & Jessup obtained supporting documentation from our client’s treating physicians and assisted our client with his application for disability benefits. Our client was further advised of the importance to have his doctors continue to document his restrictions and limitations. Within a week of filing for benefits, our client was approved for disability benefits. Disability Attorneys Dell & Schaefer continue to handle our client’s disability claim on a monthly basis.
 

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Our client, a chiropractor, was involved in motor vehicle accidents in 2005 and 2007, which resulted in him suffering from lumbar radiculopathy and cervical discogenic disease. As a solo practitioner and business owner he attempted to continue to work through the pain by working in a reduced fashion. He modified the techniques he employed for certain chiropractic procedures, and had to eliminate others all together. By the middle of 2008 the worsening pain became such that he realized he would no longer be able to work as a chiropractor. By the end of 2008 he closed his chiropractic office and filed for long term disability benefits under his AXA Equitable Policy.

→ Click here to continue reading AXA Equitable and Disability Management Services Approves Benefits For A Chiropractor Suffering From Lumbar And Cervical Disc Disease

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Our client, who suffers from Parkinson’s, was a highly skilled engineer and operations manager for an international corporation before his illness rendered him unable to perform the duties of his occupation. Diagnosed with Parkinson’s years before filing for long term disability benefits under his company’s disability plan, he did everything in his power to work at a job he enjoyed and excelled at. However, the nature of his illness began to take a heavy toll, as symptoms relating to his cognitive functioning began to worsen. Left with little choice, he applied for disability benefits under his company’s short term disability policy in March of 2008. He was approved for short term benefits under the disability policy. However, in October of 2008, when the short term disability benefits were exhausted, MetLife denied his claim for long term disability benefits.

→ Click here to continue reading Attorneys Dell & Schaefer Win Long Term Disability Insurance Appeal Against MetLife On Behalf Of Engineer Suffering From Parkinson's

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The recently decided case of Barteau v. Prudential, 2009 WL 1505193 (C.D. Cal.) is a reminder of what ends Prudential will go to in denying a claim for benefits. Carl Barteau was an Assistant Professor of Mathematics at DeVry Institute of technology for almost eight years before becoming disabled. Mr. Barteau had suffered problems with his right eye since childhood. In 2002 he underwent surgery for glaucoma, which was complicated by a scratched cornea. As a result of the scratched cornea he was instructed to wear a replaceable contact lens and was reassured the eye would heal on its own. Soon after he began experiencing excruciating pain, and on January 7, 2003 he began treatment at UCLA. Biopsies of the eye were taken and showed evidence of eye fungus. On January 17, 2003, he became hospitalized and underwent surgery to remove a large part of the infection from his right eye. On February 22, 2003, he underwent a second surgery on his right eye. Following the second surgery he began to experience a lack of vision in his right eye and disabling light sensitivity in both eyes.

→ Click here to continue reading Prudential Denies Long-Term Disability Benefits To A College Professor, But The California District Court Reverses the Claim Denial

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Since late 2004, our client, Sumiko Besser has been battling Prudential Insurance Company in an effort to secure her long-term disability benefits. Prudential currently owes her in excess of $900,000 in unpaid long-term disability benefits. Our client became disabled on May 10, 2004, as a result of chronic neck pain caused by multi-level degenerative disk disease. Attorneys Dell & Schaefer submitted two administrative appeals to Prudential and in early 2008 filed a lawsuit in United States District Court of Hawaii. On May 19, 2009, Attorneys Gregory Dell and Leonard Feuer presented our client’s case at trial and we are currently waiting for a verdict from the court.

→ Click here to continue reading Attorneys Dell & Schaefer's Client Takes Her Case To Trial Against Prudential In Hawaii District Court

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The case of Mary Midgett v. Washington Group International Long Term Disability Plan, 561 F.3d 887 (8th Cir. 2009) is a reminder that there are discrepancies in how Federal courts apply the law with regard to the weight of credibility to give to an insured’s treating physicians versus the opinions of doctors hired by the insurance carrier to conduct reviews of medical records only.

Mary Midgett was a contract manager for Washington Group International, and was insured under Washington’s group short term and long term disability policies. The policies were originally administered by Broadspire, and then by Aetna. Ms. Midgett filed for benefits under Washington’s short term disability policy due to a myriad of conditions including degenerative arthritis, fibromyalgia and cervical degenerative disc disease, and osteoporosis.

→ Click here to continue reading Broadspire And Aetna Deny Long-Term Disability Benefits To Manager Suffering From Fibromyalgia, Arthritis And Cervical Disc Disease

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Robert Stanford was a nurse anesthetist in a hospital in South Carolina. In his position, he was exposed to and responsible for administering anesthesia and narcotics to surgical and obstetric patients. Shortly after starting work, he began taking Fentanyl, a powerful narcotic. By September of 2003 he had become addicted to the drug, and entered rehabilitation the following month.

After release from rehabilitation, but before returning to work, Stanford relapsed, and returned to rehabilitation, where he stayed for 3 months this time. While in rehabilitation, he applied for long-term disability benefits with Continental Casualty, which provided benefits through his employer. While in rehab, his benefits were approved.

→ Click here to continue reading Nurse Anesthetist Denied Long-Term Disability Benefits For Drug Addiction By Continental Casualty Loses At Trial And On Appeal

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In, Lona v. Prudential, 2009 WL 801868 (S.D. Cal)., the Court determined that the opinions of three doctors hired by the insurance carrier to review the insured’s medical records did not carry as much weight as the opinions of three other doctors that physically examined the insured. This case shows that Prudential will continue to hire doctors to review a claimant’s disability file, until they have found the right doctor to provide the opinion they are looking for.

→ Click here to continue reading Judge Orders Prudential To Pay Account Manager $90,416 In Long-Term Disability Benefits

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Prior to becoming disabled, Mrs. C was an eighth grade English literature teacher in southern California. In 1996, Mrs. C began experiencing pain in her muscles and joints as well as fatigue and disturbed sleep. Her physicians soon diagnosed her with various connective tissue disorders, including: Sjogren’s syndrome, rheumatoid arthritis, atypical lupus , Raynaud’s phenomenon, fibromyalgia and muti-nodular goiter. She was experiencing pain in a number of small joints in her upper extremities, as well as her knees, ankles and hands. The stress and emotional toll was even causing her to experience hair loss. In 2002, Mrs. C was forced to stop working and file a claim for disability benefits under her long-term disability policy provided through her teacher’s association. After reviewing her claim and giving careful consideration to the medical evidence, the disability insurer approved Mrs. C’s claim and began paying total disability benefits.

→ Click here to continue reading Teacher Suffering From Sjorgen's Syndrome, Fibromyalgia And Other Conditions Receives Lump-Sum Buyout Following Denial Of Long-Term Disability Benefits

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Our client, an obstetrician/gynecologist, suffered from rheumatoid arthritis and could no longer perform his occupation. He approached Dell & Schaefer seeking assistance with his long-term disability applications. After completion of his applications for private long-term disability insurance benefits and approval by two different insurance companies, the doctor disclosed that he had recently been denied short-term disability benefits by Aetna.

→ Click here to continue reading Aetna's Denial of Disability Benefits to An OBGYN Physician Is Reversed Following An Appeal Submitted By Attorneys Dell & Schaefer

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Cigna attempted to deny lifetime disability benefits for a claimant suffering from a psychiatric organic brain disorder, but the district court of Colorado disagreed. Following a remand from the court of appeals, which ruled the district court had erred by considering evidence outside the “administrative record,” the district court nonetheless reaffirmed its ruling in plaintiff’s favor after carefully considering all of the evidence in the record and analyzing each of the medical opinions presented.

→ Click here to continue reading CIGNA'S Attempt To Limit Claimant To A Maximum Of  2 Years Of  Long-Term Disability Benefits Limitation For An Organic Brain Disorder Such As Bi-Polar Is Reversed  By The District Court

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Our client was a Territory Sales Specialist for a major medical supply company, responsible for sales spanning a large geographic area with incredibly high sales quotas. Physical requirements of her occupation required here to travel extensively, drive long distances on a day to day basis, carry samples and products that could weigh in excess of thirty pounds, and give presentations and demonstrations. Her job required her to have a strong understanding of all aspects of her company’s products, and keep current with all advancements in the field of medicine as it relates to her company’s products.

→ Click here to continue reading Prudential Reinstates Long Term Disability Benefits To Sales Specialist Following Appeal Filed By Attorneys Dell & Schaefer

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Our client was a top selling account manager in the advertising department of one of the country’s largest companies, in one of the company’s most demanding regional markets. Over the course of her career she exceeded sales quotas that were in the upper six figures, year in, year out.

In mid 2008, our client began suffering from severe anxiety and depression. Unable to handle the tremendous pressure and stress from her occupation, she made a claim for short-term disability benefits under her company’s salary continuation plan. Less than a month later Liberty Mutual denied her claim for disability benefits. It was around that time, our client relocated to be closer to family, and in the process of doing so learned of the law firm of Attorneys Dell and Schaefer. She contacted Dell and Schaefer to assist her in appealing her claim denial.

→ Click here to continue reading Liberty Mutual Reverses Denial Of Short-Term Disability Benefits And Approves Long-Term Disability Benefits For Advertising Account Manager

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The Second Circuit U.S. Court of Appeals has denied First Unum Life Insurance Co.'s request to reconsider a decision in which it found the company arbitrarily denied long-term disability benefits to a tax attorney with colon cancer.  First Unum, a unit of Unum Group (NYSE: UNM), filed the petition for rehearing with the New York-based federal appeals court in January, saying that the court "misapprehended key facts and law" (BestWire, Jan. 9, 2009).

Attempts to speak with Unum Group to see if First Unum plans to appeal to the U.S. Supreme Court were not immediately successful.  According to the December 2008 decision, written by Circuit Judge John M. Walker Jr. for a three-judge panel, First Unum operated under a conflict of interest because it was both the claims administrator and payor of benefits.

→ Click here to continue reading Unum Provident's Appeal of Long Term Disability Benefits Awarded to a New York Tax Attorney Is Denied

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Our client, a breast cancer survivor, was a senior property manager for a large property management company for nearly fifteen years. As a senior property manager, our client was responsible for planning, controlling and directing the day to day operation of multiple properties. Year after year she received numerous recognitions for the quality of her work.

Like many breast cancer survivors, our client experienced cognitive difficulties, commonly referred to as “chemo-brain,” following treatment with chemotherapy and the medication, Tamoxifen. She experienced problems remembering things, focusing, multi-tasking, as well as problems with being able to analyze information in a logical manner. These deficits in her thinking made it impossible for her to continue to perform her job, and in turn she filed for long term disability income benefits with Prudential.

→ Click here to continue reading Prudential Denies Long-Term Disability Benefits To A Breast Cancer Survivor And Attorneys Dell & Schaefer Submit An Appeal

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Our client, a Senior Sales Manager for a large medical supply company, was suffering from severe spinal stenosis and an injury to her ulnar nerve following an epidural steroid injection. As a result of these disabling conditions, our client suffered from a multitude of physical problems, which included: loss of range of motion in the neck and shoulders; loss of grip strength of the left hand; numbness, tingling, and burning of the left forearm, extreme sensitivity to cold temperatures or light touch, and constant pain. The only way to provide some relief to the constant pain was through prescription pain killers, which left our client groggy and unable to focus or concentrate fully.

→ Click here to continue reading MetLife Approves Long Term Disability Benefits for Senior Sales Manager in the Medical Supply Industry

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Attorneys Dell & Schaefer has filed a long-term disability breach of contract lawsuit in federal court against Conneticut General Life Insurance Company (“Connecticut General”) seeking lifetime disability benefits. Our client, a former floor trader on the American Stock Exchange, was disabled due to bipolar disorder, a sickness, from March 1995 until April 2006. In 2004, while our client was totally disabled due to his bipolar disorder, he suffered a hernia injury while carrying a television to his car. Our client ‘s disability policy has been administered by MetLife insurance company, which means that MetLife made the decision to deny his benefits as of age 65.

→ Click here to continue reading Former Financial Trader Files Lawsuit Against Connecticut General Life Insurance (Metlife) Seeking Lifetime Long-Term Disability Benefits

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A federal jury in Boston found that Unum, the nation’s largest disability insurer, had committed fraud in some cases by requiring customers to apply for Social Security benefits even though it knew they were not eligible.

But the verdict, based on a sample of six claims, contained enough ambiguity to leave both sides declaring victory in the case, filed on behalf of the Social Security Administration. In a verdict returned Wednesday, the jury found that two of the disability claims had been fraudulent and two others had showed no evidence of fraud. The jury was unable to reach a decision on the other two cases.

→ Click here to continue reading Unum Found Guilty Of Social Security Disability Fraud By A Federal Jury

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Medical Condition and Occupational Duties

Our Client, an OBGYN (hereinafter referred to as “Dr. OBGYN”), was employed by a hospital when he began to experience anxiety and depression following the filing of a malpractice lawsuit. Our client began drinking alcohol on a daily basis and was subsequently hospitalized for three months as a result of alcoholism, anxiety, depression and suicidal thoughts. Prior to claiming disability Dr. OBGYN’s substantial and material duties involved the delivery of babies, gynecological surgeries and on-call requirements.

→ Click here to continue reading Prudential Reverses Denial on Second Appeal & Pays $260,000 In Past Due Disability Benefits To OBGYN

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On June 19, 2008, the Supreme Court of the United States finally issued their opinion in the case of Wanda Glen v. Met Life. In a 6 to 3 decision announced Thursday, the US Supreme Court ruled that benefit denials by such companies must be examined with caution when circumstances suggest a high likelihood that financial considerations affected a benefits decision. While Ms. Glenn won her case and Met Life was ordered to pay long-term disability benefits, the Supreme Court did not make any significant findings that will change the way that Federal courts must interpret disability benefit denials.  The Supreme Court had an opportunity to modify the standard of review to "de novo" (complete review)  in all conflict of interest disability claim denials, however they did nothing to give employees a better chance of securing disability benefits that have been denied.

→ Click here to continue reading US Supreme Court Attempts To Clarify The Standard Of Review In Denial Of Long-term Disability Benefits

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Carolyn Kinser, an employee of Associates First Capital Corporation filed a lawsuit against Met Life for wrongful denial of disability benefits. Ms. Kinser was disabled from her occupation due to bipolar disorder and major depressive order. Ms. Kinser had been under continued care and treatment with the same psychiatrist for more than ten years.

→ Click here to continue reading Federal Judge Reverses MetLife's Denial of Disability Benefits

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Daniel J. Rochow, the former president of Arthur J. Gallagher & Co., was insured under Life Insurance Co. of North America’s disability plan. The Sixth Circuit affirmed that a disability insurer’s denial of benefits to a former employee who was terminated because his symptoms prevented him from performing his duties was arbitrary and capricious, even though the employee’s diagnosis was not made until after he stopped working.

→ Click here to continue reading Diagnosis of Insured's Medical Condition After Termination of Employment Does Not Preclude Disability Claim

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Pamela A. Ray, an attorney, was insured under a UNUM disability policy. A Denver trial court ruled recently ruled in her favor that working in a large office building was a material duty of a disability claimant’s occupation as an attorney specializing in major real estate, oil and gas and mining transactions. The court determined that UNUM Life insurance Company of America’s denial of benefits was arbitrary and capricious.

→ Click here to continue reading Unum Ordered to Pay Disability Benefits to Attorney Suffering From Sick Building Syndrome

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Carol Shepherd, a fork-lift operator for Daramic, was insured under the company’s group disability plan with Reliance Standard Life Insurance Company. In 2004, Ms. Shepherd had an anxiety attack at work and Daramic suspended her and required that she participate in anger management before returning to work. During her suspension, Ms. Shepherd was receiving treatment at Owensboro Medical Health System Outpatient Counseling Center where she was diagnosed with major depression and anxiety disorder.

→ Click here to continue reading Court Upheld Standard's Decision to Deny Disability Benefits

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Jenny Eberle, an employee of Purdue University, was initially approved for long-term disability benefits by the Prudential Insurance Company of America. Shortly after her claim was approved, a new claims examiner and registered nurse reviewed Ms. Eberle’s medical records and decided to terminate her long term benefits in November 2004.

→ Click here to continue reading Prudential's Motion to Dismiss Claimant's Disability Benefits is Denied

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Larry Mack claimed that he is totally disabled from his occupation as a marriage and family therapist due to diabetes. He sued his disability insurer, Unum Life Insurance Company, after being denied his claim for long-term disability benefits. Unum argued that Mr. Mack is not entitled to long-term benefits because he did not receive “appropriate care” as required by his policy. Mr. Mack admitted to not seeking help from his internal medicine doctor for long periods of time but argued that during these months he was “self-treating” his diabetes by taking Glucophage daily and by monitoring his diet.

The court said such “self-treatment” does not meet the policy requirement that the claimant be under medical treatment in order to receive benefits. The court reasoned that Mr. Mack failed to abide by the standard of care his internal medicine doctor prescribed for diabetic patients, U.S. Judge Linnea R. Johnson granted partial summary judgment to Unum.

Larry B. Mack v. Unum Life Insurance Company of America, No. 06-80308, S.D. Fla.; 2007 U.S. Dist.

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 disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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Kelly Iley, a pharmacist for Kroger Co, was insured under the company’s group long-term disability policy with Metropolitan Life Insurance Company (MetLife). In June 2001, Ms. Iley was diagnosed with lumbar disc disease.

Ms. Iley stopped working in May 2001 and had a discetomy in July 2001 and a fusion surgery in May 2002. She continued to suffer from back pain and filed a total disability benefits claim in November 2001. MetLife initially approved Ms. Iley’s claim but terminated benefits in July 2004, noting the plan’s 24 month limitation period for neuromusculoskeletal and soft-tissue disorders. On appeal, Ms. Iley’s treating physicians submitted statements that she was totally disabled due to radiculopathies. MetLife upheld its denial of benefits and Ms. Iley filed suit in the U.S. District Court for the Eastern District of Michigan, seeking reinstatement of benefits under the Employee Retirement Income Security Act (ERISA).

Upon reviewing the case, Judge Sean F. Cox found that MetLife ignored Ms. Iley’s treating doctor’s diagnosis of radiculopathy and wrongly denied long-term disability benefits under ERISA. Judge Cox found that the plan’s 24 month limitation period did not apply to Ms. Iley and ordered reinstatement of her benefits. The court also awarded Ms. Iley over $20,000 in attorney fees.

Kelly Iley v. Metropolitan Life Insurance Co., et al., No. 2:05-cv-71237, E.D. Mich.; 2007 U.S. Dist.

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 disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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Robin Plummer, a pharmacist for Kmart Corporation, was insured under the company’s group disability plan administered by Continental Insurance Company. In 2003, Hartford Life Insurance Company took over administration of the plan.

Ms. Plummer’s back problems began in 1998 and resulted in anterior and posterior fusion surgery. In 1999, Ms. Plummer began receiving long –term disability benefits. In 2004, Hartford had Dr. Klein examine Ms. Plummer who concluded that she could perform a sedentary job. Shortly after the evaluation, Hartford sent Dr. Klein video surveillance of Ms. Plummer which showed her driving for 30 minutes, shopping in a department store, and carrying her grandchild. After viewing the surveillance tapes, Dr. Klein issued an addendum to his report stating that Ms. Plummer could perform light-duty work and lift up to 25 pounds. Based on Dr. Klein’s report, Hartford terminated Ms. Plummer’s benefits. Ms. Plummer filed suit seeking benefits under the Employee Retirement Income Security Act.

U.S. Judge Thomas M. Rose of the Southern District of Ohio found that Hartford’s termination of benefits to a claimant with chronic back pain was unreasonable. Judge Rose held that the record supports that Ms. Plummer was unable to return to her job as a pharmacist. The judge said that Dr. Klein’s independent medical exam was flawed since he “initially examined Plummer and determined that she was in the sedentary job classification and then changed his opinion based totally upon videos which included observance of Plummer for a total of approximately 13 minutes.” Furthermore, Judge Rose noted that despite the activities in the video surveillance, Hartford’s doctor could not determine if Ms. Plummer “was experiencing pain”. Summary judgment was granted to Ms. Plummer finding that she was entitled to disability benefits under her plan.

Robin Plummer v. The Hartford Life Insurance Co., No. 3:06cv00094, S.D. Ohio; 2007 U.S. Dist.

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 disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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Nancy Mikrut, a pediatric nurse practitioner for Danbury Health Systems, was insured under the company’s group disability plan administered by Unum Life Insurance Company of America. In 1999, Ms. Mikrut was injured in an automobile accident and was unable to return to work due to severe back pain. In January 2000, Ms. Mikrut was diagnosed with spinal stenosis and filed for long-term disability benefits. After an intradiscal electrothermal therapy, Ms. Mikrut has a second surgery in March 2001.

After 24 months of benefits, Unum re-evaluated Ms. Mikrut’s claim. Without meeting her, a Unum medical consultant found Ms. Mikrut capable of full-time sedentary work. In August 2002, Ms. Mikrut’s treating physician told Unum that she was disabled from any occupation in which she had to bend, lift, pull, sit, or stand for periods of time. Unum terminated Ms. Mikrut’s benefits and she filed suit, seeking benefits under the Employee Retirement Income Security Act.

U.S. Judge Stefan R. Underhill of the District of Connecticut found that Unum failed to account for subjective complaints of pain and the treating physician’s opinions before terminating Ms. Mikrut’s benefits. The judge ruled that Unum did not adequately consider an award of benefits by the Social Security Administration. Judge Underhill held that Ms. Mikrut is eligible for continued long-term disability benefits under the plan since she is unable to perform the duties of any gainful occupation. While Unum is not required to credit treating physician’s opinion over other evidence, Judge Underhill stated that Unum cannot “arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of treating physicians.”

Nancy P. Mikrut v. Unum Life Insurance Company of America, No. 3:03cv1714, D. Conn.; 2006 U.S. Dist.

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 disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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Donald Holman, a maintenance technician for Tyson Foods Inc., was insured under Tyson’s group disability plan with Hartford Life and Accident Insurance Co. In April, 2001, Mr. Holman began experiencing headaches and blurred vision. After a cranial MRI, Mr. Holman’s neurologist diagnosed him with a Chiari malformation. Mr. Holman’s neurologist stated he was disabled and Mr. Holman stopped working and filed a claim for long-term benefits.

Hartford consulted their doctor who further confirmed Mr. Holman’s disability stating activities such as lifting, pushing, and pulling could cause further complications in Mr. Holman’s condition. Hartford initially approved Mr. Holman’s claim for benefits but later found he was not totally disabled and terminated benefits. Mr. Holman filed suit in the U.S. District Court for the Western District of Arkansas, seeking reinstatement of benefits under the Employee Retirement Income Security Act.

Judge Jimm Larry Hendren ruled that terminating benefits to a claimant suffering from a rare neurological condition was an abuse of discretion. Judge Hendren said Hartford had objective medical evidence of Mr. Holman’s condition and disregarded the opinion of his treating physicians. “Hartford’s failure was based on an almost total failure to investigate Holman’s claims” stated Judge Hendren and found Mr. Holman entitled to long-term disability benefits.

Donald Holman v. Hartford Life and Accident Insurance Co., No. 04-5305, W.D. Ark.; 2006 U.S. Dist.

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 disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability insurance attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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James Linnen, a powerhouse operator for Goodyear, Tire and Rubber Company, was insured under his company’s group disability plan issued by Continental Casualty Company. Mr. Linnen began collecting long-term disability benefits for narcolepsy and cataplexy in 2001. In 2004, Hartford Life and Accident Insurance Company purchased Continental and reviewed Mr. Linnen’s disability status. After the treating physician admitted Mr. Linnen was capable of sedentary work, Hartford terminated Mr. Linnen’s benefits in April 2005. Hartford found alternate occupations Mr. Linnen could perform such as cage boss and order parts clerk. Hartford upheld its decision in appeal and Mr. Linnen sued, seeking benefits under the Employee Retirement Income Security Act. (ERISA)

Judge David S. Dowd Jr. of the Northern District of Ohio reviewed Hartford’s decision to terminate benefits and ruled that Hartford used the wrong standard in assessing if Mr. Linnen was entitled to long-term benefits. The policy states the claimant must be unable to “engage in any substantially gainful occupation for which you are, or may reasonably become, qualified by your education, training or experience”. Judge Dowd ruled the term “substantially” alters the definition and Hartford should have assessed whether Mr. Linnen was able to obtain “substantial gainful employment” before terminating benefits. However, if employment is available that pays nearly the same wages and benefits, benefits could possibly be terminated.

James Linnen v. Hartford Life and Accident Insurance Co., No. 05:06CV0141, N.D. Ohio; 2006 U.S. Dist.

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 disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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Ms. Deborah Donovan, an input shift operator for Eaton Corp, was insured under the company’s self-funded group disability plan. Due to degenerative disk disease, chronic back pain and leg pain, Ms. Donovan filed a claim for total disability benefits in 1993.

→ Click here to continue reading Broadspire's Attempt to Deny Disability Benefits After Paying for 10 Years is Denied

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Mr. Mark J. Schwartz, an accountant, was insured under his employer’s group disability plan, sponsored by Metropolitan Life Insurance Co. (MetLife), which limits disability benefits for mental illness to 24 months, but to age 65 for a physical disability.

→ Click here to continue reading MetLife Ordered to Pay Disability Benefits Beyond 24 Months For a Claimant with Both Mental and Physical Disabilities

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Sandra Mikolajczyk, an employee of ABN AMBRO North America Inc., was awarded disability benefits for her depression, fatigue, chronic C6 radiculopathy, carpel tunnel syndrome, cholloid brain cyst, multivalve prolapse, cervical disc surgery, anterior cervical neural decompression and other disorders. Ms. Mikolajczyk was insured by her company’s group disability policy with Broadspire Services, Inc.

→ Click here to continue reading U.S. Judge Orders Broadspire to Reinstate a Former Bank Employee's Disability Benefits

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June 23, 2006, U.S. District Judge Joe B. McDade of the Central District of Illinois Ruled in favor of Susan Svejda, an employee of Mercantile Bancorp. Ms. Svedja was employed with Mercantile until 2002. After several visits to physicians and her neurologist, Dr. Douglas Sullivant, M.D., Ms. Svedja was diagnosed with MS, Chronic imbalance, depression and bowel problems including IBS (Irritable Bowel Syndrome) which require her to frequently rush to the bathroom, often times not making it due to other infirmities. As a result of these conditions, Ms. Svedja stopped working and applied for long-term disability benefits from Mercantile’s insurance contract with Continental. 

→ Click here to continue reading US District Judge Rules for Disability Claimant

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Rosa Wood had carpel tunnel syndrome and left work in 1999 because of it. After receiving short term disability benefits and undergoing back surgery, Ms. Wood applied for long term benefits. Initially, Ms. Wood’s claim for benefits was denied however her plan eventually agreed to pay benefits for the first phase of long term disability. Under the first phase, claimants are entitled to benefits for seven to twenty-nine months based on their ability to perform any substantial gainful work. Prudential then denied long-term disability benefits to Ms. Wood during the second phase which would continue benefits beyond the twenty-nine months. After two internal appeals, Ms. Wood sued Prudential in Federal Court.

→ Click here to continue reading California Federal Court Rejects Prudential's Attempt to Limit Claim

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Lawrence Levy, M.D., insured under two disability policies with Minnesota Life Insurance Co., became disabled in March 1996 and has been receiving total disability benefits due to osteoarthritis in his right knee. Dr. Levy claims his disability is an “injury” rather than a “sickness” because the osteoarthritis is due to a basketball injury. The policy provides disability benefits to the age of 65 if the disability is caused by “sickness”, disability benefits will be paid for life is the disability is caused by an “injury”.

U.S. Magistrate Judge Sidney I. Schnekier said the best interpretation of the policy is the term “immediate cause”. Under the immediate cause standard, Dr. Levy’s disability is due to sickness. The Judge stated the knee pain is due to degenerative arthritis and should characterize as a “sickness” under the long-term disability policy. Dr. Levy’s benefits will terminate at age 65.

Lawrence B. Levy, M.D. v. Minnesota Life Insurance Co., No. 03-C-5141, N.D. Ill.; 2006 U.S. Dist.

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 disability attorneys have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. Attorney Gregory Dell is a nationally recognized disability attorney and the author of a long-term disability insurance law book published by Thomson Reuters, which is a legal reference for attorneys and judges. For a free consultation, please call 800-828-7583 or use our contact page.

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Robert Clarke, a market sales manager for Allstate Insurance Company, stopped working in 1992 due to lumbar spinal stenosis, claiming he was unable to sit, stand, or walk for more than 10 minutes. Mr. Clarke was insured under his company’s group disability plan administered by Metropolitan Life Insurance Co. and was paid total disability benefits as of 1992. After several back fusion surgeries in 1990, 1992, and 1994, MetLife approved Mr. Clarke’s initial claim for benefits. In 2002, after paying total disability benefits for more than 10 years, MetLife decided to terminate Mr. Clarke’s disability benefits and claim that Mr. Clarke could perform sedentary work.

→ Click here to continue reading MetLife's Attempts to Stop Paying Total Disability Benefits After Paying Claimant for 10 Years is Denied

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