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

Resolved Cases:
CIGNA denies benefits after paying for 10 years, but Disability Attorney Stephen Jessup wins benefits for 60 year old client with fibromyalgia

For ten years our client was receiving long term disability benefits from CIGNA under an ERISA governed Group Disability Policy (Jaycor) due to a litany of medical conditions, which included Adult Onset Still’s Disease, Chronic Pain, Fibromyalgia and Fatigue. During the course of his claim and well prior to CIGNA’s termination of benefits, he had already met and passed the own occupation to any occupation definition change, had been approved for disability benefits by the Social Security Administration, and had even been approached by CIGNA on several occasions for a lump sum buy out of his policy. For all intensive purposes it would seem that at the age of 60 and the decade long history of his claim that CIGNA would not challenge the claim. However, CIGNA proved the adage that disability benefits are never guaranteed benefits.

Disability Blog & Cases:
California Court orders CIGNA to disclose amount paid to MES Solutions for medical reviews

CIGNA Insurance Company can run but they can’t hide. Recently, the US District Court for the Central District of California granted Plaintiff Bradley Wojno’s Motion to Compel Defendant CIGNA Insurance to reveal the extent of it financial relationship with MES Solutions. Mr. Wojno’s California disability attorney sought information from CIGNA that could unveil potential conflicts and biases of CIGNA’s hired gun doctors relied upon to terminate Mr. Wojno’s disability benefits.

Disability Blog & Cases:
Federal Judge orders Sedgwick Claims Management to pay disability benefits to PNC Financial Services Group, Inc’s Collection/Recovery Team Manager

Disability claimants need to be extremely cautious when dealing with Sedgwick Claims Management Service Inc. (Sedgwick). From our law firms’ experience of handling thousands of disability insurance claims, Sedgwick is one of the top three most difficult companies to deal with. Unfortunately, Sedgwick will capitalize on any opportunity to deny a claimant their disability benefits. This case discusses the unreasonable conduct used by Sedgwick to wrongfully deny disability benefits.

Disability Blog & Cases:
Standard Insurance Company’s attempt to dismiss disability insurance lawsuit is denied in-part by Florida Federal Judge

Disability claimant challenges Standard Insurance Company’s attempt to limit disability benefits to 24 months under the “Other Limited Conditions” provision.

Disability Blog & Cases:
Life Insurance Company Of North America denies disability benefits and battles claimant for 4.5 years in Federal Court

LINA should be embarrassed and show some respect for a former payroll clerk that had no ability to work due to numerous medical conditions. After litigating for more 4.5 years since her wrongful denial of disability benefits, Ms. Dupree finally received a ruling in her favor from the United States Court of Appeal. LINA fought this disability claim until there were no more courts left for them to appeal to. While, Ms. Dupree eventually won her disability benefits, it is sad that she had to battle for 4.5 years without any payment from LINA. LINA essentially left Ms. Dupree out in the cold. Unfortunately, Dupree’s only remedy is payment of her benefits, interest and attorney fees. This case is a prime example of the wrongful conduct by LINA and the exact reason that punitive damages should be allowed.

Disability Blog & Cases:
California Judge grants disability claimant’s request to investigate Hartford Life And Accident Insurance Company’s relationship with hired doctors

In Mary Carten vs. Hartford Life and Accident Insurance Company, Group Long Term Disability Plan for Employees Of FMR Corporation, the plaintiff brought the civil lawsuit in a California Federal Court under the Employment Retirement Income Security Act (ERISA) to challenge a denial of disability benefits made by the Hartford Life and Accident Insurance Company (Harford). The plaintiff requested an opportunity to conduct discovery into Hartford’s claims handling practices in order to determine if Hartford’s wrongful denial her long term disability benefits was done with a conflict of interest. It is ironic that Harford denies disability benefits and then tries to do whatever they can to hide the existence of their financial relationship with the doctors they hire. Hartford is suppose to be the fiduciary of Ms. Carten. Hartford’s actions clearly suggest that they are not acting in the best interest of Ms. Carten.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Disability Blog & Cases:
California disability attorney sues Standard Insurance Company for denial of long term disability benefits payments to paraplegic

In the case of D. Nielsen Pollock Vs Standard Insurance Company, filed at the District Court for the Southern District Of California, the plaintiff complained that the Standard Insurance Company (Standard Insurance) have breached the Employee Retirement Income And Security Act Of 1974 (ERISA) and suing for the recovery of disability benefits under the terms of an employee benefit plan for which Standard Life is the insurer of benefits under the “DILLINGHAM CONSTRUCTION HOLDINGS INC. GROUP LONG TERM DISABILITY INSURANCE POLICY.”

Disability Blog & Cases:
Hartford Life And Accident Insurance Company denies disability benefits and prevails in lawsuit filed by operator for Mohawk Inc.

When making a case for a claim of disability benefits, it is essential that a claimant has strong medical support from treating physicians. The disability insurance companies are not under any duty to help a claimant further his or her claim for disability benefits. It is the burden of the claimant to ensure that he or she had provided sufficient proof of his or her disability status. This case of Almetta T. Campbell Vs. Hartford Life And Accident Insurance Company is a good example of how a disability insurance company can easily win a disability denial if the administrative record does not have strong medical support. Disability claimants must anticipate and be prepared for a change of the policies definition of disability from own occupation to any occupation. ERISA governed policies can make it difficult for disability claimants to prevail.

Disability Blog & Cases:
Court Of Appeals agrees with Texas Judge that UNUM did not abuse its discretion in denying Accenture LLP’s employee’s claim for disability benefits

In the case of Gwendolyn Byrd vs. UNUM Life Insurance Company Of America, the plaintiff filed a lawsuit in Texas federal court to challenge the Unum Life Insurance Company’s (Unum) decision to terminate her long term disability benefits after paying for 5 years. In the review for the abuse of discretion, the District Court granted summary judgment to Unum. The plaintiff is appealing this decision by the District court.

Disability Blog & Cases:
Appellate Court denies Liberty Mutual’s attempt to recover $163,661.57 in disability benefits paid to disability claimant and business owner

After 5 years of receiving long term disability benefits, Robin Dolan suddenly receives a letter in 2006 from Disability Reinsurance Management Services stating that her disability benefits had been wrongfully calculated and she must repay $163,661.57. Approximately 5 years after receiving this dreadful letter and extensive litigation, Ms. Dolan has finally received an Appellate Court ruling stating that Liberty Mutual was wrong in their interpretation of the disability policy. Unfortunately Ms. Dolan has had to suffer through the unreasonable actions of Liberty Mutual and their third party administrator DRMS.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Disability Blog & Cases:
Disabled project manager for RTP Technology Corporation filed lawsuit against the UNUM Life Insurance Company of America for refusal to pay disability benefits

A New Jersey disability attorney recently instituted a lawsuit against the UNUM Life Insurance Company of America (UNUM) at the District Court for the District of New Jersey of behalf of a disabled client. In Robert Garozzo v UNUM Life Insurance Company of America and RTP Technology Corporation long term disability plan, the plaintiff Robert Garozzo is seeking payment of disability income benefits from UNUM under the terms of a long term disability Benefit plan.

Disability Blog & Cases:
Disabled interventional radiologist with sleep apnea and cardiac limitations sues Unum Provident and Hartford Life for denial of long-term disability benefits payments

For a disability insurance contract, one of the most important clauses in the contract will be the “own occupation” definition of what constitutes disability. The implication of this clause is that if you become “disabled” due to sickness or injury and are unable to work in your specific line of work, the insurance policy will pay you disability benefits even if you decide to work in another line of employment.

Disability Blog & Cases:
AT&T employee with back injury sues Sedgwick Claim Management Services, Inc. for denial of short term disability benefits

Florida Disability Lawyer Sues Sedgwick Claim Management Services

In the case of Richard Shane Burnett Vs Sedgwick Claim Management Services, Inc. D/B/A AT&T Integrated Disability Service Center, filed at the District Court for the Middle District of Florida, the plaintiff Richard Shane Burnett alleged that he is eligible for short term disability (STD) benefits under an employee benefit plan provided by his employer.

Disability Blog & Cases:
Unum Insurance claims no object evidence exist and denies disability benefits to St. Anthony Central Hospital nurse suffering from fibromyalgia

Colorado disability lawyer files lawsuit against Unum Life Insurance Company Of America for denying long term disability benefits and wrongfully asserting no objective test exist to diagnose fibromyalgia

In Kelly Ann Curtis vs Unum Life Insurance Company of America, a Colorado disability attorney filed a lawsuit on behalf of a disability claimant against the Unum Life Insurance Company of America (Unum) at Denver County District Court. The case is quite interesting as it illustrates how disability insurance companies can, by applying certain limiting clauses in disability insurance contracts, avoid paying out disability benefits to the insured.

Disability Blog & Cases:
Fifth Circuit Court Of Appeal denied Estate Of Pepsiamericas, Inc.’s employee motion to recover accidental death and dismemberment benefits from group disability insurance plan issued by Unum

Recently the Court of Appeal Fifth circuit rendered their opinion in the case of Mary Ann LETTER, Individually and as Executrix Administratrix of the Estate of Timothy D. Letter vs. UNUM PROVIDENT CORPORATION; Unum Life Insurance Company of America. They ruled that the plaintiff Mary Ann Letter, individually and as acting as the estate of her husband Timothy D. Letter was not entitled to recover Accidental Death And Dismemberment (AD & D) benefits from her deceased husband’s group insurance plan due to non payment of premium.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Disability Blog & Cases:
Washington disability attorney filed lawsuit against the Hartford Insurance Company for denial of long term disability benefits to mentally disabled woman

A Washington disability attorney recently filed a lawsuit on behalf of his client at the District Court for the Eastern District of Washington against the Hartford Insurance Company (Hartford). In the case of Robin (Hunt) Hankel v The Hartford Insurance Company /The Hartford Financial services Group, the plaintiff was a woman employed in the health Safety and Environmental Management/ Engineering field for Harpers. While employed with Harpers, she contributed to a disability insurance plan which was issued by Hartford.

Disability Blog & Cases:
Fort Dearborn Life Insurance Company faces disability denial lawsuit from disabled account clerk of Katz Insurance Group diagnosed with PTSD

Recently, a former account clerk of the Katz Insurance Group filed a lawsuit against the Fort Dearborn Life Insurance Company (Fort Dearborn Life) through a Maryland disability attorney at the District Court for the District of Maryland. In the case of Tosha Pederson v Fort Dearborn Life Insurance Company, the plaintiff alleged that Fort Dearborn Life had acted arbitrarily and capriciously in its decision to deny the plaintiff's claim for long term disability (LTD) benefits.

Disability Blog & Cases:
Northwestern Mutual Life Insurance Company denies partial disability benefits to trial attorney resulting in lawsuit for violations of Washington Insurance Fair Conduct Act

The Northwestern Mutual Life Insurance Company (Northwestern Life) was recently sued by a Washington disability lawyer for the violations of the Washington Insurance Fair Conduct Act and Washington Consumer Protection laws. In Kurt D. Bennett v The Northwestern Mutual Life Insurance Company, the plaintiff alleged that Northwestern Life in denying the plaintiff's claims for disability benefits was in violation of the above mentioned laws and breached the terms of the disability insurance policy.

Disability Blog & Cases:
Disabled employee of University Of California Davis diagnosed with fibromyalgia sues Liberty Mutual for denial of disability benefits and seeks punitive damages

Recently a California disability attorney filed a lawsuit against the Liberty Life Assurance Company of Boston (Liberty Life) at the Superior Court of the state of California. In the case of Cassie Ray v Liberty Life Assurance Company of Boston, the plaintiff alleged that by denying the plaintiff's claim for disability benefits, Liberty Life, among other things, had caused the plaintiff to suffer damages. This disability policy is not governed by ERISA as the claimant is a government employee.

FAQ: General Questions
How can a claimant exclude their disability insurance benefit payments from Federal Income Tax?

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Disability Insurance Law TV:
A Senator's view of ERISA disability insurance claims

This video features the testimony of Montana United States Senator Max Baucus at a Senate Finance Committee Meeting. Senator Baucus focuses his testimony on the problems with ERISA disability insurance laws and the unfair claims handling practices of disability insurance companies. Senator Baucus pays specific attention to two long term disability insurance claims that were wrongfully denied by The Standard Insurance Company and Hartford Financial Insurance Company.

Disability Blog & Cases:
Reliance Standard Insurance Company and Lincoln National Life Insurance Company attempt to avoid payment of disability benefits by ignoring claimant’s application

Eric Wilson has brought a lawsuit in the United States District Court of the Eastern District of Louisiana against Reliance Standard Insurance Company and Lincoln National Life Insurance Company because the companies have refused to reply either pro or con to his petition for disability benefits in compliance with his insurance policy contract.

Disability Blog & Cases:
Sun Life Assurance Company of Canada sued by gunshot victim for failure to pay long term disability benefits

A recent Sun Life disability claim by a gunshot victim ended up as a lawsuit in the Orange County Superior Court because of the reluctance of the disability insurance company to pay out any long term benefits to its plan’s participants. In Marilyn Ellis v Sun Life Assurance Company of Canada, the plaintiff Marilyn Ellis with her California disability attorney contended that she was at all times a participant to a group long term disability plan with the policy number 63311 that was provided by the Sun Life Assurance Company (Sun Life). As such, she argued that she was a beneficiary of the plan and is entitled to the long term disability benefits that were offered in the plan.

Disability Blog & Cases:
Federal Judge orders Union Security (Assurant) to re-evaluate disability denial due to failure to consider risk of substance abuse relapse as disabling condition

In any claim for any disability benefits, the deciding factor which disability insurance companies will decide on will be whether you are what they define as being “disabled” or not. Most insurance companies however, will try to define the scope of what constitutes “disabled” as narrowly as possible to their advantage. The situation is especially compounded when a claimant is disabled due to substance abuse. Substance abuse cases involved both physical disabilities and mental disabilities...

Disability Blog & Cases:
SunLife & Aetna Life Insurance Company sued for denial of disability benefits

Here are examples of two recent cases in which SunLife Insurance Company and Aetna Life Insurance Company had a structural conflict of interest and denied disability insurance benefits. In most long term disability insurance claims which are governed by ERISA there is an inherent structural conflict of interest. The conflict of interest exist because the disability insurance company not only pays the benefits, but has the ultimate authority to approve or deny benefits. How can a disability company act a fiduciary to the insured when at the same time a decision to pay benefits will reduce the net income of the company?

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Disability Blog & Cases:
Hartford Financial’s mental nervous disorder limitation clause in disability insurance policy held ambiguous

The United States Court of Appeals for the Ninth Circuit recently ordered a lower court to reconsider its decision that had affirmed Hartford Financial Insurance Company‘s denial of a woman’s claim for disability benefits. Although the claimant has not yet been awarded her requested disability benefits, the Appeals Court’s decision leaves her one step closer to achieving this goal.

Disability Blog & Cases:
Life Insurance Company of North America, part of CIGNA Corporation, sued for refusing disability insurance benefits for mentally ill teacher

Disability Insurance Attorneys Dell and Schaefer filed a Federal Lawsuit against Life Insurance Company of North America (LINA), which is part of CIGNA Corp (CI.N). The lawsuit was filed after Cigna refused to pay disability benefits to a Florida teacher forced to stop working due to mental health issues such as depression, bipolar disorder and schizophrenia.

Disability Blog & Cases:
Federal lawsuit against Hartford Insurance alleges company refuses to pay disabled Patriot Act analyst

A Federal lawsuit filed in United States District Court Southern District of Florida accuses the Hartford Life and Accident Insurance Company of breaching its contract with Branch Banking and Trust (BB&T) and a BB&T employee. Filed by noted disability insurance law firm Dell and Schafer, the suit states that Hartford is refusing to pay benefits to the employee, a U.S. Patriot Act/Anti-Money Laundering Analyst. The refusal by The Hartford violates the Employee Retirement Income Security Act of 1974, commonly referred to as ERISA.

Disability Blog & Cases:
Disability insurance lawsuit against Guardian Life Insurance serves as warning to doctors

A lawsuit filed in the United States Southern District Court of New York reveals that The Guardian Life Insurance Company of America is refusing to pay long term disability insurance benefits to a New Jersey OB/GYN critically injured in a car accident.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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.

• Email This
• Print
• Comments (4)
• Trackbacks
• Share Link

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

• Email This
• Print
• Comments (1)
• Trackbacks
• Share Link

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

• Email This
• Print
• Comments (1)
• Trackbacks
• Share Link

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

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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.

• Email This
• Print
• Comments
• Trackbacks
• Share Link

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.

• Email This
• Print
• Comments
• Trackbacks
• Share Link