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.
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.
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 PoliciesFor 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.
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.
Attorneys Gregory Dell and Cesar Gavidia filed a lawsuit in Federal Court, after The Standard denied our client long-term disability benefits. Our client, an invasive cardiologist, has been unable to work in his occupation as result of neck, back and shoulder problems. Our client purchased his long-term disability policy as a benefit offered through his membership in the Southern Medical Association. Our client has been unable to perform the duties of an invasive cardiologist due to the requirement that her wear a heavy lead apron during most of the cardiac surgeries he performs on patients. Our client’s claim is supported by his treating neurologist.
The Standard relies on the paper review of our client’s file by two neurologist in order to deny disability benefits. Moreover, while reviewing the claim, the Standard never bothered to take into consideration what percentage of our client’s occupational duties required him to wear a lead apron. During the recent depositions of The Standard employees, none of the employees had any idea how much a lead apron weighs, how long our client would need to wear the lead apron during a procedure, or specifics about the procedures that an invasive cardiologist performs. The Standard was of the opinion that our client should have no restrictions and limitations, and that the only reason he gave up his career as an invasive cardiologist was so that he could work as a chief medical officer for a medical tool manufacturer.
It is interesting to note that our client had a long-term disability policy with Unum Provident and the definition of disability during the first two year of benefits was almost identical to the definition of disability in the The Standard long-term disability policy. Unum Provident evaluated our client’s claim and determined that he was unable to perform his duties as an invasive cardiologist. Furthermore, Unum Provident’s outside neurologist reviewed our client’s medical records and opined that our client should not wear a lead apron and therefore would be prevented from working as an invasive cardiologist. During deposition of the Standard employees, they did not have any explanation as to how Unum Provident’s doctor could find that our client had restrictions and limitations, but The Standard’s doctors found that our client was perfectly healthy.
The Standard recently filed a Motion for Summary Judgment and basically alleged every possible defense they could think of, in hopes that something would stick. Attorneys Gregory Dell and Cesar Gavidia believe that the motion filed by the Standard is a desperate attempt to further their denial of long-term disability benefits. A response to the motion for Summary Judgment is currently being drafted and the jury trial is set for October 2009 in Federal Court.
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.
Prior to her suspension, Ms. Shepherd worked the swing shift but when it was time to return to work she requested the day shift because her treating physician believed the sleep disturbances would aggravate her psychological conditions. When Daramic refused to give Ms. Shepherd the day shift her doctor said she could not return to work and Ms. Shepherd applied for long-term disability benefits.
Reliance denied Ms. Shepherd’s claim stating that she is not totally disabled and had their own reviewing psychiatrist evaluate her medical records. Reliance upheld its denial of benefits on appeal and Ms. Shepherd sued, seeking benefits under the Employee Retirement Income Security Act (ERISA).
After reviewing the case, U.S. Judge Joseph H. McKinley Jr. of the Western District of Kentucky found that Reliance’s decision to deny benefits was reasonably supported by Ms. Shepherd’s medical record. The judge rejected Ms. Shepherd’s claim that Reliance failed to conduct a personal psychological evaluation since the company’s psychiatrist “thoroughly reviewed Ms. Shepherd’s medical record and relied on the evidence therein to form his opinion.” Judge McKinley found that there was no competent medical proof in the record to support a disability claim.
Carol Shepherd v. Reliance Standard Life Insurance Co., No. 4:06CV-83, W.D. Ky.; 2007 U.S. Dist.
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