Disability Insurance Cases Nationwide

Davis v. Aetna Life Insurance Company (Aetna) involves a case where a plaintiff filed an ERISA lawsuit against Aetna alleging that she should receive long-term disability benefits under her employee benefit plan. As it turns out, there was no evidence she had ever submitted a claim for benefits. When Aetna filed its Motion for Summary Judgment, plaintiff failed to file an opposition. The Court determined there was no material issue of triable fact and granted Aetna’s motion.
Continue Reading Louisiana Court Grants Aetna’s Unopposed Summary Judgment Motion

Insurance companies are notorious for relying on file reviews when reviewing disability claims and, unlike claims for social security disability benefits, insurance companies are often allowed to rely on file reviews even in spite of conflicting opinions by treating physicians who are arguably in a better position to assess the functional limitations of an individual. However, insurance companies cannot arbitrarily dismiss the opinions of credible treating physicians without providing an explanation and in certain circumstances courts have found that mere file reviews are insufficient to serve as a basis to deny a claim for benefits.
Continue Reading Liberty Life was wrong for relying on a mere psychiatric file review in reviewing mental health claim for disability benefits

People often contact us asking how they can be approved for Social Security Disability benefits yet be denied by their insurance company. Another recurring question is how the insurer can rely on the opinion of a physician hired to perform a file review over the opinion of a treating physician. While insurance companies are allowed to make a decision that is different from the SSA and/or rely on their own file reviews in many cases, they cannot do so arbitrarily. In other words, they have to provide a reason why they rely on such information over other, perhaps more credible information.
Continue Reading Michigan District Court overturns denial of benefits by Liberty Life Assurance Company of Boston

In Jacowski v. Kraft Foods, et al., the Federal District Court for the Western District of Wisconsin denied plaintiff Kathy Jacowski‘s claim that Aetna arbitrarily and capriciously terminated her long-term disability benefits in violation of ERISA.
Jacowski began working for Kraft Foods in 1981. In 2008, Jacowksi quit her job, citing her poor mental health. Her treating physician diagnosed her with depression, anxiety, and post-traumatic-stress disorder. In 2011, she was notified by Aetna, the insurer that Kraft contracted with to administer its disability benefits, that she qualified for total disability benefits. She received these benefits until February, 2014, when they were terminated.
Continue Reading Aetna Defends Claim of Arbitrary and Capricious Disability Benefits Termination

In Stupar v. Metropolitan Life Insurance Company (MetLife), plaintiff, an icer with the Kroger Company, received 24 months of long term disability benefits due to her diagnoses of post-traumatic stress disorder (PTSD), major depression, panic and anxiety disorder. At the end of the two-year period, MetLife terminated her benefits on the grounds that she was limited to 24 months of benefits under the Mental or Nervous Disorders clause of the policy. She objected, exhausted her administrative remedies, then filed this ERISA lawsuit.
Continue Reading MetLife Properly Limited Plaintiff’s Disability Benefits Under the Mental/Nervous Limitations Clause

In Schmitz v. Sun Life Assurance Company of Canada (Sun Life), the claimant, Jeff Schmitz, was fired by Banner Engineering in July 2008 on the grounds his work performance was poor. In October 2011, Schmitz was diagnosed with multiple sclerosis. He then filed for disability benefits under the policy which covered him during his employment with Banner. He claimed symptoms caused by his multiple sclerosis were what caused his poor performance resulting in him being terminated. Therefore, he argued, he was disabled at the time he was fired.
Continue Reading Court Affirms Sun Life’s Disability Benefit Denial

Susan Till v. Lincoln National Life Insurance Company (Lincoln) is a 74 page opinion in which the plaintiff, a radiology technician who suffered with severe back pain, raised many issues in her pursuit of long-term disability benefits. Till’s application for long term disability benefits was denied and, after she exhausted her administrative appeals, she filed this ERISA law suit.
Continue Reading Alabama Court Upholds Lincoln Life’s Disability Denial to Plaintiff

Collins v. Unum Life Insurance Company of America is a case with an unfortunate result for plaintiff Daniel Collins who fractured his ankle when he fell in the employee parking lot. Initially surgery was performed and various screws put in place to hold the tibia and fibula together and securing the medial malleolus. For about three months, he had no complaints and the fracture appeared to be healing appropriately.
Continue Reading Ohio Court Upholds Unum’s Denial of Accidental Dismemberment Benefits

In Rassekh Sobh v. Hartford Life and Accident Insurance Company, Hartford paid the plaintiff benefits beyond his own occupation period as a Technical Operations Lead for Chase Bank and into the any occupation period. During that time, plaintiff had two back surgeries and claimed he was disabled. His medical records and reports from his treating physician supported his claim and he received disability benefits for many years from 2009 to 2014. His treating physician, Dr. Dryer, waffled between supporting his disability claim, failing to respond to Hartford’s request for an opinion and reporting plaintiff could work in a sedentary job.
Continue Reading Appeals Court Upholds Hartford’s Termination of Disability Insurance Benefits

Kresich v. Metropolitan Life Insurance Company (MetLife) is a federal case out of the Northern District of California favorable to a plaintiff who was harassed, accused of lying and oppressed during the processing of his disability claim. Because of MetLife’s conduct, the plaintiff sued for intentional infliction of emotional distress (IIED). Despite MetLife’s vigorous argument that the claim was preempted by ERISA and the plaintiff could not pursue his tort action, the court disagreed and found in favor of the plaintiff. Relying on precedent, the court stated “Plaintiff’s IIED claim stems not from the handling and disposition of his claim, but from independent allegations of harassment and oppressive conduct. There is no alternative enforcement mechanism under ERISA by which Plaintiff could bring such a claim.” Continue Reading California Judge Allows Lawsuit for Intentional Infliction of Emotional Distress Due to Manner in Which MetLife Investigated Disability Claim