Disability Insurance Industry News

In this video Attorneys Gregory Dell and Cesar Gavidia discuss the importance of treating doctor’s to document every complaint and limitation of a disability insurance claimant. They also teach you how to keep your complaints and limitations journaled for your medical team.
Continue Reading Failure of Comprehensive Doctor Documentation Can Result in a Denial of a Disability Insurance Claim

Disability insurance policy holders that have been denied benefits have to act expeditiously to reverse their denial. There are two types of LTD policies – ERISA – purchased through your employer or an Individual disability insurance policy – purchased on your own. Each type of plan has their own set of guidelines to appeal a denial of benefits. In this video attorney Gregory Dell and Stephen Jessup discuss the processes to appeal your denial.

A lump sum buyout, also known as a disability settlement, is one payment for the agreed upon value of a claimants disability insurance policy. After this onetime payment is made, the claimant will no longer be paid benefits on a monthly basis.
Continue Reading If you are currently receiving long-term disability benefits from your insurance carrier you may be able to receive a lump sum buyout

In Corey v. Sedgwick Claims Management Services, Inc., plaintiff Bruce Corey began working as a machine operator for Eaton Corporation in 1987. Beginning in February 2014, he was periodically granted short term disability benefits when he took a few days off of work due to cluster headaches. On May 8, 2014, Corey quit working completely and again applied for short term benefits.
Continue Reading Due to Lack of Objective Evidence, Ohio Court Upholds Sedgwick’s Denial of Short Term Disability Benefits

Plaintiff Christina Saunders was employed by Proctor & Gamble when she had surgery for an ectopic pregnancy. At that time, disability claims for those employed by Proctor & Gamble in Michigan, like the plaintiff, were handled by a third party administrator, the Reed Group (Reed). Even though plaintiff did not return to work on the date her doctor said she could, Reed approved her for total disability benefits.
Continue Reading Court Affirms Procter & Gamble’s Termination of Long Term Disability Benefits

Although this California non-ERISA disability policy litigation was not handled by our disability insurance lawyers, it is relevant to contract law for those who are employed by a state or federal government and have long term disability policies not covered by ERISA.

California insurance law, not ERISA, applies to a lawsuit against a disability insurer by a former government employee

The plaintiff in Klees v. Liberty Life Assurance Company of Boston, a former employee of the University of California, a governmental employer, was initially approved for long term disability benefits due to her many medical conditions, including fibromyalgia, seronegative inflammatory arthritis and injuries she had suffered in a car accident.

When Liberty terminated the plaintiff’s benefits, she filed a lawsuit alleging breach of contract and breach of the covenant of fair dealing. Liberty responded and, among other arguments, relied on published cases citing the Employees’ Retirement Income Security Act (ERISA) in a motion to dismiss the lawsuit. The California federal court labeled Liberty’s citations of ERISA law as a “red herring” in that ERISA specifically exempts government employers from its provisions.

The termination of long term disability came after three independent medical examiners determined the plaintiff could work in some capacity. Liberty tried to convince the court to apply the ERISA definition of disability instead of using the definition of disability as it was defined in the policy terms. The California federal court had no patience with Liberty stating, “ERISA cases are irrelevant to California insurance law.”

Since the question of whether or not the plaintiff was totally disabled under the terms of the contract required resolution under California insurance law, and not by the definition of disability found in inapplicable ERISA law, Liberty’s motion to dismiss the lawsuit was denied.

If you have questions regarding your claim for disability benefits, or if your disability claim has been denied, call Disability Attorneys Dell & Schaefer for a free consultation.