Disability insurance attorneys Gregory Dell & Cesar Gavidia discuss “factual disability” versus “legal disability” for occupations that require a license to practice such as lawyers, chiropractors, financial planners, or doctors.
In Colon L. Carter v. Aetna Life Insurance Company, the U.S. District Court for the District of Maine held that Aetna did not act arbitrarily and capriciously in denying Plaintiff’s claim for long term disability (LTD) benefits. Specifically, the Court held that “the insurer had a reasonable basis and sufficient evidence to deny the plaintiff’s claim for benefits. The Court therefore grants the insurer’s and denies the plaintiff’s motion for summary judgment.”
Continue Reading Court Holds Substantial Evidence Supports Aetna’s Denial of LTD Benefits
In Pamela Fleming v. Unum Life Insurance Company of America (Unum), Plaintiff, a litigation attorney, was in a car accident in 1994 and suffered serious injuries to her spine. She never fully recovered and by July 2005, she was only able to work four hours a day and eventually had to completely stop working.
In December 2005, Unum approved Plaintiff’s claim for LTD benefits. Through the years, she periodically submitted updated medical records and continued to receive benefits until September 26, 2016, when Unum informed her by letter that her benefits were terminated. Unum stated that it believed she was no longer disabled and could return to work. After exhausting her administrative remedies, Plaintiff filed this ERISA lawsuit.
Continue Reading Court Rules Unum Life Insurance Company Wrongfully Terminated LTD Benefits
In Kevin C. McCusker v. Unum Life Insurance Co. of America, Et al., Plaintiff found his wife dead in their house on February 10, 2016. The wife had been employed by Fidelity Bank where she was a participant in a group life and accidental death plan through Fidelity’s employee welfare benefit plan. Plaintiff was named as the beneficiary. Under the plan, “Unum is vested with discretionary authority to make benefit determinations…”
Continue Reading Court Remands to Unum for Review of Plaintiff’s Claim for Death Benefits
In the case of Cheryl L. Wallace v. Reliance Standard Life Insurance Co., the U.S. District Court for the Eastern District of Michigan, Southern Division, previously held that “the administrative record undisputedly reflects that Plaintiff is totally disabled and entitled to LTD benefits under Reliance’s plan.” In the earlier case, the Court also ordered Reliance to pay Plaintiff’s legal fees and also ordered for the parties to meet and try to settle the case between them.
Continue Reading Reliance Ordered to Pay Back LTD Benefits to 2013, Using $66,830 Salary, Plus $58,740.00 in Legal Fees
MetLife long term disability policies are notorious for containing very restrictive 24 month limitations for medical conditions that they classify as a neuromusculoskeletal and/or soft tissue disorders. The limitation typically limits benefits to two years for disabilities caused by neuromusculoskeletal and soft tissue disorders, “including, but not limited to, any disease or disorder of the spine or extremities and their surrounding soft tissue.”
However, the limitation is inapplicable if the claimant has objective evidence that establishes the presence of at least one of six exceptions, including radiculopathy which MetLife policies typically define as “Disease of the peripheral nerve roots supported by objective clinical findings of nerve pathology.”
Continue Reading MetLife improperly dismisses evidence of radiculopathy and limits benefits under 24-month Neuromusculoskeletal limitation in LTD Policy
In David L. Rothman v. Unum Group, Unum Life Insurance Company of America (Unum), Plaintiff was a Certified Financial Planner who had worked for almost 30 years in a business owned by his father, Rothman Securities, when he developed a drug addiction. He was unable to perform the duties of his regular occupation and received disability benefits from October 12, 2012, until October 2015. On October 1, 2015, Unum terminated Plaintiff’s benefits. Plaintiff’s appeals were denied and he then filed this lawsuit against Unum for breach of contract and bad faith.
In addition to his drug abuse problems, in March 2013, Plaintiff pled guilty to wire fraud and money laundering and was fired by Rothman Securities. In January 2014, he was sentenced to a 4-year prison sentence and in February that same year, his professional license was revoked due to his criminal conviction.
Continue Reading Court Rules in Favor of Unum and Finds Plaintiff Not Factually Disabled
In Lavery v. Restoration Hardware, Inc., (D. Mass.), No. 17-10856, March 28, 2018, Plaintiff John Lavery (“Lavery”) filed a claim against Defendant Restoration Hardware, Inc. (“RHI”), based on RHI’s alleged misclassification of Lavery as an independent contractor when Lavery was allegedly in fact in employee under Massachusetts law. Lavery seeks among other damages the value of benefits plan (i.e., a welfare benefits package) that he would have received had he been classified as an employee. RHI moved to dismiss Lavery’s claim for damages with respect to the welfare benefits because RHI contended that claim was preempted by federal law.
Continue Reading Benefits Claim of Employee Who Claimed Prior Misclassification Was Preempted by ERISA
In Mary Beth Tobin v. Hartford Life and Accident Insurance Company, Plaintiff worked in Florida as manager of costuming operations for Disney Worldwide Services. She had been under the care of a physician for fibromyalgia beginning in February 2012. Her last day of work was October 2, 2012. She subsequently moved to Michigan and continued medical treatment with a board-certified family medicine physician.
Plaintiff filed a claim for long-term disability (LTD) benefits, providing Hartford with her medical records, which included the physician’s statement of functionality. Hartford denied her claim and her subsequent administrative appeals, so she filed this ERISA lawsuit in the U.S. District Court for the District Court for the Western District of Michigan.
Continue Reading Michigan Court Reverses Hartford’s Denial of Disability Benefits for Claimant Diagnosed with Fibromyalgia
It seems that claimants are denied long term disability benefits by CIGNA every day. CIGNA’s denials are predictable and tend to follow the same denial techniques from one claim to the next. After a LTD denial claimants are forced to go through the appeals process to get back on claim and with CIGNA it seems almost impossible to convince the appeals department to overturn an initial denial of benefits.
Such was the case with Ms. Sangha as she was left with no other option but to file a lawsuit against CIGNA in a California federal district court.
Continue Reading California Court overturns denial of benefits by CIGNA