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.

Background

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