Disability Insurance Cases Nationwide

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For approximately 16 years, Shirley Lacko was employed by BKD, Inc., an accounting firm. When her health issues forced her to quit her job, she applied for both short-term disability (STD) and long-term disability (LTD) benefits due to her numerous documented medical problems. At the time she stopped working on September 25, 2015, her position was that of Senior Manager in the Audit Department with an annual salary of $93,250.04.

The disability insurance group policies her employer provided to her were issued by United of Omaha Life Insurance Company (United). United initially approved her claim for STD from October 12, 2015, through November 22, 2015.

United informed her she would receive no benefits after November 22, 2015. United seemed to accept that Lacko had a plethora of medical problems, but it concluded that she failed to prove that these problems prevented her from performing a material duty of her regular occupation.
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After working for a law firm as a healthcare attorney for more than seven years, Amanda Foster began having intractable migraine headaches, so she stopped working. She received long term disability (LTD) benefits from Principal Life Insurance Company (Principal) from September 4, 2013, until they were terminated effective December 9, 2014.

Foster filed two administrative appeals and submitted additional medical records. After Principal paid numerous physician reviewers, it denied her claim and found she was not disabled according to the meaning of her disability insurance policy. She then filed an ERISA lawsuit. That was decided in favor of Principal, so she appealed that denial to the Fifth Circuit Court of Appeals.
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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.”
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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.
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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…”
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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.”
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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.
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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.
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