Disability Insurance Cases Nationwide

Disability News:
Long Term Disability Claims Due to Back Pain
One of the most common causes for filing a short or long term disability insurance claim is due to “back pain.” Although this encompasses a wide range of conditions – from disc herniations and bulges to soft tissue disorders and fibromyalgia – insurance companies will evaluate entitlement to benefits as a result of back pain in the same manner regardless of the medical basis for the pain.


FAQ: Claim Handling
When is the Best Time to Submit a Claim for either STD or LTD insurance benefits?
The answer to this question depends on numerous factors such as disability policy language, medical support and treating physician medical documentation. In this video, disability insurance attorneys Gregory Dell and Cesar Gavidia discuss some of the common issues encountered when selecting a date of disability.


Disability News:
United of Omaha criticized for relying on in-house medical review and failing to obtain independent examinations
This case was decided by a district court in Illinois and involved United of Omaha Life Insurance Company. An ERISA action was filed by the Plaintiff, Gina Tassone, after her LTD benefits were terminated. She had been paid two-years of regular-occupation benefits for her inability to work as a Finance Manager and like many group disability policies, her insurance policy’s definition of disability changed after two-years of benefits.

As we have indicated time and time again, an ERISA administrative appeal is one of the most important documents to be filed as part of your disability insurance claim. Second only to the initial application for benefits, your administrative appeal is often your only opportunity to provide evidence of disability sufficient for an insurance carrier to overturn a denial of benefits. Although some insurance carriers such as Lincoln require a mandatory second appeal and others such as Prudential and Cigna allow for voluntary second appeals, the vast majority of insurance carriers only allow for one level of appeal and if that is denied the only recourse available is to file a lawsuit under ERISA. We have explained the perils of litigating an ERISA based disability policy on many occasions on our website, as such, in this article so we will not go into the Arbitrary and Capricious standard of review commonly applied in ERISA cases. However, it is important to note that in a lawsuit brought under ERISA there are no jury trials nor is there live testimony at “trial,” which means neither you as the insured or your doctors will be allowed to testify before the judge, and last, relevant to this article- no new information after the final denial of benefits will be allowed at trial. With this final caveat, it becomes all the clearer why filing as complete an Appeal as possible is crucial to receiving your disability benefits.
Continue Reading Court Rejects New Information in ERISA Disability Case

In this video Attorneys Gregory Dell & Rachel Alters discuss the 6th Circuit Court of Appeals decision that United of Omaha’s termination of LTD benefits of an unskilled and illiterate Plaintiff was unfair and arbitrary and capricious as the Plaintiff was unemployable in any other occupation.

Insurance companies are known for having delays. In this video Attorney Gregory Dell & Stephen Jessup discuss very specific facts surrounding the timeframe for which UNUMS’s extension was to begin and could be tolled in McFarland vs. First UNUM. Learn about the importance of providing all pertinent information during the ERISA administrative appeal process.

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