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.

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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.

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In Owens v. Liberty Life Assurance Company of Boston (Liberty Life), plaintiff Paulette Owens quit her job at Walmart when physical restrictions prevented her from working. This opinion does not provide a job description nor mention her specific disability other than saying she quit work when “physical restrictions and limitations” prevented her from working. She was granted long term disability benefits, but one year later, her benefits were terminated. She exhausted her administrative appeals and then filed this ERISA lawsuit.
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In an opinion issued on September 4, 2014 by the United States Court of Appeals for the Sixth Circuit, an Appeals Court upheld a District Court’s opinion that awarded Ms. Ashima James long term disability benefits. Despite Liberty Life’s two independent medical examinations and at least 4 “independent” file reviews, both Courts concluded that James produced a sufficient amount of evidence to qualify for disability benefits under the Policy.
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An Illinois disability lawyer filed a federal lawsuit in Federal court against Liberty Life Assurance Company of Boston (Liberty) and Allstate Cafeteria Plan (Allstate). The Plaintiff, William B., was employed by Allstate as a Claim Senior Manager. Due to this employment, Plaintiff was eligible to receive short-term and long-term disability benefits under the Allstate STD

A Colorado disability attorney filed a federal lawsuit in the Federal court against Liberty Life Assurance Company of Boston (Liberty) and Estes Express Lines (Estes). The Plaintiff, David F., was employed by Estes as an over-the-road truck driver. Due to this employment, Plaintiff was covered by an employee welfare benefit plan that was sponsored by

An Alabama Claimant and her Alabama disability attorney filed suit against Liberty Life Assurance in the United States District Court for the Northern District of Alabama Northeastern Division. A former DIRECTV Group, Inc. employee, Juarlesa W. worked as a customer service representative and was fully vested in her company’s Liberty Life Insurance Plan when she

Wanda N. and her North Carolina disability attorney filed a lawsuit in the United States District Court for the Eastern District of North Carolina Western Division, claiming that Liberty Life wrongfully terminated Wanda N.’s long term disability benefits in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) and other federal statutes.

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On November 10, 2011, Liberty Life Assurance Company of Boston claimant, Dana E., and his California disability lawyer filed a complaint against the insurer in the United States District Court for the Northern District of California under the Employee Retirement Income Security Act of 1974 (ERISA) and 29 USC § 1132(a)(1)(B) in an effort to