Disability Insurance Cases Nationwide

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In this recent case out of the Eastern District of Pennsylvania the court found that Unum had abused its discretion when it failed to consider whether the claimant could do the material and substantial duties of her regular occupation. The case answers a question posed by many claimants: Is the insurance company obligated to consider my job duties when evaluating my claim?
Continue Reading Unum was wrong for not considering the claimant’s job duties during its claim review

In a recent ruling from the United States District Court District of Nevada, a Judge ruled that CIGNA/LINA was wrong in denying continued Long Term Disability Benefits to Kimberly Brown.
Continue Reading Court Rules that CIGNA/LINA Wrongfully Terminated Disability Benefits of Person with Cognitive Limitations caused by a Brain Tumor

We have written on this subject before and the issue is one we get many questions on. Whether a disability insurance claimant must repay the insurance company for a retroactive social security award depends on the policy at issue and any subsequent agreements between the claimant and insurance company. Unfortunately, most ERISA governed long-term disability policies contain language giving the insurance company the right to recover any award of back benefits made by the Social Security Administration. Insurance companies often take it a step further by requiring claimants to sign “reimbursement agreements” by which the claimant promises to pay back any award of SSDI benefits that would result in an overpayment by the insurance company.
Continue Reading Court Rules Aetna Cannot Collect SSDI Overpayment

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.
Continue Reading Appeal Court Affirms District Court’s Ruling that Liberty Life Was Wrong in Denying a Disabled Woman’s Long Term Disability Benefits

Sedgwick Claims Management is notorious for abusing its discretion when determining whether a claimant qualifies for disability benefits. The most common ways in which Sedgwick abuses its discretion includes, the failure to consider treating doctors’ opinions, failure to consider a favorable determination by the Social Security Administration, failure to speak to treating doctors regarding the claimants’ disabling conditions, failure to have the claimant examined and relying solely on paper reviews of paid doctors. A court in the Northern District of California addressed some of these very issues resulting in a very favorable outcome for the Plaintiff.
Continue Reading Plaintiff Awarded Benefits when Sedgwick Abuses its Discretion

This is yet another case shedding light on the importance of timely exhausting administrative remedies before filing an ERISA lawsuit. In this recent case, which was decided by a U.S. District Court in Arkansas, Mr. Deaton, a former Walmart Stores employee, was on claim for disability with Walmart’s disability insurer, Hartford Life and Accident Insurance Company (“Hartford”).
Continue Reading Arkansas court grants Hartford’s motion for summary judgment for claimant’s failure to exhaust administrative remedies

Long term disability lawyers Gregory Dell and Rachel Alters recently released an educational video which discusses the issues surrounding an award of attorney fees in ERISA disability claim. In this video, they discuss the standards that must be satisfied to win attorney fees and the difficulties that can arise in a court awarding ERISA attorney…

In an unpublished opinion issued on July 7, 2014 from the United States Court of Appeals for the Tenth Circuit, a Federal Court ruled somewhat surprisingly and approved Sun Life’s decision to “offset” VA Benefits from a disabled Veteran’s monthly disability benefits. While this case is not “binding precedent,” it can serve as a warning for those that are receiving VA Benefits, or any other income benefits, that are not listed in their Long Term Disability (LTD) ERISA Policy.
Continue Reading Federal Appeals Court Rules that Sun Life Can Offset VA Benefits Even Though Such Benefits Are Not Listed in the Policy

When reviewing a claim for disability benefits a plan administrator is not required to do an in-person exam of the claimant. However, in certain circumstances courts have found that an administrator’s failure to do so is arbitrary and capricious.
Continue Reading Reliance Standard abused its discretion when failing to conduct in-person exam for psychiatric disability

In Hester v. Life Insurance Company of North America, a recent case out of the Eastern District of Kentucky, the widow of a deceased employee of CSX attempted to bring an ERISA action, alleging that LINA wrongfully denied her claim for death benefits nearly eleven years earlier. Finding plaintiff’s civil action to be untimely, the Kentucky court entered judgment in favor of LINA.
Continue Reading Kentucky District Court concludes that Kentucky’s five year statute of limitations applies to ERISA actions