In this video, Attorneys Gregory Dell and Rachel Alters discuss a recent court decision in which Principal Life attempted to ignore an income qualifier in an “any occupation” definition as a technique to deny benefits. The court determined the policy language to be ambiguous and provided an interpretation in favor of the claimant. If you have been denied by Principal Life, or any disability insurance company, call Attorneys Dell & Schaefer for a Free Consultation.
Recently, two different lawsuits were filed under the Employee Retirement Income Security Act (ERISA) against the Principal Insurance Company of America. In both cases filed through the respective plaintiffs’ disability attorney, Principal was alleged to have wrongfully denied the respective plaintiffs their claims for long-term disability (LTD) benefits.
The First Case
The plaintiff through a California disability attorney filed a lawsuit in the Federal Court. The plaintiff was employed as a general partner in an executive search firm, Vantage Partners. This occupation required high levels of energy, concentration, and intellect to perform successfully. While working for Vantage Partners, the plaintiff participated in a disability insurance plan provided by Principal. Principal was the plan administrator for the disability insurance plan.
In 2003, Plaintiff became sensitive to several forms of technology, including cellphones, that resulted in cognitive and physical symptoms, including memory loss, numbness, and pain. He continued working, but the symptoms gradually became worse over time between 2003 and March 2008.
The pains intensified to the point where Plaintiff had heart pain, sleep disturbances, and lack of concentration. His physician diagnosed him with fibromyalgia, which the Plaintiff had suffered from years earlier.
By this time, Plaintiff’s business productivity had declined because of having to reduce his workday by several hours per day and reducing the number of client field visits. He also required more frequent breaks, as well as developed blurred vision from staring at a computer screen. Plaintiff’ mental awareness continued to decline.
Despite this, in May 2008, Plaintiff decided to try to work full time again. This only lasted until October 2008, when his medical condition caused him to reduce his workload to part-time status. His symptoms continued to grow more intense.
In November 2008, he submitted a claim for benefits under the terms of the Policy continuously from October 2008 to the present. His condition will likely continue beyond the age 65 policy anniversary. Plaintiff has continually provided the Defendants with sufficient proof of his loss and his necessary medical and financial documentation of his right to benefits.
Principal did not decide on Plaintiff’s claim until July 14, 2009, taking the time to conduct an investigation to find any reason to deny the Plaintiff of his benefits. This included three separate instances of surveillance on the Plaintiff, with no legitimate cause to conduct surveillance on him to begin with. Additionally, it also requested a paper medical review from a company that has a reputation for finding claimants not disabled. Principal also required the Plaintiff to undergo an examination with a doctor who had no expertise in treating and evaluating patients with exposure to electromagnetic fields.
Principal paid partial disability benefits for the period of October 3, 2008 until May 12, 2009, but denied the Plaintiff’s claim for the period thereafter. In the lawsuit, Plaintiff claims Defendants ignored the evidence presented to them that proves Plaintiff’s condition, misrepresented facts about the Plaintiff’s condition, and have taken actions to deny paying the benefits called for in the terms of the Plan.
The Second Case
In the second case, an employee of Old Hickory Furniture Co., with the help of an Indiana disability lawyer, filed an ERISA lawsuit against Principal Life Insurance Company. He was provided with a LTD coverage plan that was fully insured by Principal. At the same time, Principal was also the Claims Adjudicator for the plan. In this case, it was alleged that Principal did not have a principled and reasoned decision making process for denying the plaintiff’s claim for LTD benefits, but was instead influenced by its inherent conflict of interest as a fiduciary, payer, and claims adjudicator of the Plan.
Relief Sought in the Lawsuits
In both of the cases mentioned above, the relief sought by the Plaintiffs from Principal in their lawsuits comprises of:
- A declaration that the plaintiffs are entitled to LTD benefits under their respective plans
- Benefits that have not been paid to be paid, along with interest
- Reimbursement for attorney fees and costs
- All other relief that the court deems proper and just
About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.
Dr. Bruce Leipzig had been denied long-term disability benefits by Principal Life Insurance Company, and brought his ERISA case before the District Court covering the northern part of Texas. After hearing the case, the Court issued summary judgment in favor of the disability insurance company.
An interesting disability claim arose in 2008 that highlights the challenges a disabled individual can face when a span of time exists between the time of a covered event and the manifestation of an injury associated with that event. This case against CIGNA is rare because it is an accident and sickness policy rather than a traditional disability insurance policy. It is also rare, because most disability insurance companies will not lose a copy of your policy. A disability claimant should make every effort to keep the original copy of their disability insurance policy. A New York ambulance volunteer, George Glew, discovered this when he sought to claim disability benefits under a CIGNA Life Insurance Company of New York (CIGNA) policy that covered accidents and sickness for employees and volunteers in the Shirley Community Ambulance Company. This case is rare because it is an accident and sickness policy rather than a traditional disability insurance policy.
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