Gregory Dell

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What is my "Own Occupation"? The overwhelming majority of ERISA governed group disability policies provide benefits for a period of time normally lasting 12-24 months for one’s inability to perform the duties of their "Own Occupation." Although the actual policy language varies from insurance carrier to carrier, each insurance company will usually define Own Occupation to mean the duties of the occupation as is it found in the national economy and not the actual job duties you are performing for your employer. The insurance companies will in turn review your Own Occupation as it is found in either the Dictionary of Occupational Titles (DOT), O*Net or some other similar vocational resource. More often than not, many people who have had their claim for benefits denied argue that the insurance company did not consider their claim in light of the actual job duties. A recent court decision may give this argument more strength.Continue Reading A New York Federal Court rules that Lincoln Financial abused its discretion, in part, by failing to consider the actual job duties of claimant

An Illinois court rules in favor of Prudential and finds that the claimant failed to provide objective evidence confirming the existence of his alleged vestibular disorder. The court also gave greater weight to the opinions of the claimant’s treating specialists, and dismissed the contention of the primary care doctor that the claimant was disabled from working.
Continue Reading Illinois court rules in favor of Prudential, finding that claimant failed to provide objective evidence of his alleged vestibular disorder

As disability insurance attorneys that help disability claimants nationwide it is frustrating when we see a repetitive trend of denial tactics by the same company. We are contacted multiple times every day from people denied benefits by Sedgwick Claims Management. Here is a recent denial of disability benefits story we received from a claimant that was denied by Sedgwick:Continue Reading A Common Sedgwick Short Term Disability Denial Story

Mr. R had worked as a shop floor supervisor before his chronic back pain, which resulted from a slip and fall that herniated several disks in his back, and resulted in three failed back surgeries, caused him to file for long-term disability under his Sun Life Assurance Company of Canada group long-term disability insurance policy. Like most group long-term disability policies, Mr. R’s Sun Life policy paid disability benefits for the first 24 months if he was disabled from his own occupation as a shop floor supervisor.Continue Reading Federal Court Finds Sun Life Assurance Company of Canada’s $8000 Worth of Surveillance on Disabled Shop Floor Supervisor Unreasonable

A recent ruling in a California ERISA lawsuit against Hartford discusses 2 interesting issues: 1) retroactive benefit awards when a case is remanded back to the carrier for a full and fair review; and 2) awards for attorneys fees and costs.Continue Reading California Court Denies Retroactive Benefit and Attorneys Fees Awards Despite Remand Back to Hartford for a Full and Fair Review

A Puerto Rico court rules in favor of the claimant and finds that denial of her STD benefits made her ineligible for LTD benefits, thereby exhausting her administrative remedies for LTD benefits.
Continue Reading Sedgwick and Walgreens Deny STD benefits, But Puerto Rico Court Rules That Pharmacist Can Seek LTD Benefits without Exhausting ERISA Appeal