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

FAQ: Appeals & Lawsuits:
What Should I Expect When Suing Prudential for a Disability Insurance Benefit Denial?
Disability insurance lawyers Gregory Dell and Rachel Alters discuss their experience in handling ERISA lawsuits against Prudential.


Resolved Cases:
Cigna Overturns Denial Following Dell & Schaefer Appeal
Ms. D contacted our firm when she was denied long term disability benefits by her disability insurance carrier, CIGNA. Ms. D was a Catheterization Lab Tech and was often required to perform her duties during stressful situations involving emergencies like heart attacks and other life-threatening events. She was required to be on call for a minimum of 24 hours, often 2-3 times per week. She had a demanding job that required her to have the ability to maintain focus and concentration.


Resolved Cases:
After appeal filed by Attorney Jay Symonds, CIGNA overturned its previous denial of short term disability benefits for New Jersey Project Manager
Our client, Mr. W, formerly worked as a Senior Project Manager of an Industrial building/construction contractor. In May 2015 a number of medical issues, including chronic pain syndrome, cervical post laminectomy syndrome, cervical pseudarthrosis, as well as degenerative cervical joint disease, cervical facet arthropathy, spinal stenosis, forced Mr. W to stop working and submit his claim for disability benefits, first under his employer’s short-term disability (STD) policy and then continuing under its long-term disability (LTD) policy.


Disability Insurance Claims News:
California Court Rules Disability Claim Accrues When Disability Terminates
Soon after plaintiff left work, the television station fired him. He only learned from another employee that he had long-term disability coverage through the television station and that United was the insurer. The employer refused to give him a copy of the policy, and he did not receive one until after his attorney filed a suit for wrongful discharge and retaliation. Plaintiff then filed a claim for long-term disability benefits.

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.

In this video, disability Insurance lawyers Cesar Gavidia and Gregory Dell discuss multiple issues dealing with treating doctors that do not properly document the actual complaints and objective findings of a patient. Continue Reading How Does my Treating Doctors Lack of Documentation Result in A Denial of My LTD Benefits?

In this video Attorneys Gregory Dell and Cesar Gavidia discuss the importance of treating doctor’s to document every complaint and limitation of a disability insurance claimant. They also teach you how to keep your complaints and limitations journaled for your medical team.
Continue Reading Failure of Comprehensive Doctor Documentation Can Result in a Denial of a Disability Insurance Claim

Disability insurance policy holders that have been denied benefits have to act expeditiously to reverse their denial. There are two types of LTD policies – ERISA – purchased through your employer or an Individual disability insurance policy – purchased on your own. Each type of plan has their own set of guidelines to appeal a denial of benefits. In this video attorney Gregory Dell and Stephen Jessup discuss the processes to appeal your denial.

A delay in benefits is a very serious problem in the world of disability insurance benefits. Often the insurance companies delay payments, because they can. The disability insurance attorneys at Dell & Schaefer cut through the clutter and get to what the insurance companies are doing to delay your claim.
Continue Reading What Can You do If There is a Delay in Receiving Your Disability Payments?

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