Disability Blog & Cases:
California Court denies Plaintiff’s Attempt to Introduce New Medical Information During ERISA Disability Lawsuit Against Hartford for Long Term Disability Benefits

One of the largest obstacles facing an insured in bringing a lawsuit against a disability insurance company for benefits under an ERISA governed group disability policy is the inability to add additional information, in most cases medical information, to the administrative record after a final denial has been entered by the insurance company.

Disability Blog & Cases:
Cigna Denies Disability Benefits, But Additional Information Could Have Resulted In A Victory

When filing a disability application or appeal it is of the utmost importance to provide the insurance company all of the relevant medical records and/or documentation supporting your disability in a timely manner.

If you fail to submit any important documents or records they will not be considered by the judge at a later date if your disability claim is denied.

Disability Blog & Cases:
Boeing Employee Suffering From Severe Chronic Back Pain Sues Aetna For Denial Of ERISA Benefits

An Oregon disability lawyer has filed a lawsuit in the District Court of Oregon against The Boeing Company Employee Benefit Plan (Boeing) and Aetna Life Insurance Company (Aetna). The Plaintiff, Susan A, worked as an assistant to the Vice President and General Counsel of The Boeing Company. Due to her employment, Plaintiff was protected by Boeing’s Employee Benefit Plan.

Disability Blog & Cases:
Unum Disability Denial With Medical Record Review Only

Can Unum deny disability claims and appeals by merely conducting paper reviews of a claimant’s medical records? Yes, apparently they can.

Disability Blog & Cases:
Sedgwick And AT&T Disability Denial Scheme Exposed In ERISA Lawsuit

On May 14, 2012, the U.S. District Court for the Northern District of California issued an order on a very hot topic for ERISA Disability Lawsuits. The issue concerns how much “Discovery” a denied person is able to obtain from the Disability Insurance Company while litigating a case.

FAQ: Appeals & Lawsuits:
If my long term disability benefits are governed by ERISA and I win at trial, does the insurance company have to pay me for the remainder of the policy life, or a lump sum amount?

Should your case go to trial under an ERISA governed disability plan and you win the insured is only entitled to an award of disability benefits that have not been paid by the insurance company. This is further contingent on whether the insurance company denied your claim under the “own occupation” or “any occupation” definition of disability…

Disability Blog & Cases:
California Federal Court Finds That MetLife Abused Its Discretion And Awards Financial Analyst Long-Term Disability Benefits

Shelia W. and her California disability lawyer prevailed in a lawsuit against MetLife when the United States District Court of the Southern District of California found the insurer to have abused its discretion when it terminated Shelia’ disability benefits under the “own occupation” standard.

Disability Blog & Cases:
Sun Life Pays Disability Benefits For Three Years To A Claimant Who Wasn’t Actually Covered Under A Sun Life Policy

In the case of Pamela P. v. Sun Life and Health Insurance Company, the court record shows that Pamela P. applied for long-term disability benefits under an employee benefits plan that was maintained by Los Padres Bank for its employees and was awarded disability benefits for over three years. Said plan was underwritten by Sun Life with its Group Certificate governed by ERISA (the Employee Retirement Income Security Act)…

Disability Blog & Cases:
Another Cigna Hired Gun Doctor To Be Exposed!

Utah Court Wants To Know Relationship Between Dr. Carol Flippen and Cigna Life Insurance

The Plaintiff, Christopher L., with the help of his Texas Disability Attorney, has filed this lawsuit against Sedgwick Claims Management Services , Inc. (Sedgwick), Administrator of the Hewlett-Packard (HP) Company Disability Plan.

In Christopher L. v. Sedgwick Claims Management Services, Inc., Plaintiff has filed this lawsuit to regain all short-term and long-term disability payments that were wrongfully terminated.

Plaintiff’s Rights of Disability Benefits Under The Plan

Plaintiff is a 44 year old man who is a citizen and resident of Tomball, Texas. Sedgwick was responsible for funding and administering the Plan, which Plaintiff was entitled to the benefits of based on his employment with HP as a Project Manager.

Plaintiff was forced to cease work on April 25, 2008 due to bipolar disorder, schizophrenia, chronic fatigue, diabetic neuropathy, memory loss, sleep issues, fibromyalgia, depression, vision problems, high blood pressure, and sunlight sensitivity.

Plaintiff filed applications for short term and long term disability benefits. Plaintiff’s claim for short term disability benefits were granted by Sedgwick. Plaintiff later filed for long term disability benefits, which were initially granted by Sedgwick on December 1, 2008.

Sedgwick Changes Decision And Denies Future Long Term Disability Benefits

On August 20, 2010, Sedgwick denied further long term disability benefits to the Plaintiff. Plaintiff had 180 days to appeal this decision. The disability standard to apply in order to approve or deny a claim was being unable to perform "Any Occupation." If the application was approved, the Plan would pay a monthly benefit of $4,351.72.

Plaintiff requested an administrative review of the denial of benefits on December 6, 2010. Plaintiff included medical records to show his total disability, and thus, his argument for being approved for further long term disability benefits. In addition, the Social Security Administration issued a fully favorable decision on Plaintiff’s claim for disability benefits under Title II and Title XVI of the Social Security Act.

Despite this, Sedgwick upheld its original denial on March 17, 2011. Sedgwick also informed Plaintiff that he had exhausted all administrative remedies. Due to this, Plaintiff has filed this lawsuit against Sedgwick.

Lawsuit Filed Against Sedgwick

Plaintiff filed a lawsuit against Sedgwick because Sedgwick discounted the opinions of Plaintiff’s treating physicians, of others, and of the documented limitations that the Plaintiff suffers from due to his medical conditions, thereby preventing him from fulfilling the duties of any occupation and entitling him to the long term disability benefits as detailed under the Plan.

Plaintiff claims that Sedgwick failed to give proper weight to the evidence submitted to them regarding Plaintiff’s condition and his inability to work. Plaintiff also claims that Sedgwick did not properly define disability as outlined in the terms of the Plan, calling it "unreasonable, arbitrary, and capricious." Plaintiff claims that Sedgwick failed to fulfill its contractual obligations to provide disability benefits to the Plaintiff.

The Relief Sought

Plaintiff wants a judgment against Sedgwick for the following:

  • All short term and long term disability benefits that have not been paid as of yet
  • All future short term and long term disability benefits according to the terms of the Plan for so long as the Plaintiff meets the terms of the Plan
  • All reasonable attorney fees and expenses due to the filing of this lawsuit
  • All other relief that the Court deems just and proper 

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.

Disability Blog & Cases:
Aetna Is Sued For Failure To Pay ERISA Benefits To Boeing Employee For Injuries Sustained In A Shooting

A Washington disability lawyer filed a federal lawsuit in the District Court for the Western District of Washington, at Seattle, against Aetna Life Insurance Company (Aetna) and The Boeing Company Long Term Disability Plan (Boeing). The Plaintiff, Patrick D., worked as a real-time software engineer for Boeing, which contracted with Aetna to provide long-term disability coverage to its employees. The Plaintiff’s employment with Boeing afforded him the protections under this Plan.

Disability Blog & Cases:
Unum Sued By An Ophthalmologist And A BJC Healthcare Employee Who Both Were Denied Disability Benefits

Unum Life Insurance Company Of America (Unum) was sued in two different lawsuits filed in the Federal Courts of Missouri, by two plaintiffs who did not receive the long-term benefits that were entitled to them under the terms of their respective Plans that were issued and administered by Unum.

Disability Blog & Cases:
Misrepresentation By Claimant Results in Unum Disability Claim Denial

Unum disability claimants need to be aware that when filling out an application for disability insurance benefits it is necessary to disclose your medical history accurately and to make sure your insurance agent is doing the same. Should the insurance company discover a material misrepresentation, the policy could be rescinded, and the claimant could be required to pay back any and all benefits previously paid and then be subject to a fraud investigation…

 In Hoang N VS Unum Life Insurance Company of America and Northrop Grumman Long Term Disability Plan, Plaintiff wants reinstatement of long term disability payments that were originally paid, then terminated, by Unum.

The Plaintiff, with the help of his California Disability Attorney, has filed this lawsuit in the United States District Court Central District of California against Unum.

Plaintiff’s History and Reasons For Filing a Claim

Plaintiff worked as a systems administrator and network engineer at Northrop Grumman. His employment entitled him to be a participant in the Long Term Disability plan and other employee benefit plans that were established and maintained by Northrop Grumman.

Plaintiff suffered serious injury to his cervical spine when a heavy metal door fell on his head at work and knocked him to the ground unconscious. This accident caused the Plaintiff to become disabled as defined under the terms of the LTD Plan. Plaintiff filed a claim with the Defendants for LTD benefits under terms of the Plan. The Defendants originally approved the claim for LTD benefits.

Unum and Northrop Grumman Improperly Terminate Long Term Disability Benefits

On or about November 4, 2008, Defendants abruptly terminate the LTD benefits received by the Plaintiff. From the period of November 2008 through June 2009. Plaintiff’s doctor reports that the Plaintiff was suffering from the following conditions:

  • Dysphoric mood
  • Excessive worrying
  • Insomnia
  • Confusion
  • Irritability
  • Lack of appetite
  • Intermittent suicidal ideation
  • Social isolation
  • Paranoia

Plaintiff filed an appeal of Defendants’ denial on June 12, 2009. Unum replied to Plaintiff on June 15, 2009 that they could not review Plaintiff’s claim because the appeal came after the 180-day deadline, meaning that the original decision on the claim must stand.

After Plaintiff received a Social Security Administration decision in his favor, Plaintiff again requested that Defendants reinstate his long term disability benefits on April 25, 2011. Once again, on May 2, 2011, Defendants deny Plaintiff’s request.

Due to the fact that Plaintiff has exhausted all administrative remedies required under ERISA, Plaintiff has filed this lawsuit against Unum and Northrop Grumman.

Basis for Plaintiff’s Lawsuit

Plaintiff claims that Defendants failed to allow Plaintiff to file an administrative appeal against California’s notice-prejudice rule, which only prevents a person from filing an administrative appeal after a deadline if the Defendants are actually and substantially prejudiced by the delay. Plaintiff also claims that Defendants prevented Plaintiff from filing an administrative appeal when Defendants knew that the Plaintiff was suffering from severe cognitive problems.

Plaintiff also claims that Defendants did not provide any reasonable explanation of why Plaintiff’s appeal was not considered, nor why his original claim was denied. Defendants also did not provide any explanation of what materials could have been added to increase the chances of a successful claim.

Plaintiff also claims that Defendants failed to adequately inform the Plaintiff of notice requirements under ERISA. Additionally, Defendants failed to properly investigate the merits of the Plaintiff’s claim.

Type of Relief Requested from the Court

Plaintiff requests that the Court grant the following relief:

  • Plaintiff is able to file an administrative appeal of the denial of his original claim
  • The administrative appeal will be given full and fair consideration
  • All associated costs are paid
  • All appropriate attorney fees are paid
  • All other relief decided upon by the Court is fulfilled

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.

Disability Blog & Cases:
New York Federal Court Denies MetLife’s Motion To Dismiss Lyme Disease Victim’s Petition For Disability Benefits

In the case of Karen N. v. Metropolitan Life Insurance Company et. al, the United States District Court of New York, after hearing arguments from both sides regarding MetLife’s Motion to Dismiss the case, denied the motion in its entirety and directs the parties to appear for a status conference to determine how and when the case will proceed. And, while the Court did deny the insurer’s motion, that doesn’t mean that Karen N. will receive a favorable outcome in her lawsuit to receive her disability benefits. It does mean that the Court believes that the case deserves to be heard and ruled upon once all facts have been established.

Disability Blog & Cases:
Pennsylvania Pharmacy Owner Learns The Hard Way That Accuracy Is Everything When Applying for Disability Insurance Benefits

On January 28, 2011, the United Sated District Court of the Eastern District of Pennsylvania granted Berkshire Life Insurance Company of America’s Motion for Summary Judgment in Michael S. v. Berkshire Life Insurance Company of America, et. al. In addition, the plaintiff’s disability policy and FIO policy were rescinded negating…

FAQ: Social Security Disability Benefits
Can My Disability Insurance Benefits Be Denied If I Am Approved For Social Security Disability Benefits?

Disability Insurance Attorneys Gregory Dell and Cesar Gavidia discuss the misconception that a claimant will be approved for long term disability insurance benefits if social security disability benefits are approved.

The Plaintiff, Joni D., with the help of her Alabama Disability Attorney has filed a lawsuit against Reliance Standard Life Insurance Company and the Group Long Term Disability Policy For Employees Of Madison County Community Hospital for the wrongful termination of long term disability benefits.

In Joni D. Vs. Reliance Standard, Plaintiff is suing the Defendants for the unjust termination of her long term disability benefits under the terms of the long term disability plan.

Plaintiff Needed To Use LTD Plan

Plaintiff worked as a Critical Care Registered Nurse, an occupation that required her to perform and fulfill numerous essential job functions, requirements, and qualifications associated with her occupation, including providing direct and indirect patient care, responding quickly and accurately to changes in condition or response to treatment, and performing general nursing duties. Due to her employment, Plaintiff was eligible and partook in the LTD policy that was underwritten by Reliance Standard.

On or about May 5, 2003, Plaintiff became unable to work due to a culmination of disabling physical health issues. These issues were clearly documented in the Plaintiff’s medical records. Plaintiff became totally disabled on a permanent basis on or about February 25, 2010. This prevented her from any type of gainful employment as was confirmed by the Social Security Administration as of May 4, 2003. But does receiving disability benefits from the Social Security Administration mean the insurance company will also continually provide long term disability benefits? As Joni came to find out, that answer is no.

Filing of Benefits

Plaintiff filed for LTD benefits on or around November 24, 2003. Reliance Standard agreed to pay the LTD benefits effective October 31, 2003. According to the terms of the Plan, the Plaintiff’s condition changed from "disability" to "inability" as of October 31, 2006.

Reliance Standard paid LTD benefits for six years. This included paying the Plaintiff disability benefits under the "any occupation" definition of disability from October 31, 2006 to August 31, 2009.

Reliance Standard Terminated the Benefits Five Times From 2003-2010

On five different occasions, Reliance Standard terminated, denied, or closed the claim between October 31, 2003 and January 7, 2010. This was despite the fact that numerous objective tests showed that the Plaintiff’s back pain and radiculopathy continued to exist. The Plaintiff has also continually submitted additional evidence confirming her pain, including medical records and information from doctor visits.

Reliance Standard also improperly handled the Plaintiff’s claims over the years, including a time when it claimed that the Plaintiff returned to work even though she never did. It is alleged that Reliance Standard did this to avoid paying the Plaintiff LTD benefits. Despite Reliance Standard’s own "quality review unit" claiming that Plaintiff met LTD terms of the Plan and could not handle "any occupation," Reliance Standard continually terminated Plaintiff’s benefits until its final termination letter on January 7, 2010.

Plaintiff Files Lawsuit Against Reliance Standard and Group

Plaintiff filed this lawsuit against Reliance Standard because Reliance Standard based its denial on its own "independent" medical examiner’s report and attached physical capacity form, even though the two reports contradicted each other and the Plaintiff’s submitted medical records and reports. The examiner was also provided through MES Solutions, a biased third party company that has regularly had contact with Reliance Standard, indicating a conflict of interest. Plaintiff also claims that Reliance Standard failed to consider all medical records and other information submitted by the Plaintiff.

Plaintiff Seeks The Following From This Lawsuit

Plaintiff wants the following relief from Reliance Standard and Group:

  • A de novo review of the Plaintiff’s claim for long term disability benefits
  • All of the past due long term disability benefits
  • Reinstatement of Plaintiff’s claim to all present and future disability benefits so long as Plaintiff is eligible under the LTD Plan
  • Award of all attorney’s fees and expenses
  • Interest on all past due benefits
  • All other relief that the Court deems to be just and proper 

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.

Disability Blog & Cases:
Eastman Chemical Company Employee Loses Lawsuit Against MetLife for Disability Benefits

In a case recently decided by an Arkansas Federal Court, MetLife prevailed in a lawsuit filed by an Eastman Chemical Company Employee. Ultimately, due to video surveillance, a lack of medical support, and the fact that the claimant had continued working at a side job (of which he had failed to inform MetLife of) while claiming to be disabled, the Court, it seems, had no choice but to agree with MetLife’s decision to deny Long Term Disability Benefits.

Disability Blog & Cases:
Bon Secours Employee Wins Lawsuit Against Unum who had Denied Him Disability Benefits

A former Engineer Director for Bon Secours, with the help of his Pennsylvania  Disability Attorney, were forced to file a federal ERISA lawsuit after Unum repeatedly denied his claim for Long Term Disability Benefits under a disability policy he was covered under through his employment with Bon Secours. After filing Cross Motions for Summary Judgment, the Court ultimately ruled in favor of the claimant and against Unum.

Disability Blog & Cases:
Do You Know The Job Requirements To Be A Lincoln Financial Disability Claim Specialist?

As a disability lawyer that has handled thousands of disability insurance claims I often wonder about the qualifications and experience of the disability company employee that is making the decision to approve or deny my client’s claim. During our routine activities of watching The Lincoln Financial Group, I came across an internet job posting for an “Associate LTD Benefit Specialist” at Lincoln Financial in Atlanta, Georgia.The qualifications and requirements for the Lincoln benefit Specialist position are also listed at the end of this article.

Disability Blog & Cases:
A Claimant’s View of a Prudential Disability Benefit Denial

We always welcome our clients and other disability claimants nationwide to share their experiences regarding the handling of their disability insurance claim. A client of our law firm that was denied long term disability benefits by Prudential Insurance Company recently posted her thoughts…

Disability Blog & Cases:
Do You Know The Differences Between ERISA Disability Policy And NON-ERISA Disability Policy?

Watch our video to learn more about long term disability insurance claims which are subject to ERISA.

Disability Blog & Cases:
Will A $38 Million Loss Result In More Prudential Disability Insurance Claim Denials?

Prudential is not very happy right now and disability claimants may suffer as a result. Prudential’s group insurance division, which includes long-term disability insurance policies, reported a 2012 first quarter loss of $38 million compared to a gain of $39, million a year ago…

The Plaintiff, with the help of her Massachusetts Disability Lawyer, has filed this lawsuit in the United States District Court against Standard Insurance Company (Standard) for the denial of long term disability benefits as defined by the Plan that the Plaintiff was eligible due to her employment as a nurse with UnitedHealth Group.

The Plaintiff is a 63-year-old resident of Wrentham, Norfolk County, Massachusetts, while Standard is engaged in the business of disability insurance, and is licensed and authorized to engage in the business of insurance within the Commonwealth of Massachusetts. In regards to this lawsuit, Standard engaged in the administration and, in pertinent part, insurance, of the UnitedHealth Group, Long Term Disability Plan.

In Kathleen F Vs Standard Insurance Company, Plaintiff seeks reinstatement of long term disability benefits as defined by the terms of the Plan.

Plaintiff’s Background and Reasons For Submittal of Claim

Plaintiff worked as a healthcare utilization review coordinator for UnitedHealth Group, up to and including January 3, 2006. On or about January 3, 2006, Plaintiff was involved in a motor vehicle accident and suffered a right acetabular (hip) fracture. She could not perform the duties of her occupation, or any occupation, due to multiple complications of the healing of the fracture (non-union), as well as severe posttraumatic arthritis secondary to the injury and depression secondary to the injury.

Plaintiff filed for long term disability benefits under the LTD plan. She provided the necessary claim forms, physicians’ statements, and supportive medical records. UnitedHealth Group, who funds the first 24 months of benefit payments, approved the claim. This would last through July 2, 2008. After this date, Standard was expected to take over the LTD payments.

Standard Decides To Not Fulfill LTD Payments To Plaintiff

Via letter dated March 31, 2008, Standard denied Plaintiff’s claim for disability benefits when it was due to take over payments on July 3, 2008. Plaintiff filed an appeal of this denial, including additional medical support for her claim. However, Standard denied her appeal on July 28, 2008.

Plaintiff was offered, and through counsel, requested an additional level of review by letter dated September 22, 2008. Plaintiff thereafter submitted additional support for her claim, including a recorded video statement on DVD. Plaintiff requested a copy of the complete claim file from Standard on September 22, 2008. Standard did provide some of the requested records, but not provide any of the requested guidelines, policies, or procedures. Plaintiff again requested these relevant documents via letter dated November 27, 2008.

Standard denied Plaintiff’s appeal via letter dated April 27, 2009. Standard informed Plaintiff that she has exhausted her administrative remedies. Because of this, Plaintiff has filed this lawsuit against Standard.

Merits of the Lawsuit Against Standard

Plaintiff asserts that Standard did not properly apply the provisions of the LTD plan to her claim. Plaintiff still has not received the requested documents she asked for from Standard. This has denied the Plaintiff her ERISA’s statutory right to a "full and fair review" of her claim, as it has prevented her from mounting additional argument in favor of her claim and deprived her of the opportunity to submit evidence that may perfect her claim. This leads to the assertion that Standard breached its fiduciary duties as an ERISA administrator and shows a clear abuse of discretion.

Plaintiff’s Relief Requests

Plaintiff wants the following relief from Standard:

  • Plaintiff has been and continues to be eligible to receive LTD benefits as defined by the terms of the Plan
  • Standard must pay all disability benefits to which the Plaintiff is entitled to and owed from July 3, 2008 to the present date
  • All attorney’s fees, interest, costs, and disbursements be paid
  • All other relief that the Court determines to be necessary 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.