Disability Blog & Cases:
Kentucky Woman Wins Lawsuit Against Mutual Of Omaha Insurance

Claiming that her long term disability benefits were denied improperly under the Employment Retirement Income Security Act of 1974 (ERISA) and 29 U.S.C.§ 1001, et. seq., Nancy C. and her Kentucky disability lawyer filed a disability lawsuit against her employer and disability insurer alleging that the denial of her long-term disability benefits by the insurer was “arbitrary and capricious” and constituted a “breach of fiduciary duty and/or bad faith” on the part of the defendants.

Disability Blog & Cases:
Prudential Claimants Unsuccessful At Challenging The Offsetting Of Dependents’ SSDI Benefit Award

Challenging the calculation that Prudential Insurance Company made when reducing their private benefit payments, Kathleen Schultz and Mary Kelly filed a class action lawsuit in hopes of receiving a positive, definitive decision concerning their claims.

In Jeffrey D Vs. Unum Life Insurance Company of America, the Plaintiff, with the help of his Connecticut Disability Attorney, filed this lawsuit due to the wrongful denial of long term disability benefits as promised under theERISA welfare benefit Plan that is underwritten and insured by Unum.

History of Plaintiff

Plaintiff, who is 46 years old, worked as a machinist at two companies in Bristol, Connecticut for a total of 16 years. He then worked as an Electrical Discharge Machine Operator at EDAC Technologies Corporation (EDAC) in Farmington, Connecticut since 2000. His job required him to position and secure workpieces on a table using clamps; measure parts; manually input data into a computer; and regularly exert between 10 and 50 pounds of force with his hands to move objects.

Plaintiff suffers from gout, a form of severe arthritis characterized by joint pain, tenderness, and reduced mobility in the areas affected. These areas usually include the hands, wrists, feet, and ankles. wrists, feet, and ankles. This medical condition causes him consistent severe pain, occasional complete immobility, and a regular inability to use his hands, wrists, feet, and ankles for almost anything, including grasping, pushing, holding, walking, and standing. His dominant (right) hand and wrist are affected more than his non-dominant hand and wrist. Plaintiff first suffered from gout approximately 20 years, and it has worsened progressively over the years.

Due to the continuing deterioration of his gout, Plaintiff can no longer operate as a machinist or in any other occupation. This has been the case since late-September 2010. Plaintiff takes powerful prescription drugs to combat the consistent pain, but the serious side effects from these medications include lightheadedness, forgetfulness, nausea, and fatigue. These prevent him from driving a motor vehicle or operating other types of machinery and industrial equipment.

Plaintiff filed an application for benefits under EDAC’s Unum Plan in September 2010. He was to have received 60% of his "monthly earnings" until a maximum age of "Social Security Normal Retirement Age." According to the terms of the Plan, the Plaintiff satisfied the definition of being disabled both regarding his own occupation (first 24 months of benefit collection) and any other occupation (after 24 months of benefit collection).

Unum Denies Claim

On June 29, 2011, Unum denies Plaintiff’s benefit application due to the reason that the medical evidence did not support that his gout was disabling under the Plan’s definition; he did not satisfy the Plan’s requirement that he work 35 hours per week prior in order to qualify for benefits; and he held another part-time job that he did not disclose to Unum, which disqualified him from benefit collection.

Plaintiff filed an appeal on September 24, 2011 disputing these reasons, which Unum essentially admitted as being true and that it was mistaken in Plaintiff having a part-time job. Plaintiff added 68 pages of medical records, letters from his physicians, Unum’s internal claim evaluation notes, and seven sworn records to his appeal.

Plaintiff underwent wrist surgery in fall 2010. His surgeon said in June 2011 that he will have no use of his right hand and wrist, further strengthening Plaintiff’s claim that he is disabled under the terms of the Plan. A fusion procedure that is recommended for the Plaintiff would prevent him from undertaking any gainful employment that requires Plaintiff to use his right hand to any significant degree.

Plaintiff also demonstrated that he has done no work for his wife’s vending cart business. Plaintiff also showed that he briefly dropped under 35 hours of work per week due to gout flare-ups in his feet.

Despite showing all of this, Unum denied Plaintiff’s appeal on October 20, 2011 on the same reasons as its original denial. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit against Unum.

Reasonings Behind the Lawsuit

Plaintiff claims that Unum’s failure to pay these benefits was wrongful, arbitrary, capricious, and otherwise unlawful. Additionally, Unum also chose to disregard the opinion of its own claim reviewer nurse who stated that "it is unlikely that the insured will regain his premorbid level of" functional capacity.

Unum also never requested that Plaintiff undergo an independent medical examination or functional capacity evaluation so that it could attempt to determine the severity of his gout or its impact on his ability to work in his own job or others.

Requested Relief

Plaintiff wants the following relief to be granted by this Court:

  • Payment of all unpaid monthly disability payments
  • All prejudgment interest
  • Costs associated with filing this lawsuit
  • All appropriate attorney’s fees
  • Reinstatement of Plaintiff’s eligibility for continued disability benefit payments in the future
  • All other relief deemed proper by this Court 

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:
Minnesota Disability Claimant Filed Suit Against Employer Over Terminated Disability Benefits

A Minnesota Federal Court recently ruled against a claimant and in favor of the employer with regards to disability benefits. This case is a poignant reminder that even after being on claim for nearly 7 years, a claimant can be denied at any time. It further shows why it is important to have your claim sufficiently supported with evidence from your treating physician whether the claim administer requests it or not. Let’s take a closer look at the case of Richard P. v. Kohler Co.

Disability Blog & Cases:
Court Finds MetLife Has No Right To Request An IME After Unnecessary Delay

Recently, a claimant was forced to hire a California Disability Lawyer and file a lawsuit against MetLife after being denied continued Long Term Disability Benefits. After agreeing with the claimant that she was disabled through the "own occupation" period, the Court awarded the claimant benefits for that limited time period. However, the court then asked MetLife to take a closer look at the "any occupation" period. For an unexplained reason, MetLife dragged its feet on making a determination.

In Mary A. Vs Sun Life Assurance Company of Canada, the Plaintiff, with the help of her Alabama Disability Attorney, files this lawsuit against Sun Life seeking reinstatement of long term disability benefits as promised under the terms of the Plan.

History of Case

Plaintiff is a disabled individual who was employed by Liberty National as a Sales Agent. This occupation required her to consistently spend an average of nine hours "in the field" traveling to and from job sites. It further required 10-11 hour work days during the course of a week. The Plaintiff was required to perform and fulfill numerous essential job functions, requirements, and qualifications associated with her occupation. Some of these functions included compiling lists of prospective clients, contacting those prospective clients, calling on policyholders to deliver and explain the policy, and servicing the business of existing and new customers.

On or about January 28, 2007, Plaintiff became unable to work due to a culmination of disabling physical health issues. These issues related to seizure auras, physical pain, fatigue, sleepiness, dizziness, and problems with memory. These issues primarily relate to seizure auras, physical pain, fatigue, sleepiness, dizziness, and problems with memory. As a result of her health problems and inability to continue working, the Plaintiff filed an application for long term disability benefits with Sun Life on or around July 12, 2007.

Sun Life approved the claim and began paying out monthly disability benefits effective July 27, 2007. The Social Security Administration determined that the Plaintiff was unable to perform any gainful occupation based on her physical health problems, thereby approving her for Social Security Disability benefits upon her initial application. These benefits began to be paid out in July 2007.

Sun Life Abruptly Terminates Long Term Disability Benefit Payments

On or about July 31, 2008, Sun Life informed Plaintiff that she no longer qualified for disability payments based on a review of her records. Plaintiff filed an appeal of this decision via letter dated August 4, 2008. Plaintiff also supplied additional medical documentation that she was still disabled and unable to work. She included notes from two different physicians she had been seeing, both of whom stated that Plaintiff was not able to work.

Despite this mounting evidence, on August 17, 2009, Sun Life terminated Plaintiff’s long term disability benefits retroactive to July 27, 2009. Plaintiff filed an appeal letter on or about October 21, 2009. Once again, she submitted multiple pieces of medical evidence, including statements from both treating physicians, to back her claim. Sun Life failed to respond to this latest appeal until it finally sent a letter to the Plaintiff on March 26, 2010.

Due to its failure to follow ERISA regulations, Plaintiff’s administrative remedies have been exhausted, leading to the filing of this lawsuit against Sun Life.

Premise of Argument Against Sun Life

Sun Life wrongfully denied Plaintiff’s claim and subsequent appeals. It relied upon several biased and erroneous physician consultant reports generated by physicians who are regularly utilized by insurance companies to deny claims.

Furthermore, these physicians were employed by third-party vendor companies Network Medical Review and Professional Disability Associates, companies which receive a substantial portion of income from providing physician consultant reviews to insurance companies and employers. These physicians ignored most of the medical evidence in the claim, cherry-picked evidence favorable to justify a termination of benefits, and misconstrued evidence and statements contained in the claim record.

Relief Sought By Plaintiff Against Sun Life

Plaintiff wants the following relief due to the wrongful termination of long term disability benefits:

  • An award of penalties of $110.00 per day, per violation for each day that the Defendants fail to provide the long term disability benefits that are promised under the Plan
  • An award of all associated attorney’s fees and court costs
  • All other relief that the Court decides to be proper and fair 

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:
Court Takes Sun Life To Task For Denial Of Disability And Life Insurance Benefits Of Man With Brain Tumor

The widow of a claimant, who died from a malignant brain tumor, brought this lawsuit with the help of her Colorado Disability Lawyer after Sun Life refused to award cancer disability benefits.

Disability Blog & Cases:
CIGNA Disability Claim Denial: A Claimant’s View

Every day disability claimants around the country contact our disability attorneys about a CIGNA disability claim. Many individuals tell us similar stories about the manner in which their CIGNA disability claim has been handled. We wanted to share with you a recent comment that was posted on our website about a CIGNA denial.

Disability Blog & Cases:
Sedgwick Terminates PNC Compliance Specialist’s Long Term Disability Benefits

Recently, a former Compliance Specialist for PNC Financial Services Group was unsuccessful in her lawsuit again her former employer and Sedgwick. This case is a strong reminder that even though a claimant has been awarded disability benefits from the Social Security Administration, it does not mean that the Long Term Disability Insurance Provider must also award disability benefits.

The Plaintiff, with the help of a California disability attorney, filed this lawsuit in the United States District Court against Standard Insurance Company (Standard) and the Oscient Pharmaceuticals Corporation Employee Benefit Plan (Oscient). The lawsuit claims that the Plaintiff did not continue to receive the disability benefits that she was entitled to under the Plan that she was eligible for due to her employment with Oscient.

In Christine W. Vs Standard Insurance Company, Plaintiff has filed this lawsuit to gain the rightful disability benefits owed to her under the Plan that were not paid by Standard.

How Plaintiff Was Covered Under The Plan

Plaintiff worked for Oscient as a sales representative, which entitled her to be a participant in Group Insurance Policy Number 139943-B. This Plan would entitle Plaintiff to long term disability benefits equivalent to 67% of Plaintiff’s monthly earnings minus any other income benefits beginning 90 days after the approval of a claim until Plaintiff’s 65th birthday.

Plaintiff began suffering significant neck pain over several years. She also endured several treatments in an attempt to alleviate this pain, which continued to worsen over time. These treatments began on or about May 29, 2007 and continued until September 11, 2007. These treatments included two right sacroiliac joint block injections, a right L4, L5, S1 and medial branch nerve blocks, an MRI of her lumbar spine, a lumbar epidural steroid injection, and right S1 selective nerve root block.

Plaintiff continued to receive more treatments and have more visits with her physicians, but the pain continued to worsen. It was advised that she stay out of work until at least November 25, 2007 so that she could collect short term disability payments.

Plaintiff filed for long term disability payments, which was approved by Standard on or about March 12, 2008. Plaintiff was also granted life insurance waiver of premium on or about September 2, 2008. Treatments and more appointments occurred between May 21, 2009 and April 6, 2010.

Standard Decides To Cut Off Plaintiff’s Long Term Disability Benefits

On or about August 16, 2010, Standard denied Plaintiff’s claim for ongoing disability benefits beyond August 18, 2010. Plaintiff still continued to suffer from symptoms of severe neck pain, as evidenced by a follow-up examination by Tina L., MD on or about November 29, 2010.

On or about December 28, 2010, Plaintiff filed an appeal of Standard’s denial. Plaintiff consulted with Regina N., MD regarding her increasing difficulties with fine motor movements, speech, and word-finding. This prompted Plaintiff to supplement her denial with a follow-up letter on or about February 11, 2011.

Despite two more follow-up examinations with two other physicians in February and April 2011, Standard denied Plaintiff’s appeal on or about May 5, 2011. This has forced Plaintiff to file this lawsuit against Standard.

Merits of the Case Against Standard

This lawsuit was filed because Standard ignored the opinions of Plaintiff’s treating physicians. Standard also did not give proper consideration of Plaintiff’s medical records and her overall condition. Standard’s denial of benefits was wrongful, capricious, arbitrary, and irrational.

The Relief Sought Against Standard

Due to the hardship experienced by the Plaintiff, Plaintiff requests following relief against Standard:

  • An award of unpaid benefits due to the Plaintiff from August 19, 2010 to the date of the judgment of this case
  • An award of all future payments so long as Plaintiff remains eligible under the terms of the Plan
  • An award of reasonable attorney fees
  • An award of all other relief that the Court deems appropriate

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:
Are Independent Medical Evaluation (IME) Providers Really “Independent”?

After being twice denied continued disability benefits, an Addiction Medicine Physician, with the help of his California Disability Attorney, was forced to file a lawsuit against Hartford.

Disability Blog & Cases:
North Carolina Court Determines That Sedgwick Abused Their Discretion And Wrongfully Denied Disability Benefits For BellSouth Employee

A BellSouth Customer Service Assistant, with the help of his North Carolina Disability Attorney, was forced to file a lawsuit against Sedgwick after being denied continued disability benefits.

Disability Blog & Cases:
American Red Cross Worker Sues Reliance Standard Life Insurance Company For Wrongful Termination of Long Term Disability Benefits

In Joanne C. Vs Reliance Standard Life Insurance Company, the Plaintiff seeks the reinstatement of her long term disability benefit payments as defined by the terms of the Plan.

Disability Blog & Cases:
Two Takes on Fibromyalgia

A representative from the American Chronic Pain Association and a Fibromyalgia physician recently appeared on a local news station to discuss Fibromyalgia and methods for treating Fibromyalgia.

Disability Blog & Cases:
Total Knee Replacement, Yet Sedgwick Still Denies AT&T Employee’s Disability Claim

The unreasonable Sedgwick Claims Management disability denial of AT&T employees appears to be a daily occurrence. Recently, it seems as if Sedgwick does not feel the need to comply with ERISA regulations.

In Daniel C. Vs Reliance Standard Life Insurance Company, the Plaintiff has filed a lawsuit with the help of his Ohio Disability Lawyer for the termination of long term disability benefits that were promised under the Plan provided by Plaintiff’s employer, United Dairy Farmers, Inc. (UDF).

History of the Plaintiff

Plaintiff worked at UDF from 1988 to 2006, seven years as a Store Manager, six years as an Area Supervisor, and five years as a Zone Manager for multiple UDF stores. Plaintiff was earning a monthly salary of $5,441.67 when he was unable to continue his work duties due to complications from human immunodeficiency virus disease (HIV).

Plaintiff’s HIV led to his developing Acquired Immune Deficiency Syndrome (AIDS), as well as a related peripheral neuropathy of his lower extremities, which caused pain so severe that it required daily pain treatment with morphine, along with the multiple medications he needed to control his HIV.

Reliance approved Plaintiff’s application for long term disability benefits according to the terms of the Plan in February 2007, with an effective date for benefits of December 18, 2006. In November 2009, Plaintiff was approved for total disability benefits through the Social Security Administration, with an effective date of March 2007. Reliance continued to pay LTD benefits to the Plaintiff through October 24, 2010.

Reliance Cuts Plaintiff Off From Further Long Term Disability Benefits

Via letter dated October 11, 2010, Reliance informed Plaintiff that a review of his medical records determined that he could do work at a sedentary level. Based on this, Reliance terminated future long term disability benefits effective October 24, 2010.

Plaintiff appealed this decision and presented additional records and comment from his primary care physician, a board certified family practice physician and specialist in the treatment of HIV and AIDS. The doctor concluded that the Plaintiff could work no longer than four hours per day. Additionally, his pain from peripheral neuropathy was only moderately controlled by the multiple narcotic medications he took, but these medications also caused added fatigue and concentration problems.

Reliance hired an occupational medicine specialist to perform a file review and independent medical examination of Plaintiff in July 2011. The Reliance IME physician concluded there was not sufficient information in the clinical record to support the plaintiff’s doctor’s peripheral neuropathy diagnosis or to confirm that the Plaintiff was actually taking the prescribed medications that caused his reported side effects. The IME physician stated that the Plaintiff was capable of light demand level, full-time work "if motivated."

As a result, of this review and examination, Reliance rejected Plaintiff’s appeal on August 11, 2011. Due to the exhaustion of all administrative remedies, Plaintiff has filed this lawsuit against Reliance.

Basis of Lawsuit Against Reliance

Plaintiff claims that Reliance unfairly, wrongfully and arbitrarily denied Plaintiff’s claim for long term disability benefits despite the Plaintiff’s submission of medical evidence from his primary care physician, a qualified specialist in his illness, that established that the Plaintiff remains unable to perform the duties of any full-time occupation.

Plaintiff Seeks Following Relief From Reliance

Plaintiff wants the Court to provide the following relief from Reliance:

  • All long term disability payments as defined by the terms of the Plan that have not been paid, along with accrued interest
  • Consequential damages and costs associated with this lawsuit
  • All reasonable attorney’s fees associated with this lawsuit
  • All other relief that the Court finds proper and appropriate

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.

Resolved Cases:
AT&T Employee Dealing With Sedgwick Has Horrible Disability Benefit Claim Experience

Our client, an AT&T employee for more than 40 years became disabled and unable to do her job due to cervical myeolapathy neck pain, chronic headaches and a torn rotator cuff in her shoulder. Her claim for short term disability benefits under the AT&T disability benefits plan has been nothing but a “headache”. AT&T hires Sedgwick Claims Management to handle the administration of all disability benefit claims.

Disability Blog & Cases:
KeyCorp District Manager Sues The Prudential Insurance Company Of America For Improper Termination Of Long-Term Disability Benefits

A New York attorney recently filed a federal lawsuit against The Prudential Insurance Company of America (Prudential). The Plaintiff, Gaye D., was employed by KeyCorp as a District Manager/Area Retail Leader. Her employment enabled Plaintiff to be covered by KeyCorp’s long-term disability Plan, which was funded by Prudential.

Disability Blog & Cases:
DRS Technologies Employee Sues Prudential For The Wrongful Termination Of Long-Term Disability Benefits

An attorney from California recently filed a federal lawsuit against The Prudential Insurance Company of America (Prudential). The Plaintiff, Brian W., was employed as a Field Technician by DRS Technologies, Inc. (DRS). This employment entitled the Plaintiff to short-term and long-term disability benefits under DRS’ Disability Plan.

Disability Blog & Cases:
Court Compels Metlife To Reconsider Its Decision To Terminate Claimant’s Long-Term Disability Benefits

The United States District Court for the Southern District of New York recently held that MetLife’s decision to deny benefits to a Plaintiff was unreasonable and ordered MetLife to reconsider Plaintiff’s Long Term Disability claim.

Disability Blog & Cases:
Unum Tries To Hide Fact That Its “Independent” Medical Advisors Are Actually Employees Of Unum

This case sheds light on some of the questionable practices that some disability companies engage in when reviewing a disability claim.

Disability Blog & Cases:
Unum CEO Testifies At US Senate Hearing About Disability Insurance

On March 22, 2012, UNUM insurance company’s CEO Tom Watjen spoke at a United States Senate Committee hearing about the value of disability insurance coverage for individuals and the need for the private disability insurers and the government to work together in order to offer the coverage to more employees.

ERISA is a federal law that governs most disability plans offered through employers and was enacted in part to make it more affordable for employers to offer long-term disability coverage and health insurance for employees. Unfortunately, ERISA tends to be an unfair law for disability insurance claimants.

The limitations and obstacles inherent to an ERISA regulated disability policy do not present themselves oftentimes until a claimant is faced with the unfortunate occasion of becoming disabled and unable to work. One such limitation is that an ERISA governed policy requires a claimant to exhaust administrative remedies before filing a lawsuit. This oftentimes only serves to prolong the time a disabled claimant must wait to receive benefits to which he or she is entitled. In the event that a claimant does file a lawsuit, under ERISA, a claimant is not entitled to a jury trial. The decision is therefore up to the judge who is usually limited to a review of the "claim file" under a standard requiring the judge to determine simply if the administrator acted unreasonably even if the judge thinks the claimant is in fact disabled.

Not surprisingly, disability insurers fight to have ERISA be the governing law over disability policy disputes.

In the case of Healy v. Minnesota Life Insurance Company, Dr. H. was a member of a medical group through which he obtained a disability policy administered by Minnesota Mutual. When Dr. H. and his disability lawyer sued Minnesota Mutual seeking long-term disability benefits, it was unsurprising when Minnesota Mutual argued that ERISA governed the policy.

Dr. H. argues his disability policy is not covered by ERISA

Dr. H. argued that his disability policy is not an "employee welfare benefit plan," and therefore not subject to ERISA, because the plan was not "established or maintained" by the employer. Specifically, Dr. H. argues that his employer:

  • Did not negotiate the terms of the policy;
  • Did not pay any portion of the premiums;
  • Did not participate in Dr. H’s application for the policy; and
  • Had no involvement in the administration or submission of the claims.

According to Dr. H, his employer’s only responsibility with regard to the policy was to forward his premium payments to the insurer. Ultimately, the court agreed with Dr. H. explaining that there was no evidence that Dr. H’s employer had established or maintained the program with the purpose of providing benefits to its employees as required by the ERISA statute.

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.