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.

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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.

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

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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.

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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.

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Microsoft Employee Sues Prudential For Wrongful Denial Of Long-Term Disability Benefits

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Toyota Quality Assurance Monitor Sues Life Insurance Company Of North America For Denial Of Long-Term Disability Benefits

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A Pennsylvania court recently awarded $27,000 in attorneys’ fees to Ms. G. after she and her disability attorney won a judgment against Life Insurance Company of North America (“LINA”) also known as CIGNA for short-term disability (“STD”) benefits. This case is a good discussion of the analysis a court will go through in order to award attorney fees to a prevailing disability insurance claimant.

Long term disability insurance provides the needed safety net to protect against disabling injury or illness. Some insurance companies offer a provision called a "lump sum buyout" which may be beneficial to the policy holder.

A lump sum buyout is the payment of funds in exchange for the surrender of one’s long term disability policy. As a way to save money, insurance carriers calculate these buyouts based on the amount they project they will have to pay a claimant in the future, but at an overall reduced rate.

Each insurance company has their own methodology in determining the buyout amounts, however, there is a general principle that most insurance companies follow: if the lump sum buyout amount is less than the expected monthly payments, insurers will try to negotiate a buyout.

Lump sum buyouts are always at a discounted rate, which seems like it would be in an insurer’s interest to continue to collect benefits instead of a lump sum payment. However, this is often not the case.

Let’s examine the potential benefits of a lump sum buyout below:

  1. Lump sum buyouts provide extra security for a claimant’s family. Long term disability insurance policies contain no rights of survivorship that are commonly present in life insurance policies. To obtain a lump sum buyout, there is additional financial security in case of an emergency.
  2. While receiving long term disability benefits, there’s always a risk that benefits will be denied or cut off. With a lump sum buy out, there is a freedom to live without the constant fear of a denial.
  3. The cash received in the lump sum buyout is often tax-free and free to use and further invest.
  4. A claimant can return to work without hurting a claim or subject to the scrutiny of insurance companies.

It is essential to consult an attorney when planning a lump sum buyout. These are complicated processes which require the expertise of an attorney to negotiate the best possible lump sum settlement.

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.

The Prudential Insurance Company of America (Prudential) was sued in three separate cases in the Federal Courts of Missouri, Georgia, and Arizona for the wrongful termination of long-term disability benefits that are promised under the Employee Retirement Income Security Act (ERISA). In all three cases filed through the respective plaintiffs’ disability lawyers, Prudential is accused of denying the Plaintiffs the short-term or long-term disability benefits that were promised under the Plaintiffs’ respective plans.

The Missouri Case

In Mary J. Vs. The Prudential Insurance Company of America, a long-term disability lawsuit was filed by the Plaintiff against Prudential via a Missouri disability attorney in the Eastern District of Missouri Eastern Division. The Plaintiff had been employed full-time by Harrah’s Operating Company, Inc. (Harrah’s) since 2000, making her eligible for long-term disability benefits through Harrah’s Group Policy No. 42111 Plan. This Plan was insured by Prudential.

The Plaintiff ceased working in October 2007 due to degenerative arthritis of both knees and filed for long-term disability benefits. Prudential approved the claim on February 21, 2008. However, Plaintiff was notified on September 23, 2009 that she would no longer receive long-term disability benefits after February 20, 2010.

Plaintiff appealed the denial on February 9, 2010, but Prudential upheld the denial on August 30, 2010. Due to exhausting all administrative remedies, Plaintiff has filed this lawsuit against Prudential.

The Georgia Case

In Deborah D. Vs. The Prudential Insurance Company of America, Plaintiff was employed as a Program Manager by DRS Technologies, Inc., which provided both short-term and long-term disability benefits via an insurance plan that was insured and paid for by Prudential.

Plaintiff became disabled on or about August 23, 2010, leading to her filing a timely short-term disability claim, along with medical documentation, with Prudential. Prudential initially approved the STD claim and paid Plaintiff through October 24, 2010.

However, beginning October 24, 2010, Prudential terminated Plaintiff’s benefits on the basis that it had not received enough medical information to continue providing STD benefits. Plaintiff appealed this termination, but via letter dated March 7, 2011, Prudential upheld its original denial.

On September 2, 2011, Plaintiff again appealed and provided additional medical and vocational information to support her claim. However, on October 6, 2011, Prudential upheld its previous denials and declared that this decision was its final decision on the Plaintiff’s claim. Plaintiff has exhausted all administrative remedies and has filed this lawsuit against Prudential.

The Arizona Case

In Gerard L. Vs. Prudential Insurance Company of America and Anheuser-Busch Companies, Inc. (Anheuser-Busch), Plaintiff was employed by Anheuser-Busch as a local employee until on or about March 31, 2009 when he became disabled and unable to work as a Senior Manager of Accounting due to serious medical conditions. This employment enabled the Plaintiff to be covered under Anheuser-Busch’s group long-term disability insurance policy, which was funded by Prudential.

Plaintiff filed a disability application for Total and Permanent Disability and Group Life Insurance benefits under the terms of the Plan. Prudential denied his claim via letter dated December 14, 2010. Plaintiff filed an appeal of this decision and submitted additional medical evidence to support his claim. This included an Independent Medical Evaluation performed on January 26, 2010 that stated that Plaintiff would be unable to work for at least the next 12 months. In addition, Plaintiff applied for and received Social Security Disability benefits through the Social Security Administration.

Despite the additional evidence, Prudential upheld its original denial via letter dated March 23, 2011. Plaintiff again filed an appeal and submitted additional medical evidence. Prudential issued a final denial via letter dated August 1, 2011. Plaintiff has exhausted all administrative remedies and has filed this lawsuit against Prudential.

Relief Requested From The Lawsuits

In the three aforementioned cases, the Plaintiffs seek the following relief from Prudential in their lawsuits:

  • Prudential pays all benefits that are owed to the Plaintiffs, along with accrued interest
  • Prudential reinstates the eligibility of Plaintiffs to receive future benefits for as long as they remain eligible to receive such benefits as defined by the terms of their respective Plans
  • Prudential pays all attorneys’ fees
  • Prudential pays all associated court costs
  • Prudential pays all other relief that the Court deems to be fair 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 800-698-9162.