Disability Blog & Cases:
Assistant Vice President of Meadowbrook Insurance Group files a lawsuit against CIGNA for denied disability benefits claim

In a lawsuit against CIGNA Group, Paul M. and his Massachusetts disability lawyer allege that the insurer is guilty of…

Disability Blog & Cases:
56-year-old disabled District Manager of Dollar Financial Group sues AETNA for denial of disability benefits

Carmen R. and her Florida disability lawyer take AETNA to task in a suit filed on December 19, 2011 in the United States District Court for the Southern District of Florida Fort Lauderdale Division. Claiming AETNA violated ERISA and other employment laws, Carmen and her lawyer accuse the insurer of wrongfully denying Carmen her entitled long term disability benefits after she became unable to perform her job duties as a result of degenerative and traumatic injuries.

Disability Blog & Cases:
Hartford interview request is a trap used to support a disability denial

As disability attorneys that have handled hundreds of Hartford disability claim denials nationwide, we are always trying to warn Hartford disability claimants about the claim handling tactics used by Hartford. Hartford handles every disability claim in a similar manner and they can be relentless in their pursuit of a claim denial. Our suggestion is to never allow a Hartford employee to interview you without representation…

Disability Blog & Cases:
Liberty Mutual Disability Denial Of Wachovia Employee Upheld By Appellate Court

This case is another reminder of the importance to comply with ERISA disability Appeal time deadlines. Plaintiff was a commissioned securities broker for Wachovia Corporation, and a participant in Wachovia’s Long Term Disability Plan (“the Plan”). Liberty Mutual was the administrator of the plan. He was awarded Long term disability benefits in 2005, though he disputed the amount he was being paid monthly.

Disability Blog & Cases:
Lincoln Financial Disability Denial: Determining a Date of Disability is Critical

Applying for disability insurance benefits is a complex process that requires a claimant to be familiar with all of the requirements in a disability policy. We often see that disability claims are denied benefits because a claimant does not select the correct date of disability.

A Colorado disability attorney filed a federal lawsuit in the Federal court against Liberty Life Assurance Company of Boston (Liberty) and Estes Express Lines (Estes). The Plaintiff, David F., was employed by Estes as an over-the-road truck driver. Due to this employment, Plaintiff was covered by an employee welfare benefit plan that was sponsored by Estes and insured by Liberty.

In David F. Vs Liberty Life Assurance Company of Boston and Estes Express Lanes, Plaintiff seeks the reinstatement of short-term disability benefits and the payment of long-term disability benefits as defined by the Plan.

Case Facts Against Liberty and Estes

Plaintiff worked as an over-the-road truck driver for Estes’ facility in Colorado until he became disabled due to seizure disorder, vertigo and balance problems, severe neck and facial pain, poor concentration, and other ailments. These ailments caused the Plaintiff to cease working on approximately October 25, 2010.

On or around October 25, 2010, Plaintiff applied for short-term disability benefits, which were granted by Liberty under the "own occupation" definition of disability as described in the Plan. The STD benefits began to be paid out on October 30, 2010, though the amount received was miscalculated. Liberty informed Plaintiff via letter dated February 8, 2011 that the STD benefits would run through February 8, 2011.

Termination of Short-Term Disability Benefits By Liberty

Liberty informed Plaintiff via letter dated March 28, 2011 that the STD benefits would be terminated after February 8, 2011. Plaintiff filed an appeal letter on April 14, 2011, pointing out that his numerous ailments led to his commercial driving license being terminated by the U.S. Department of Transportation, thereby qualifying him to continue receiving STD benefits.

However, Liberty denied the appeal letter on May 2, 2011. Liberty also informed Plaintiff that all administrative appeals were exhausted and that the only other option was to file a civil lawsuit under ERISA.

Disability Attorney Files Lawsuit Against Liberty

The terms of the lawsuit state that Liberty failed to provide the following to the Plaintiff:

  • Performing its fiduciary duties under ERISA
  • Coherent, specific reasons why the Plaintiff’s claim was denied
  • Reasons why specific medical evidence provided by the Plaintiff as part of his case was ignored by Liberty

The terms of the lawsuit claim that Liberty committed the following wrongful acts against the Plaintiff:

Denying benefits based on "cherry-picking" portions of the Plaintiff’s medical record
Failure to perform other acts that constitute a full and fair review of the Plaintiff’s claim
Using a conflict of interest to wrongfully deny Plaintiff’s claim, as Liberty was both the decision-maker and payer of the claim and benefits under the Plan

Plaintiff Seeks The Following Relief From The Court

Due to Liberty’s actions against the Plaintiff, Plaintiff seeks the following relief from Liberty:

  • All Plan benefits from the date that his benefits were denied
  • Reinstatement of Plan benefits that remain as long as Plaintiff is eligible under the terms of the Plan
  • All prejudgment interest owed on unpaid benefits from the date they were stopped until the present date of this judgment
  • All reasonable attorney fees and court costs
  • All other relief that the Court deems fair 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:
Weston Engineering employee sues AETNA Life Insurance Company for denied disability benefits

Richard R. and his Illinois disability attorney filed a lawsuit in the United District Court in the Northern District of Illinois, Eastern Division on December 9, 2010 against his employer and AETNA Life Insurance Company for long term disability benefits. A Weston Engineering Inc. employee since July 6, 2009, Richard R., a headache sufferer since he was a teenager, complained to his family doctor of intensification of his headache problems. Consequently, Richard R.’s doctor increased Richard R.’s pain medication to try to remedy the situation.

FAQ: Disability Policy Language
What should I be aware of if I am buying a disability insurance policy?

It is important to take into consideration that every disability income policy may have different features.

FAQ: Disability Companies
What are the differences between an individual disability insurance policy and an ERISA / Group disability policy?

Most group disability policies (also known as ERISA policies) are governed by a very complex federal statute called the Employees Retirement Income Securities Act (“ERISA”). An individual usually has a disability policy governed by ERISA, if they received the disability policy as an employee benefit from an employer.

 Product Analyst, Nancy W., 49, and her Arizona disability attorney filed a complaint in the United States District Court for the District of Arizona on October 26, 2011 against her employer Intel Corporation, Aetna Life Insurance Company and Reed Group (the administrator of Intel’s Aetna Plan) to force them to provide her with her entitled disability benefits per the terms and conditions of her employee disability insurance policy.

Citing ERISA (the Employee Retirement Insurance Security Act of 1974) violations and 29 U.S.C. § 1132(a)(1)(B) provision violations that the Defendants engaged in regarding Nancy W.’s disability claim, Nancy W.’s attorney petitioned the District Court to provide Nancy W. with:

  • A judgment in her favor against the Defendants;
  • Reinstatement of Nancy W.’s short term disability benefits and her long term disability benefits;
  • Prejudgment interest on any benefits accrued prior to the date of judgment;
  • Payment of Nancy W.’s disability benefits per the terms and conditions of her plan;
  • Attorneys’ fees; and
  • Any other relief she may be entitled to.

Arizona Claimant Denied Aetna Short Term Disability Benefits in 2007

Nancy W. became disabled in 2007 and applied for her short term disability benefits through her employee disability benefits plan. Nancy W. was denied continuing short term disability benefits in November 20, 2007 at which time she appealed the termination of those benefits and after exhausting all administrative appeals, filed a Complaint on May 20, 2010. Eventually, Nancy W. and her disability attorney voluntarily dismissed the complaint after the plan administrator Reed Group agreed to conduct supplemental review of Nancy W.’s claim. Reed Group upheld the earlier decision, Nancy W.’s disability benefits remain terminated, and Nancy W. filed suit again in the United States District Court of Arizona.

Background of Aetna Claimant’s Disabling Condition

The first termination of Nancy W.’s benefits occurred when two physicians indicated that Nancy W.’s previous blood pressure condition had stabilized and stated that her medical records "failed to show that the severity of her symptoms precluded her from performing job duties." Providing the insurer with contradicting medical records, Nancy W. challenged the two doctors’ opinions to no avail. So, Nancy W. applied for her long term disability benefits. Unfortunately, since her short term disability benefits had been terminated and Nancy W. had only used 183 days of her 364 days of short term disability benefits, she was disqualified from being eligible for long term disability benefits.

Lawyer Backs up Client’s Claim with Ample Case Law

Citing case law to back up Nancy W.’s claim, Nancy W.’s lawyer asks the District Court to consider that Aetna might have a conflict of interest in that the insurer not only provides the claimant’s employee insurance plan but is involved in the administrative decisions determining if a claimant has a legitimate claim as well. The pair allege that Aetna deliberating or negligently refused to comply with it obligation to inform claimants of why a claim decision was made denying benefits. They accuse Reed Group as an affiliate of Aetna of being negligent as well.

In the suit, Nancy W. and her disability lawyer ask the District Court to:

  • Enter a judgment in favor of Nancy W.;
  • Reinstate Nancy W.’s short term disability benefits and long term disability benefits retroactively to November 21, 2007;
  • Order Aetna to pay prejudgment interest on all owed benefit amounts accrued prior to the date of judgment;
  • Order the insurer to continue paying Nancy W. disability benefits per the plan;
  • Award Nancy W. attorneys’ fees; and
  • Provide Nancy W. with other relief she might be entitled to pursuant to Arizona law.

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:
CIGNA faces a lawsuit by American Homecare Supply Respiratory therapist for termination of disability benefits

In a December 2, 2011 lawsuit filed in the United States District Court for the Middle District of Pennsylvania, Sharon H. and her Pennsylvania disability attorney allege that CIGNA Group Insurance unjustly terminated Sharon H.’s disability benefits.

Disability Blog & Cases:
Long time Bank of America employee sues AETNA for denial of disability benefits

Filing a lawsuit under ERISA (the Employee Retirement Insurance Security Act of 1974) against AETNA, Leslie R, and her Arizona disability lawyer accuse the insurer of operating under a conflict of interest in the denial of Leslie R.’s short term disability benefits. As the decision maker and payor of benefits, AETNA has a bias toward denying benefits. And, according to Leslie R.’s disability lawyer in such incidents like Leslie R., the insurer is inclined to deny short term disability benefits in an effort to not have to follow through with long term disability benefits payments.

Disability Blog & Cases:
Sedgwick continues to deny disability benefits to AT&T employee

An AT&T employee recently shared her experience about dealing with Sedgwick for a short term disability claim. This story is a routine situation for people that are forced to deal with Sedgwick for the handling of their disability insurance claim.

 Cigna again finds itself in court over termination of entitled disability benefits. In the United States District Court of the Eastern District of Pennsylvania case Gena N. v. Liberty Insurance Company of North America a/k/a Cigna, Gina N. and her Pennsylvania disability attorney have appealed to the District Court to enter a judgment against the insurer for an award of her full and complete payment of long term disability benefits from the date of the termination of her long term disability benefits moving forward per the terms of her employee CIGNA plan, reasonable attorneys’ fees, costs and "expenses as permitted under ERISA, interest and any other equitable relief" the Court deems appropriate.

Office Manager Hires Disability Attorney to File Lawsuit against Cigna

Gina N. was employed at Drexel University College of Medicine as the Office Manager until February 7, 2003 when she ceased work as the result of a serious lower back injury which she sustained when she slipped and fell on ice in a parking lot. After intensive medical treatments and failed surgeries, Gina N. was forced to stop working, applied for her Cigna disability benefits, was awarded those benefits, and was awarded Social Security Disability Benefits. Then in January of 2009, some seven years later, Cigna terminated Gina N.’s disability benefits, basing its decision on its allegation that Gina N. "was not in compliance with the policy for failure to attend a scheduled Functional Capacity Evaluation (FCE), and by February 2010, Gina N. had exhausted all her administrative appeals forcing her to seek the assistance of a disability attorney to litigate her case.

Attorney Says Cigna was Arbitrary and Capricious in Denial of Disability Benefits

Charging Cigna with arbitrarily and capriciously terminating and denying her long term disability benefits, Gina N. and her disability attorney state that Gina N. had at all times sent medical documentation to the insurer as required, verifying her disabled condition. In addition, while Gina N. did miss one FCE appointment, she did undergo an FCE on November 17, 2009 and the test revealed that Gina N. did have limited movement and did suffer from back pain; the report did not, however, evaluate whether Gina N. had the "exertional capacity to re-engage in even a sedentary level position." In fact, Gina N. provided Cigna with this FCA report in one of her appeals to no avail. Gina N. and her attorney believe, and state in her complaint, that the insurer upheld its termination of Gina N.’s disability benefits on the exclusive opinion of a doctor from MLS Group of Companies, a peer review and report ordered by Cigna.

Doctor for Cigna Passed Judgment without Examining Claimant in Person

The doctor who evaluated Gina N.’s claim did not personally interview or evaluate Gina N.’s medical condition and, in fact, used a "standard form instruction sheet that it transmits to the physicians it selects and contracts with to conduct evaluations, which form is not contained in Cigna’s claim file," but which instructs evaluating physicians to "ignore subjective complaints" and limits the scope of any investigation. Gina N.’s attorney thus alleges that Gina N.’s assessment was "intentionally constrained" and that the assessment ignored her medical records and that the evaluation of "her condition was unfair, inappropriate, misleading, and did not constitute anything remotely resembling an ‘independent medical evaluation’."

In addition, Gina N. and her attorney allege that Cigna breached its disability insurance contract with Gina N. in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) by not providing a full and fair review of Gina N.’s claim. They allege that these violations entitle Gina N. to a judgment of wrongful denial on Gina N.’s claim, and seek to reinstate her long term benefits and compensation for attorneys’ fees and other damages to be determined by the District 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:
Texas claimant takes Reliastar to task for denied disability benefits

Suffering from multiple medical conditions and unable to function in a daily job, a health care professional and her Texas disability lawyer filed a lawsuit against Reliastar Life Insurance Company to force the insurer to pay disability benefits as contracted in an employee welfare benefit plan.

Disability Blog & Cases:
Wells Fargo disability claimants in Alabama and Florida file lawsuits against Liberty Life Assurance Company of Boston for unpaid long term disability benefits

Wells Fargo disability claimants in Alabama and Florida file lawsuits against Liberty Life Assurance Company of Boston for unpaid long term disability benefits

Recently, two Wells Fargo employees were forced to file Federal Lawsuist against Liberty Life after being denied disability benefits. Utilizing the services of an Alabama Disability Attorney and a Florida Disability Lawyer, the two lawsuits are currently pending. Let’s take a closer look at both cases:

Disability Blog & Cases:
Tempur employee suffering from chronic fatigue syndrome sues Union Central Life for denial of disability benefits

A federal lawsuit was recently filed in the U.S. District Court in Pennsylvania against the Union Central Life Insurance Company (Union) by a Pennsylvania disability attorney. The Plaintiff, Janet G., worked as a Direct Sales Supervisor for Tempur World, Inc. (Tempur). Due to her employment at Tempur, Janet was provided long-term disability insurance with Union Central.

An Alabama Claimant and her Alabama disability attorney filed suit against Liberty Life Assurance in the United States District Court for the Northern District of Alabama Northeastern Division. A former DIRECTV Group, Inc. employee, Juarlesa W. worked as a customer service representative and was fully vested in her company’s Liberty Life Insurance Plan when she became disabled in January 2010.

Suffering from the "combined effects of several impairments, including cervical/lumbar degenerative disc disease, lumbar/cervical radiculitis, osteoarthritis, fibromyalgia, degenerative joint disease of the right shoulder, chronic pain syndrome, post-op knee arthropathy, hypertension, GERD, migraines, restless leg syndrome, and insomnia," Juarlesa W. and her disability attorney filed suit against the insurer on November 7, 2011 for denial of Juarlesa W.’s long term disability benefits.

Background of Alabama Claimant’s Suit against Liberty Life

Approved for her short term disability benefits by Liberty Life, Juarlesa W. has an issue with only the denial of her long term disability benefits. After her short-term disability benefits expired, Liberty life began paying Juarlesa W. her long-term disability payments, but arbitrarily decided to terminate those payments in September 2010. The insurer asked for further information from Juarlesa W.’ treating physician to further evaluate her disability claim. In response, Juarlesa W.’s treating physician submitted a letter in November 2010, confirming that Juarlesa W.’s condition remained the same, meaning the same as when Liberty Life approved Juarlesa W.’s disability claim and paid her disability benefits.

Ignoring Juarlesa W.’s physician’s opinion as well as the insurer’s own physician consultant, Liberty Life continues to stand by their opinion that Juarlesa W.’s is not disabled and denies her further disability benefits. According to the complaint filed by Juarlesa W.’s disability attorney, "Liberty Life redid its prior decision concluding that [Juarlesa W.] was no longer disabled for the very same reasons it previously approved her claim." In addition, the insurer has not provided any other evidence that would indicate that Juarlesa W. is not disabled. After appealing and losing all administrative challenges to Liberty Life’s decision to terminate her long term disability benefits, Juarlesa W. hired a disability attorney to litigate her claim in District Court.

Disability Attorney States Case against Liberty Life

Offering up Juarlesa W.’s lengthy medical history as well as the opinions of her treating physician and Liberty Life’s own evaluating physician, Juarlesa W.’s attorney claims that Liberty Life wrongfully terminated Juarlesa W.’s disability benefits in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) as well as in violation of Liberty Life’s own policies. Consequently, Juarlesa W. and her disability attorney ask the District Court to:

  • Review her disability benefits claim with Liberty Life;
  • Award her all past due long-term disability benefits to which she is entitled;
  • Reinstate Juarlesa W.’s claim to all present and future long-term disability benefits under her plan;
  • Award her attorney’s fees;
  • Award Juarlesa W. interest on all past due disability benefits; and
  • Further relief as is proper 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.

Disability Blog & Cases:
At least five lawsuits were recently filed in Florida District Courts against Prudential for non-payment of disability benefits to deserving claimants

With at least five suits filed against them in July for denying disability benefits, Prudential Insurance Company of America has a lot of unhappy claimants in Florida.

Disability Blog & Cases:
California Consultant sues Northwestern Life Insurance Company for unpaid disability benefits

Northwestern Insurance beneficiary Todd W. and his California disability attorney‘s complaint against the insurer accuses Northwestern of breach of the Duty of Good Faith and Fair Dealing and Breach of Contract in response to its denial of Todd W.’s disability benefits.

Disability Blog & Cases:
Duke University Doctor sues UNUM Life Insurance Company for long term disability benefits

Dr. Karen M. and her North Carolina disability attorney filed a lawsuit against UNUM in the United Stated District Court for the Eastern District of North Carolina to acquire her long term disability benefits. The beneficiary of disability benefits under a plan provided through her employer Private Diagnostic Clinic PLLC at Duke University Medical Center, Dr. Karen ceased working as a general practitioner on February 23, 2007.

Wanda N. and her North Carolina disability attorney filed a lawsuit in the United States District Court for the Eastern District of North Carolina Western Division, claiming that Liberty Life wrongfully terminated Wanda N.’s long term disability benefits in violation of the Employee Retirement Insurance Security Act of 1974 (ERISA) and other federal statutes.

In the suit, Wanda N.’s disability attorney petitions the District Court to rule in favor of Wanda N. by:

  • Passing judgment against Liberty Life and obligating the insurer to pay Wanda N. her entitled disability income benefits from December 30, 2010 through the date of the judgment, plus pre-judgment interest;
  • Passing judgment against Liberty Life and obligating the insurer to fulfill its future obligations to pay Wanda N. her monthly disability income benefits as long as she is eligible to receive them under the terms of her policy;
  • Awarding Wanda N. attorney’s fees and court costs at the discretion of the court; and
  • Providing Wanda N. with any other "relief as the Court deems just and proper."

Claimant’s Disability Benefits are Terminated by Liberty Life in Violation of ERISA

As an employee at Kidde Aerospace & Defense, a subsidiary of United Technologies Corporation, Wanda N. was enrolled in her employer’s insurance policy benefit plan when she became disabled due to back pain in February of 2010. After receiving her short term disability benefits for six months and being approved for her long-term disability benefits in August 2010, Wanda N. discovered that her disability benefits would be terminated in December 2010. Apparently, the insurer concluded that Wanda N. was no longer disabled and believed that the previous evidence it had of Wanda N.’s disabled condition "no longer supported [Wanda N.’s] claim." On appeal of this decision, Wanda N. was denied.

Disability Attorney Presents Claimant’s Case in Their Complaint

A Floater at Kidde Aerospace, Wanda N. "performed various jobs when co-workers were absent from work or when additional workers were required for a particular job." Prior to her work stoppage, Wanda N. had a two-year history of "lower back pain radiating into her buttocks and legs, with numbness and tingling in her buttocks and thighs." Wanda N. underwent surgery in an effort to relief her back problem in March 2010, with some improvement of her condition, but no complete resolution. On various medication and attending to her healing process through physical therapy, Wanda N. received short-term disability benefits from Liberty life through August of 2010. Still recuperating, Wanda N. then applied for long term disability benefits, provided the insurer with her a completed Physical Job Evaluation Form, and Liberty Life approved her long term disability claim with plans to re-evaluate her situation in November 2010.

In November, a Liberty Life physician, in dispute with Wanda N.’s treating physician, determined that Wanda N. could perform light-duty work. Unfortunately, the Liberty life physician ignored Wanda N.’s medical records, which explicitly described how much pain Wanda N. was in and that her activity level potential was far short of the requirements of her position at Kidde Aerospace. In response Wanda N. "submitted a one-page appeal to Liberty Life in January 2011" and "advised Liberty Life that she could not sit up straight in a chair, could not sit for more than 15 minutes at a time without pain, could not stand for more than 10 minutes without pain, could not bend over, she laid down in the afternoons with a heating pad to help with the pain, she was currently on Zanaflex, Vicodin, Neurontin and Mobic, she was not allowed to drive a car due to the medication she was taking, and she remained under the care of" two doctors.

After another Liberty Life physician concluded that Wanda N. could work, Liberty Life again denied Wanda N.’s appeals resulting in Wanda N. hiring a disability lawyer to fight for her disability benefits in District 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.