Disability Blog & Cases:
Clopay Corporation Customer Service Representative Sues Prudential For The Wrongful Denial Of Long-Term Disability Benefits

An attorney recently filed a federal lawsuit in the Ohio district court against The Prudential Insurance Company of America (Prudential) and Clopay Corporation Long-Term Disability Coverage (Clopay). The Plaintiff, Kimberly G., was employed as a Customer Service Representative at Clopay Corporation, providing her with short-term with Principal Financial and long-term disability benefits with Prudential.

Disability Blog & Cases:
Asurion Employee Files Lawsuit Against Life Insurance Company Of North America For Wrongful Termination Of Long-Term Disability Benefits

A lawyer from Colorado just filed a federal lawsuit in Federal Court of Colorado against the Life Insurance Company of North America (LINA). The Plaintiff, Carl E., was employed by Asurion. This made the Plaintiff eligible and covered by a group disability insurance plan provided by Asurion and administered and funded by LINA.

Disability Blog & Cases:
Court orders Life Insurance Company of North America to pay claimant long-term disability benefits

After failing to pay a LINA disability policyholder his entitled disability benefits the insurance company was forced by a New York court to follow through with its contractual obligations. Curt, a former employee of BorgWarner Morse TEC Inc. received long-term disability benefits under the group insurance policy issued by LINA. LINA later concluded the BorgWarner employee no longer met the definition of disabled under the policy and terminated his benefits.

An Illinois disability lawyer filed a federal lawsuit in Federal court against Liberty Life Assurance Company of Boston (Liberty) and Allstate Cafeteria Plan (Allstate). The Plaintiff, William B., was employed by Allstate as a Claim Senior Manager. Due to this employment, Plaintiff was eligible to receive short-term and long-term disability benefits under the Allstate STD Program, which was funded by Liberty.

In William B. Vs. Liberty Life Assurance Company Of Boston and Allstate Cafeteria Plan, Plaintiff seeks payment of wrongfully terminated long-term disability benefits by Liberty.

Case Facts Against Liberty and Allstate

Plaintiff worked as a Claim Senior Manager for Allstate until February 17, 2010 when he stopped working due to a combination of several psychiatric impairments. Before he stopped working, Plaintiff filed a claim for short-term disability benefits under the Allstate STD Program, which was approved by Liberty. Plaintiff began receiving STD benefits from February 25, 2010 to July 7, 2010.

Liberty informed Plaintiff via letter on August 4, 2010 that he was also eligible to receive long-term disability benefits as of July 8, 2010. From August 19, 2010 to May 2011, Plaintiff also received LTD benefits from a separate LTD policy he had purchased on his own.

Termination of Long-Term Disability Benefits By Liberty

On May 5, 2011, Plaintiff was notified by Liberty that he would no longer receive LTD benefits after May 12, 2011. This denial was made primarily due to the results of a file review performed by a non-examining physician.

On July 15, 2011, Plaintiff filed an appeal of this denial, supplying additional evidence that he was still participating in an extended treatment plan and that his doctor refused to grant permission to the Plaintiff to return to work based on his current condition. Despite this additional evidence, Liberty denied the Plaintiff’s appeal on September 9, 2011, again basing their decision on the file reviews conducted by non-examining physicians.

Due to the fact that all administrative remedies have been exhausted, Plaintiff has filed this lawsuit against Liberty and Allstate.

Disability Lawyer Files Lawsuit Against Liberty And Allstate

According to the lawsuit, the Plaintiff claims that Liberty committed the following wrongful actions against the Plaintiff:

  • Terminating the Plaintiff’s long-term disability benefits based on file reviews conducted by non-examining physicians
  • Failing to provide a full and fair review of the Plaintiff’s claim
  • Failing to fully consider the Plaintiff’s current medical condition, which is enough evidence for Prudential Insurance Company of America, payer of the Plaintiff’s other LTD policy, to provide LTD benefit payments to the Plaintiff
  • Causing the Plaintiff financial hardship due to the wrongful termination of LTD benefits

The Following Relief Is Sought By The Plaintiff Against Liberty And Allstate

Due to the actions of Liberty and Allstate, Plaintiff requests the following relief to be granted by the Court:

  • To pay all owed long-term disability benefits
  • To pay all prejudgment interest on owed LTD benefits at a rate of 9% per annum
  • To pay all future LTD benefits as long as the Plaintiff remains eligible to receive them according to the terms of the Plan
  • To pay all reasonable attorney’s fees
  • To pay all associated court costs
  • To pay all other relief that the Court deems 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 800-698-9162.

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 the claimant sought long-term disability ("LTD") benefits from his insurer and filed suit in Missouri. The Defendant insurance company argued that ERISA governed the policy.

While most plans offered through employers are governed by ERISA, such plans may be exempt from ERISA if the disability plan meets all four requirements set forth in the federal Safe Harbor Regulations.

If a court finds that an employer has "contributed" to the plan then it cannot be exempt under Safe Harbor Regulations.

Minnesota Mutual argues a 10% discount of claimants’ premiums was a "contribution" and that the policy is subject to ERISA

Naturally, Minnesota Mutual argued in an effort to convince the court ERISA governed the policy. Ultimately, the court ruled that the plan was not subject to ERISA after finding the policy had not been "established or maintained by an employer"—a requirement under ERISA. However, the court also explained that the policy was not exempt from ERISA based on the federal Safe Harbor Regulations.

This case is important because the Missouri Federal court joined several other courts in finding that a discount of the claimant’s premiums was a "contribution" and therefore the Safe Harbor exclusionary provision does not apply. In other words, the disability policy, although held by the court to fall outside the purview of ERISA regulation, came dangerously close to falling within ERISA simply because the insurance company offered a 10% discount for purchasing the policy through the claimant’s employer.

When an insurance company offers a discount for obtaining a long-term disability policy through your employer it is important to consider the possible effects the discount may have on the policy. A contribution by an employer could put a policy under ERISA regulation thereby subjecting a claimant to various obstacles and limitations.

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:
Employees of Staples & Nortel Networks among Four Plaintiffs To Sue Prudential For Wrongful Denial Of Long-Term Disability Benefits

The Prudential Insurance Company of America (Prudential) had four different lawsuits filed against it by four Plaintiffs in the District Courts of South Carolina (2 cases), New York, and West Virginia. In all four cases filed via the respective Plaintiffs’ disability lawyers, Prudential is accused of wrongfully denying or terminating the Plaintiffs’ claims for long-term disability benefits as promised under their respective plans and by ERISA.

Disability Blog & Cases:
Kirk & Blum/CECO Environmental Employee Files Lawsuit Against Lincoln Financial Group For Wrongful Termination Of Long-Term Disability Benefits

An attorney has filed a Federal disability lawsuit in Ohio Federal Court against Lincoln Financial Group (Lincoln). The Plaintiff, George P., was employed by Kirk & Blum, a subsidiary of Ceco Environmental, as a metal fabricator. This employment enabled the Plaintiff to be covered by a group insurance policy provided on behalf of Ceco Environmental employees and insured by Lincoln.

FAQ: Overpayment Issues:
Can a disability company sue me to recover an SSDI overpayment?

This case shows how a long-term disability insurance company can claim an overpayment once a claimant is approved for social security disability income benefits.

Disability Blog & Cases:
Hartford Disability Denial of Insurance Agent with Fibromyalgia and Chronic Fatigue is Reversed

A Utah Federal Judge reversed a Hartford long term disability insurance benefit denial on the basis that it was “unreasonable and, thus, arbitrary and capricious”. The judge’s opinion in this case is a great victory for disability insurance claimants disabled by Fibromyalgia or by…

Disability Insurance Law TV:
Episode 24: Top Five Reasons for Disability Insurance Denials

Nationwide Disability attorneys Gregory Dell and Rachel Alters discuss the top five reasons that Disability Insurance Claims are denied. The information in this video applies to both ERISA and Non-ERISA disability insurance policies.

A Virginia disability lawyer recently filed a federal lawsuit against The Guardian Life Insurance Company Of America (Guardian). The Plaintiff, Randal M., worked as a Master HVAC Installer for Parrish Services in Manassas, Virginia since October 15, 2008. Due to this employment, he was eligible for and enrolled in an employee welfare benefit plan that provided long-term disability benefits. These benefits were sponsored by Parrish Services and were underwritten and administered by Guardian.

In Randal M. Vs The Guardian Life Insurance Company Of America, Plaintiff filed a disability lawsuit to recover the long-term disability benefits wrongfully denied by Guardian.

Case Facts Against Guardian

Plaintiff worked as a Master HVAC Installer for Parrish Services in Manassas, Virginia since October 15, 2008. Plaintiff also had certifications to work as a gasfitter, plumber, HVAC, and electrician for Parrish Services.

In August 2009, Plaintiff was first diagnosed with an injury or illness to his spine at Lumbar 3 (L-3) and Lumbar 4 (L-4), which eventually led to his being totally disabled. Plaintiff applied for and received short-term disability benefits from Guardian. Plaintiff then applied for long-term disability benefits after the short-term disability benefit payments had run out.

Denial of Long-Term Disability Benefits By Guardian

In April 2010, Guardian denied Plaintiff long-term disability benefits due to the stated reason that the Plaintiff’s condition was pre-existing, making him ineligible for long-term disability benefits as defined by the Plan.

Plaintiff applied for Social Security Benefits and received them beginning on June 1, 2010. Due to the fact that Guardian’s Long-Term Disability benefit is a greater amount than Plaintiff’s Social Security Disability benefit, Guardian is required to supplement the Social Security Benefit amount.

Plaintiff became totally disabled at age 51. Guardian’s Long-Term Disability benefit is to provide LTD benefits to the Plaintiff up to the age of 65. Plaintiff was never diagnosed or treated for an injury or illness to L-3 and/or L-4 before August 2009, thereby negating Guardian’s stated reason of a pre-existing injury or illness making Plaintiff ineligible for LTD benefits as defined by the Plan.

Plaintiff has exhausted his administrative remedies, thereby leading to the filing of this lawsuit against Guardian.

Disability Attorney Files Disability Lawsuit Against Guardian

In the lawsuit, Plaintiff claims that Guardian failed to provide the following to the Plaintiff:

  • Guardian did not follow the terms of the Plan in determining that Plaintiff was ineligible to receive long-term disability benefits
  • Guardian did not arrive at the proper conclusion that the Plaintiff was eligible for long-term disability benefits because it claimed that the Plaintiff had a preexisting injury or illness in his spine, which was shown to not be the case during the look-back period as defined in the terms of the Plan
  • Guardian did not provide long-term disability benefits as were promised under the terms of the Plan

Plaintiff claims that Guardian committed the following wrongful actions against the Plaintiff:

  • Guardian committed an abuse of discretion of determining that Plaintiff was ineligible for LTD benefits based on a conflict of interest as both decision-maker and payer of benefits under the Plan
  • Guardian caused Plaintiff damages currently unknown to the Plaintiff, but will be approximate to the amount of benefits due to the Plaintiff since April 2010
  • Guardian will continue to cause damage to the Plaintiff each month until Plaintiff reaches 65 years of age due to the wrongful denial of LTD benefits, an approximate value of $1,335.00 per month

Relief Sought By Plaintiff In Guardian Lawsuit

Due to the wrongful actions of Guardian, Plaintiff seeks the following relief:

  • Guardian pays all long-term disability benefits to the Plaintiff from April 2010 to the present date, along with all accrued interest at the greater interest rate of the prime rate or the rate earned by Guardian on the unpaid policy benefits since April 2010
  • Guardian pays all future long-term disability benefits to the Plaintiff so long as he remains eligible under the terms of the Plan
  • Guardian pays all of Plaintiff’s attorney fees and cost of experts
  • Guardian pays all associated court costs
  • Guardian pays punitive damages according to the proof that is presented in the case
  • Guardian pays all other relief that is deemed proper and just by the 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:
Medical Doctor suffering from disabling chronic conditions sues AXA Equitable for wrongful denial of disability benefits

A Montana disability lawyer recently filed a federal lawsuit against the AXA Equitable Life Insurance Company (AXA). The Plaintiff, Marise J., M.D., was employed as a licensed medical doctor and was board certified in internal medicine. She had been practicing medicine for over 30 years.

Disability Blog & Cases:
Aetna Disability Denial of Marriott Employee Upheld by Louisiana Federal Judge

A former Marriott Employee was unsuccessful in his lawsuit seeking a reversal of Aetna Life Insurance Company’s disability insurance denial. As a former director of engineering, earning more than $200,000 a year, this former Marriott employee stopped working due to disabling lumbar herniations and back pain…

Disability Blog & Cases:
Who is Making the Decisions on a Sun Life Disability Benefits Claim?

Disability insurance claimants are routinely telling our disability insurance attorneys about their dissatisfaction with the manner in which a disability insurance company has handled their claim for disability benefits. Let’s take a look at why this disappointment is taking place.

FAQ: Tax Issues
How can a claimant exclude their disability insurance benefit payments from Federal Income Tax?

What actions can a claimant take in order to exclude Disability Insurance Benefits from personal income tax?

Aetna Life Insurance Company (Aetna) was recently sued in three cases in the Federal Courts of Oregon, Tennessee, and Missouri by three separate Plaintiffs due to the wrongful denial of long-term disability benefits as covered by the Employee Retirement Income Security Act (ERISA). All three cases claim that Aetna wrongfully denied the rightful long-term disability benefits to the Plaintiffs as defined by the terms of their respective Plans.

The Oregon Case

In Troy R. Vs Aetna Life Insurance Company, Plaintiff was employed as a residential appraiser by Bank of America for the past 20 years. Plaintiff was enrolled in a group long-term disability Plan that was issued by Aetna, who also is the claims administrator of the Plan.

On or about May 6, 2009, Plaintiff became disabled as defined by the terms of the Plan and submitted a timely claim for benefits. Aetna began paying short-term disability benefits on May 6, 2009 and continued doing so until November 3, 2009. Plaintiff provided all information requested by Aetna throughout the process, leading to the initial claim for short-term disability (STD) benefits.

Plaintiff submitted a claim for long-term disability (LTD) benefits, but on November 4, 2009, Aetna denied this claim despite the fact that Aetna had not received any new information about the Plaintiff’s condition from the time the last STD extension was granted on October 20, 2009 to the date that LTD benefits were denied on November 4, 2009.

Plaintiff appealed the denial, adding more reports and medical information to support his claim that the denial should be overturned. However, on November 23, 2010, Aetna made a final administrative denial of the Plaintiff’s appeal and claim for benefits based on "a lack of medical evidence" regarding his condition and his inability to work. Due to exhausting all administrative appeals, Plaintiff has filed this lawsuit against Aetna.

The Tennessee Case

In Eileen S. Vs Aetna Life Insurance Company and Gannet Company, Inc. (Gannet), Plaintiff was employed as a copy editor for the Tennessan, a newspaper based in Nashville, Tennessee and owned by Gannet Company, Inc. Plaintiff was covered under an Income Protection Plan that provide a sick pay program, a short-term disability program, and a long-term disability program. Gannet maintained this program for its employees, while Aetna was the claims administrator.

Due to a disability, Plaintiff ceased working on July 12, 2008. Plaintiff filed a timely claim for STD benefits, which should have been paid between July 19, 2008 and January 10, 2009. Plaintiff’s claim for STD benefits were approved, but only paid through October 30, 2008.

Aetna sent a letter to Plaintiff dated November 12, 008 that terminated her STD benefits due to a lack of documented evidence of her medical conditions. Plaintiff appealed this denial and sent substantial amounts of additional evidence to prove her claim. She also submitted a claim for disability benefits to the Social Security Administration (SSA) as required under the terms of the Income Protection Plan, which was granted a Fully Favorable Decision on April 20, 2010.

Despite this, Aetna issued a final denial of STD and LTD benefits via a December 8, 2010 letter to the Plaintiff. Plaintiff has exhausted all administrative remedies, leading to the filing of this lawsuit against Aetna.

The Missouri Case

In Sandra A. Vs Aetna Life Insurance Company, Plaintiff was employed by Verizon Wireless (Verizon) and was covered by the disability insurance company as provided by Verizon, which was fully insured by Aetna.

Due to her medical conditions, Plaintiff has been totally disabled as defined by the terms of the Plan since November 1, 2009. Plaintiff submitted a claim for benefits, but was denied by Aetna. Plaintiff has exhausted all administrative appeals and has filed this lawsuit against Aetna.

Plaintiffs Seek The Following Relief

In all of the aforementioned cases, Plaintiffs seek the following relief from Aetna:

  • Full entitled benefits as defined by the terms of the Plaintiffs’ respective Plans.
  • All reasonable attorneys’ fees.
  • All related court costs.
  • All other fair and just relief as decided upon 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:
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.