Two different ERISA lawsuits were recently filed by disability attorneys in California and Florida against Reliance Standard Insurance Company for the wrongful denial of disability benefits.

The First Case

In the first case, the plaintiff, through a California disability attorney filed a lawsuit in the District Court for Eastern California. The plaintiff was employed by Nu Skin Enterprises. While working for Nu Skin Enterprises, the plaintiff participated in Nu Skin’s Long-Term Disability Package to its employees. Reliance was the plan administrator for the disability insurance plan.

The plaintiff applied for Long Term Disability through Reliance on June 1, 2007 due to falling ill and experiencing severe pain in both his hips and knees that kept him from being present at work and being unable to perform the duties of his position for three continuous years. Reliance stated its approval of Plaintiff’s claim for benefits on December 14, 2007. Plaintiff applied for Social Security benefits as required by the Plan and his disability began on June 1, 2007. Plaintiff received a back award of $21,769.68 from the Social Security Administration and made a payment in this same amount to Reliance to meet the terms of the Plan. Plaintiff still receives Social Security Disability Benefits.

On September 29, 2009, Reliance informed Plaintiff that further long-term disability benefits would be denied based on the condition that the Plaintiff was suffering from a mental or nervous disorder. Reliance informed Plaintiff that because he was not in a Hospital or Institution, he could not receive further payments beyond August 30, 2009, 24 months after the first benefits were paid out.

The plaintiff appealed the denial and was issued a final denial by Reliance on October 26, 2010. In the lawsuit, the Plaintiff alleged that Reliance breached the terms of the Plan, which has caused the Plaintiff to suffer currently and to continue suffering in the future.

The Second Case

The second lawsuit was filed at the Middle District Court for the District of Florida by a Florida disability attorney. The plaintiff in this case was an employee for Southern Freight. He was provided with a LTD coverage plan that was fully insured by Reliance. Plaintiff received short-term benefits that ran from January 26, 2010 to April 27, 2010. However, despite continuing to fulfill the definition of "disabled" as defined by the Plan and being backed by the written testimony of his physicians, Reliance denied LTD benefits on July 21, 2010.

Relief Sought in the Lawsuits

In the aforementioned cases, the relief sought by the plaintiffs from Reliance in their lawsuits comprises of:

  • A declaration that the plaintiffs are entitled to LTD benefits under their respective plans
  • Benefits that are due and have not been paid, as well as interest
  • An award of attorney’s fees and costs
  • Any other relief that the court deems just 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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On July 5, 2011, Annie T. Merion and her Georgia disability attorney filed a lawsuit against UNUM Life Insurance Company of America in the United States District of Georgia, Macon Division on a claim for long term disability benefits. As a governmental employee plan for disability benefits, Merion’s claim is excluded from being a plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). Merion, however, was entitled to her disability plans as she was covered under a UNUM disability plan that was provided through the Peach County Board of Education. As such, Merion brought her claim against UNUM Life because of its termination of her disability benefits that are owed her.

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Filing a lawsuit under the Employee Retirement Income Security Act (ERISA) against Prudential Insurance Company of America and KeyCorp Group Insurance Plan in Ohio Federal Court, Tom Morgan and his Ohio disability attorney are seeking to have Prudential award Morgan his rightfully owed disability benefits. Having exhausted all administrative appeals available, Morgan and his disability attorney have no other recourse but to seek a verdict in Court.

An employee at KeyCorp, Morgan was a vested participant in the company’s group long term disability plan and "meets the criteria for payment of benefits under said Plan." Morgan was hired at KeyCorp in March of 2008, was issued a Prudential plan that included disability benefits and promised in the event of disability, he would be entitled to monthly disability benefits should he need it. On March 24, 2010, Morgan ceased working at KeyCorp as the result of a "combination of medical problems." Morgan properly applied for his disability benefits under the insurer’s plan and met the criteria for receiving his disability payments, but was denied those benefits upon initial application and all administrative appeals that followed.

Morgan and His Disability Attorney Accuse Prudential and KeyCorp of Being Unreasonable

Alleging that Prudential and his KeyCorp Group Plan has unjustifiably denied Morgan benefits, Morgan and his disability attorney filed their ERISA lawsuit on June 21, 2011. According to the complaint, Morgan and his disability attorney claim that Prudential owes Morgan long-term disability payments from September, 22, 2010 to the present and continuing. They allege that Prudential’s denial of Morgan’s long term disability application was unreasonable as well as "arbitrary and capricious" because the insurer filled the dual role of evaluator and payor of benefits. Therefore, the decision to deny Morgan his long term disability benefits contains an inherent conflict of interest.

Morgan and his disability attorney believe that Morgan’s medical records conclusively reflect that Morgan "is not capable of performing his own occupation or any other occupation due to his documented medical impairments and that he meets the definition of disability under the policy in question." The complaint states that Prudential and KeyCorp acted "arbitrarily and capriciously" when it refused Morgan’s offer to be subject to a multi-day Function Capacity Evaluation (FCE)to prove his disabled condition. The complaint goes on to allege that Prudential "improperly denied [Morgan’s] application for benefits in violation of the appropriate standard under ERISA statutes.

Relief that Morgan and His Disability Attorney Seek

Consequently, due to the insurer’s violation of ERISA standards, Morgan and his attorney ask the Court to:

  • Provide Morgan accrued and ongoing disability insurance payments per the policy, with the inclusion of cost of living adjustments;
  • Award Morgan attorney’s fees and cost;
  • Award Morgan interest on his benefits;
  • Award Morgan statutory damages; and
  • Provide Morgan with "other legal and/or equitable relief to which [he] may be deemed entitled. 

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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In possession of five insurance policies from Northwestern Mutual Life Insurance Company, Frank De Jong and his New Jersey disability attorney were forced to take the insurer to court as a last resort for De Jong to collect his disability benefits. Filed on July 5, 2011 in the United States District Court for the District of New Jersey, the complaint against Northwestern Mutual requests that the Court order Northwestern Mutual to pay damages to De Jong for "breach of contract, together with interest, attorney’s fees and cost of suit." De Jong and his disability attorney are asking to recover compensatory, consequential and punitive damages from Northwestern Mutual.

Painter Purchased Five Individual Disability Insurance Policies from Northwestern

In June 2006, De Jong purchased several individual disability insurance policies from Northwestern Mutual. In those policies, the definition of disability that the insurance company provided De Jong stated that "the insured is totally disabled when both unable to perform the principal duties of the regular occupation and not gainfully employed in any occupation." De Jong submitted an application to claim his disability benefits to Northwestern Mutual on April 10, 2010. His complaint was that since he was experiencing "a constant ringing in his right ear, severe to profound hearing loss bilaterally, and an inability to concentrate and focus due to the constant distraction of the ringing noise and balance issues due to loss of equilibrium, he is unable to perform the required duties of a painter." De Jong’s profession as a painter requires him to use ladders, climb scaffolds, and work in and around heights, and he is unable to perform those duties as a result of his present condition.

De Jong and His Disability Attorney File a Complaint against the Insurer for Breach of Contract on Two Counts

Stating that De Jong "was capable of performing his own occupation" in a letter dated November 30, 2009, Northwestern denied De Jong his long term disability benefits. Having provided Northwestern with appropriate proof of his condition, De Jong and his attorney contend in the First Count of their complaint that Northwestern breached their contract of disability insurance with De Jong. De Jong was up to date in his payment of insurance premiums and accuses Northwestern of breaching not only its contractual obligations but its obligation of good faith and fair dealing in the denial of De Jong’s disability benefits.

In the Second Count of the complaint, De Jong and his attorney claim that Northwestern breached its contractual obligation by denying De Jong’s claim for loss of business income. Even though De Jong provided the insurer with proof of the loss of business income as a result of his disability, the insurer stated that in its opinion, De Jong’s "loss of business income was not the result of any disability."

A complicated issue, De Jong v. Northwestern Mutual Life Insurance Company may prove to be a precedent-setting case for solo business owners everywhere. 

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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The plaintiff Laura Schlitt worked as a Regional Marketing Director for Camden Property Trust. She was a participant to a group Prudential disability insurance policy which was fully insured and administered by Prudential by virtue of her employment with Camden Property Trust.

Disability Benefits Application with Prudential

On January 8th 2010, the plaintiff became disabled under the term of the policy and was unable to perform the duties required of her occupation. According to the lawsuit, the plaintiff applied for short term disability benefits which were paid in full. Upon the expiry of her short term disability benefits, the plaintiff applied for long term disability benefits and was notified by Prudential on June 14th 2010 that she was approved for long term disability benefits for the period of April 9, 2010 through May 31, 2010.

Prudential Denies Long Term Disability Benefits and Arizona Attorney Files Suit

In the June 14th 2010 letter, the plaintiff was also informed that Prudential was terminating her disability benefits beyond June 1st 2010 as there was a lack of medical documentation supporting her inability to return to her regular occupation. In response, the plaintiff appealed the decision to deny her claim for long term disability benefits on July 25th 2010. To support her appeal, she submitted additional medical evidence to Prudential.

During the ERISA appeal, Prudential had a review done on the plaintiff’s medical record by a consulting physician from MES Solution. According to the lawsuit, the plaintiff stated that the review done was based on selective review of the evidence and ignored evidence in order to provide opinions or reports which supported the denial of claim. Hence, on August 27th 2010, Prudential informed the plaintiff that it was upholding its prior decision to terminate the plaintiff’s disability benefits beyond June 1st 2010.

The plaintiff made a second appeal to Prudential on February 18th 2011. Again, to support her appeal, the plaintiff submitted additional medical evidence including a Functional Capacity Evaluation (FCE) that indicated "inability to perform tasks, even at the sedentary work level, due to her restrictions and limitations".

Another "paper review" was done by Prudential and the plaintiff was notified by Prudential on May 13th 2011 that it was denying her appeal. At the same time, Prudential also informed the plaintiff that she had exhausted her administrative appeals and could file a civil action lawsuit in federal court pursuant to ERISA.

Arizona Disability Lawyer Files Lawsuit Against Prudential

In the case of Laura Schlitt vs. Prudential Insurance Company of America, Camden Property Trust, Camden Property Trust Employee Disability Plan filed at the District Court for the District of Arizona, the plaintiff alleged that the Prudential Insurance Company of America (Prudential) was denied her claim for long term disability benefits in order to save itself money in the long run.

The plaintiff alleged in the lawsuit that:

  • Prudential failed to adequately investigate the Plaintiff’s case and failed to engage the Plaintiff and her treating physician in a dialogue during the appeal of her claim with regard to what evidence was necessary so the Plaintiff could perfect her appeal and claim.
  • Prudential denied the Plaintiff a lawful, full and fair review pursuant to ERISA for various reasons by:
  • Failing to consider all evidence submitted by Plaintiff or de-emphasizing the medical evidence supporting Plaintiff’s disability.
  • Disregarding Plaintiff’s self-reported symptoms.
  • Failing to consider all the diagnoses and limitations set forth in her medical evidence as well as the combination of those diagnoses and impairments.
  • Failing to obtain an Independent Medical Examination when the policy allowed for one.
  • Failing to engage Plaintiff in a dialogue so she could submit the necessary evidence to perfect her claim.
  • Failing to consider the impact the side effects from Plaintiff’s medications would have on her ability to engage in any occupation.

Relief Sought By The Plaintiff

In the lawsuit, the plaintiff stated that she is seeking from the Court the following relief:

  • An Order requiring Prudential to pay the plaintiff disability benefits and any other employee benefits she may be entitled to as a result of being found disabled pursuant to the policy or Plan retrospectively.
  • A finding that the plaintiff meets the definition of disability set forth in the relevant Prudential policy and directing Prudential to continue paying the Plaintiff the disability benefits until such time she meets the conditions for termination of the benefits.
  • An award for attorney’s fees and costs.
  • An award for such other and further relief as the Court deems just and proper.

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-411-9085.

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After receiving disability benefits for 5 years from Sun Life insurance Company, Connie never expected her disability insurance benefits would be denied. Connie Hepburn was a "participant" in a Sun Life Disability benefit plan ("the Plan,") due to her employment with Toyoda-Koki Automotive North America, Inc. ("Toyoda") as a Shipping Supervisor in the Production Control Department. Sun Life acted as the plaintiff’s group disability insurer during the period for which her claim for benefits accrued, in addition to being the claims administrator for these benefits. The abovementioned plan was initially underwritten and administered by Genworth Financial prior to its employee benefits business being sold to Sun Life in 2007.

Sun Life Disability Application History

In April 2004, the plaintiff had developed a pituitary tumor known as a "pituitary adenoma." As a result of a decline in her health, the plaintiff stopped working on May 26th 2004. The plaintiff also stated that she underwent surgery to remove the tumor on the following day, May 27th 2004.

Claim For Sun Life Disability Benefits

On August 3rd 2004, the plaintiff filed a claim for long-term disability benefits with Genworth Financial on the ground that the surgical treatments the plaintiff underwent to remove the tumor had left her impaired both cognitively and functionally. The plaintiff’s claim was approved by Genworth Financial and her disability benefits was continuously recertified for a period of five (5) years based on her substantial medical proof of disability.

The plaintiff stated in the lawsuit that her condition had progressively worsened, and her memory problems have correspondingly worsened as well. She also developed a series of immunodeficiency ailments, including Gullian-Barre disease, a rare and very serious disorder which leads to paralysis of the limbs and restricts gait and movement. In addition, she has also been diagnosed with a number of intestinal and bladder infections which cause her great personal discomfort throughout the day and have permanently altered her ability to lead a normal life.

Termination of Long Term Disability Benefits After Receiving Payments for 5 Years

On October 20th 2009, Sun Life terminated Plaintiff’s long term disability benefits. Sun Life’s purported "reason" for terminating the plaintiff’s benefits was that "the medical on record does not support an inability to perform any gainful occupation at a sedentary level of activity."

The plaintiff submitted an ERISA appeal to the decision to terminate her disability benefits by Sun Life. Sun Life, however, upheld its denial on March 4th 2010. Subsequently, the plaintiff made another appeal to Sun Life’s denial and was again denied on November 2nd 2010 on the ground that the plaintiff did not provide "satisfactory proof’ that she remained disabled under the contract. This was despite the fact that in all of her appeals, the plaintiff provided substantial, credible, and overwhelming medical evidence of her continuing disability.

On November 2, 2010, Sun Life, again, upheld the termination of the claim stating, that, in its discretionary review of her claim, Plaintiff had not provided "satisfactory proof’ that she remained disabled under the contract. The plaintiff claimed that her medical condition has been in a period of steady deterioration of both her mental and physical abilities. Specifically, the Plaintiff stated that she suffered a loss of:

  • Her cognitive abilities to think and process information correctly.
  • Her ability to react and respond appropriately to stimuli.
  • Her gait and ability to move, stand, and sit properly.
  • Her ability to speak, concentrate and communicate effectively.

The plaintiff also stated that she suffered a series of debilitating physical ailments which have permanently altered her mobility and she had been rendered totally and permanently disabled within the definition of the Plan. The plaintiff also informed Sun Life that the Social Security Administration had determined the plaintiff to be totally and permanently disabled.

In the lawsuit filed by her Tennessee disability lawyer, the plaintiff alleged that after losing the above mentioned argument, Sun Life purported to review Plaintiff’s medical evidence and concluded that she suffers from "no disability" in the face of multiple different medical experts and the Social Security Disability Administration, all of whom found her to be totally disabled.

Legal Grounds For Lawsuit Filed by Tennessee Disability Insurance Attorney

Accordingly, under ERISA, the Plaintiff’s claim has been improperly denied as:

  • Sun Life has failed to properly interpret its own group disability insurance contract such that Plaintiff’s long-term disability benefits were terminated, despite her meeting the policy’s basic eligibility requirements.
  • The plaintiff and her employer fully paid all premiums and was entitled to coverage under the subject disability insurance policy.
  • She has been adjudicated totally and permanently disabled by the Social Security Administration.
  • The Plaintiff provided evidence of total and permanent medical disability to Sun Life from multiple physicians.
  • Sun Life’s selective evaluation of the plaintiff’s medical evidence precludes Sun Life from claiming that Plaintiff is not totally disabled.

Relief Requested by the Plaintiff

The plaintiff seeks the following relief from the Court:

  • An order compelling Sun Life to pay the plaintiff forthwith the full amount of benefits due to her and to continue such payments for the period set forth in the Plan, including interest on all unpaid benefits.
  • Disgorgement of any profits or gain Sun Life has obtained as a result of the wrongful action alleged in her Complaint and distribution of any profits or gain to the plaintiff.
  • Any and all such other relief as may be just and appropriate.
  • Reasonable attorneys fees and costs pursuant to ERISA

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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