Unfortunately for employees of AT&T, if you are disabled you will be forced to deal with Sedgwick Claims Management Services Inc. ("Sedgwick"). Sedgwick is a third party administrator that has been hired to administer and make claim decisions on AT&T short term and long term disability claims. The AT&T disability benefit plan is written with language that makes it very difficult for disability claimants to obtain benefits. Sedgwick is notorious for unreasonable claim denial and has been sued on numerous occasions. Despite an approval of SSDI benefits and a finding of disability by a doctor hired by Sedgwick, this claimant’s disability benefits were still denied.

The Facts of the Sedgwick Disability Claim

The plaintiff was an employee of BELLOUTH TELECOMMUNICATIONS Inc (now known as AT&T, Inc due to the merger between BELLSOUTH and AT&T). By virtue of her employment with BELLSOUTH a Network Manager of Construction and Engineering, the plaintiff was a participant in the BELLSOUTH SHORT AND LONG TERM DISABILITY PLAN FOR MANAGEMENT EMPLOYEES, (now known as the AT&T Umbrella Benefit Plan No. 1) an employee welfare benefit plan that was administered by Sedgwick Claims Management Services Inc. (Sedgwick).

Claim for Short Term disability Benefits

On August 10, 2007, due to her medical conditions, including but not limited to post traumatic stress disorder, anxiety and major depressive disorder, the plaintiff stopped working. She became disabled as a result of these medical conditions and subsequently filed a claim for Short Term disability benefits under the abovementioned plan. Sedgwick approved her claim for short term disability benefits and the plaintiff began receiving short term disability benefits effective from August 20th 2007. According to the lawsuit, Sedgwick paid the plaintiff the maximum 52 weeks of short term disability benefits under the Plan, from August 20th 2007 to August 17th 2008 and withheld premium from after tax dollars for supplemental Long Term disability benefits purchased by the plaintiff.

Claim for Long Term disability Benefits

On May 9th 2008, the plaintiff was notified by Sedgwick that that continued benefit payments were contingent on the results of an Independent Medical Evaluation (IME).
As such, the plaintiff attended the IME scheduled for her on June 3rd 2008. The result of the IME supported the Plaintiff’s continued disability. Hence, the plaintiff was approved for long term disability benefits on August 18th 2008.

On November 20th 2009, the plaintiff was approved for disability benefits from the Social Security Administration. From the payment of her retroactive Social Security Award, Sedgwick recovered from the plaintiff an overpayment of benefits amounting to $19,679.48. Despite the favorable IME and approval of her claim for Social Security Disability benefits, on April 28th 2010, Sedgwick notified the plaintiff that recent review of her claim showed that she may have some work capacity and continued benefits were contingent on a vocational review.

Long Term Disability Benefits

Thus, on June 8th 2010, Sedgwick terminated the plaintiff’s long term disability benefits on the grounds that she did not satisfy the definition of disability under the Plan. The plaintiff appealed Sedgwick’s termination of her disability benefits and improper withholding of taxes from her long term disability supplemental benefits by a letter dated November 22nd 2010. The plaintiff stated that despite her continuing disability consistently documented by her treating providers, medical literature, and other medical reports demonstrating that Ms. Arnold is unable to perform the duties of any occupation, Sedgwick upheld the termination of benefits on January 7th 2011.

The plaintiff alleged that Sedgwick had ignored some medical records and deemphasized others, including consistent reports of the plaintiff’s treating physician, favoring her claim for disability benefits. She also argued that the decision to terminate her disability benefits was an abuse of discretion, a breach of the terms of the Plan, and was wrong, arbitrary and capricious and having exhausted all her administrative remedies is entitled to seek relief from the Court under ERISA.

Plaintiff Hires A Disability lawyer to File her Lawsuit

The case of Debra A. Arnold vs. AT&T, Inc., AT&T Umbrella Benefit Plan No. 1 F/K/A SBC Umbrella Plan No. 1, Bellsouth Long Term Disability Plan For Management Employees And Sedgwick Claims Management Services, Inc was a legal action under the Employee Retirement Income Security Act of 1974 (ERISA) and was filed at District Court for the Middle District of Florida. Acting through a Florida disability attorney, the plaintiff alleged that Sedgwick Claims Management Services Inc (Sedgwick) and the Plan Administrator for the AT&T Umbrella Benefit Plan had violated the provisions of ERISA in the denial of her claim for long term disability benefits.

The plaintiff alleged that she is entitled to these benefits under the Plan since she had:

  • Satisfied all conditions to be eligible under the Plan; and
  • Has not waived or otherwise relinquished her entitlement to these benefits.
  • Hence, the plaintiff is requesting a judicial review of the denial of benefits in this case and declare that she is entitled to all benefits under the Plan, including:
  • Payment of all back benefits with interest,
  • The underpayment of benefits resulting from tax withholdings wrongfully withheld.
  • Payment of all attorney’s fees and costs associated with attempting to secure these benefits.
  • Penalties payable in the amount of $110/day or other amount as to be determined by this Court as a result of the failure of Sedgwick and the Plan Administrator to provide the information requested.
  • Any such other relief deem just and proper 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 sues Guardian / Berkshire Life Insurance Company Of America for $1.2 million dollars following denial of disability insurance benefits

Recently, in the case of Laser & Cosmetic Dermatology S.C and Jawdat Abboud Vs. Guardian Life Insurance Company Of America, Berkshire Life Insurance Company of America filed at the District Court for Northern Illinois Eastern Division, the plaintiff Jawdat Abboud through his Illinois disability attorney alleged that the Berkshire Life Insurance Company of America (a subsidiary of Guardian Life Insurance Company Of America) had caused him and his business to suffer damages due to the Berkshire Life Insurance Company of America (Berkshire) wilful conduct in constructively denying the plaintiff’s disability claim benefits due under the insurance policies that he purchased and contracted from Berkshire.

Disability Blog & Cases:
Medical Secretary suffering from “failed back syndrome” and leukemia sues The Standard Insurance Company for disability benefit denial

Despite numerous disabling medical conditions, The Standard Insurance Company Denied disability benefits. The plaintiff was a medical secretary working at a private practice. By virtue of her employment, the plaintiff became eligible for coverage under the Standard Insurance’s Select Trust Group Policy, Long Term Disability Benefits, Group Policy. Under the terms of the Plan, Standard Insurance is the Plan fiduciary and insurer.

Disability Blog & Cases:
CIGNA pays disability benefits for 10 years, offers a lump sum buyout and then denies disability claim

The case of Therese Regan vs. CIGNA Corporation d/b/a CIGNA Group Insurance and Pactiv Corporation concerns a former Pactiv Corporation’s Lab Technician who recently, through a New York disability attorney, filed a lawsuit at the District Court for the Northern District of New York against the CIGNA Corporation for wrongfully denying her claim for disability benefits.

An Illinois disability attorney, on behalf of a FedEx employee, recently filed a lawsuit at the District Court for the Northern District Of Illinois against the Life Insurance Company of North America (now part of CIGNA Group) for wrongfully classifying the post of a Line Haul Manager as a sedentary occupation thereby resulting in the claimant being denied his long term disability benefits.

Fedex Disability Insurance Claim Against Cigna

The case of Robert Best vs. Life Insurance Company of North America concerned the plaintiff who worked as a line haul manager for the FedEx Freight Systems, Inc. (FedEx). The plaintiff participated in an employee welfare benefit plan, as defined by the Employee Retirement Income Security Act (ERISA) that was issued by FedEx and administered by CIGNA. The plan provided for payments of disability benefits in the event the insured became disabled. Under the plan, the insured is:

Considered Disabled if solely because of Injury or Sickness, you are:

  • Unable to perform the material duties of your Regular Occupation; and
  • Unable to earn 80% or more of your Indexed Earnings from working in your Regular Occupation.

After Disability Benefits have been payable for 12 months, you are considered Disabled if, solely due to Injury or Sickness, you are:

  1. unable to perform the material duties of any occupation for which you are, or may reasonably become, qualified based on education, training or experience; and
  2. unable to earn 80% or more of your Indexed Earnings.

We will require proof of earnings and continued Disability.

While working with FedEx, the plaintiff began experiencing significant arthritis pain in his back and right hip which affected his ability to perform his tasks as a Line Haul Manager for FedEx. As a result of his medical condition, the plaintiff was forced to take medical leave in November of 2009. Subsequently, in April 2010, the plaintiff submitted a claim for long term disability benefits to CIGNA.

On June 3rd 2010, CIGNA approved the plaintiff’s Claim for long term disability benefits effective from November 11th 2009. Although CIGNA began paying long term disability benefits to the plaintiff in June 2010, CIGNA informed the plaintiff that it was “unable to continue paying benefits beyond September 9, 2010… Since you are able to perform a sedentary job, you are capable of returning to your job as a Line Haul manager which is a sedentary job,” and therefore the “claim has been closed.”

The plaintiff alleged that CIGNA’s determination that the Line Haul Manager position is a “sedentary job” was contrary to the evidence and affidavits provided to CIGNA which established that the position is clearly not a sedentary job but instead involves significant physical activity. Although the plaintiff appealed CIGNA’s decision and exhausted all avenues of administrative appeal, CIGNA continued to uphold its decision to deny the plaintiff his claim for long term disability benefits.

Alleged Legal Grounds For Lawsuit Against CIGNA filed by Illinois Disability Lawyer

In the lawsuit, the plaintiff alleged that CIGNA’s action to deny his claim for long term disability benefits was arbitrary and capricious as CIGNA’s denial was based on an erroneous basis that the plaintiff’s position as a Line Haul Manager was a sedentary position.

Relief Sought by the Plaintiff

The plaintiff also stated in the lawsuit that as a result of CIGNA’s actions, he had suffered damages and is seeking through the Court the following relief:

  • Judgment in the plaintiff’s favour and against ÇIGNA and an order for CIGNA to pay long term disability benefits to the plaintiff in an amount equal to the contractual amount of benefits that the plaintiff is entitled to under the Plan.
  • An order for CIGNA to pay the plaintiff prejudgment interest on all benefits that have accrued prior to the date of judgment.
  • An order to CIGNA to continue paying plaintiff benefits until the end of the Maximum Benefit Period as defined by the Plan.
  • An order to CIGNA to pay any and all additional benefits associated with long term disability coverage, including, but not limited to, health insurance coverage.
  • An award of attorney’s fees and costs of the lawsuit.
  • An award for all other relief to which the plaintiff may be 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.

Learn about the disability benefits denial for managers and what you can do to protect your benefits.

Disability Blog & Cases:
Group Health Plan Inc’s Actuary sues Reliastar Life Insurance Company and ING Disability Claims Management Services for recovery of disability benefits under The Ramsey Health Care Services Short Term Disability Plan

A Minnesota disability attorney recently filed a lawsuit on behalf of a client against the Reliastar Life Insurance Company and ING Disability Claims Management Services (Reliastar & ING) for denying her claim for short term disability benefits. The case of Susan Fonseth vs Ramsey Health Care Services Short Term Disability Plan, Reliastar Life Insurance Company, and ING Disability Claims Management Services was filed at the District Court for the District of Minnesota.

Disability Blog & Cases:
Prudential denies disability benefits despite FCE Exam stating former Data Distributor Inc. employee with heart condition cannot perform sedentary occupation

A Georgia disability attorney recently filed a long term disability lawsuit due to Prudential Insurance Company’s wrongful denial of disability benefits to a former project manager. This case shows that despite strong objective evidence and a positive FCE exam in support of multiple disabling conditions, Prudential can still hire physicians that can review a file and determine that a claimant has no restrictions and limitations.

Disability Blog & Cases:
Court of Appeals, Seventh Circuit ruled Unum Life Insurance Company Of America is prevented from using Self-Reported Symptoms Limitation Clause to discontinue long term disability benefits payments for woman with fibromyalgia

In the case of Susie Weitzenkamp, Vs. Unum Life Insurance Company Of America, the Court of Appeals, Seventh Circuit recently ruled that the Unum Life Insurance Company Of America (UNUM) cannot rely on a Self-Reported Symptoms Limitation Clause to discontinue the plaintiff’s long term disability benefits as UNUM had failed to include the self-reported symptoms limitation in the Summary Plan Description (SPD).

The Aetna Life Insurance Company (AETNA) was recently sued in three separate cases in Florida and Texas for denying claims for disability insurance benefits under employee welfare benefit plans that was administered by it. Let us have a closer look at the circumstances of the different cases below.

Lawsuits filed by Bank of America employees against AETNA – Failure to comply with the Provisions of ERISA in claims for disability benefits

The following two cases below both concerned Bank of America’s employees filing lawsuits against AETNA for denying their claims under the Bank of America short term and long term disability insurance plans. Let us examine in more detail the two cases.

Rachel Jones vs. Aetna Life Insurance Company And Bank Of America Corporation

The case of Rachel Jones vs. Aetna Life Insurance Company And Bank Of America Corporation was also filed by a Florida disability attorney for the plaintiff at the District Court for the Middle District of Florida. The plaintiff Rachel Jones was a Bank of America (BOA) employee. By virtue of her employment, she was a participant in the Bank of America Short Term and Long Term Disability Plans which was administered by AETNA.

In the lawsuit, the plaintiff claimed that although she had satisfied all the conditions for her to be eligible for the disability benefits, AETNA had continued to deny both her claim for short term and long term disability benefits. The plaintiff stated that in deciding her claim for long term disability benefits, AETNA failed to act within the stipulated 45 days time frame provided by ERISA. As such, the plaintiff alleged that AETNA had failed to follow claims procedures that were consistent with the requirements of ERISA. It is not uncommon for Aetna to fail to render a claim decision within 45 days.

Christopher Koberstine vs. Aetna Life Insurance Company – Unreasonable Claim Process

The case of Christopher Koberstine vs. Aetna Life Insurance Company was filed at the District Court for the Middle District of Florida for the plaintiff by a Florida disability attorney. The plaintiff Christopher Koberstine was a participant of an employee welfare benefit plan sponsored by his employer and administered by AETNA. The plan provided for both short and long term disability insurance benefits. According to the lawsuit, the plaintiff alleged that AETNA had subjected the plaintiff to an unreasonable claim process by failing to provide a decision within the time limits provided by the Employee Retirement Income Security Act (ERISA). The plaintiff also claimed that AETNA failed to comply with its own internal rules, guidelines, protocols, and other similar criteria relied upon in making the determination to deny his claim for disability benefits.

Relief Sought By The Plaintiff

The plaintiff in this case was seeking from the Court the following relief:

  • A declaration of the plaintiff’s rights to the disability benefits under the long term disability insurance policy funded and administered by AETNA.
  • Reinstatement of the plaintiff’s rights to the disability benefits under the long term disability insurance policy funded and administered by AETNA.
  • An award of attorney’s fees and cost and prejudgement interest.
  • Award any such other relief as the Court may deem appropriate.

Richard Devlin Mcnamara vs. Aetna Life Insurance Company

The case of Richard Devlin Mcnamara vs. Aetna Life Insurance Company was filed at the District Court for the Western District of Texas by a Texas disability attorney. The plaintiff Richard Devlin became disabled in 2009. It was stated in the lawsuit that his claim for disability benefits was initially approved by AETNA. He received monthly disability benefits payments from AETNA until September 3rd 2010 when AETNA decided to terminate his disability benefits payment.

The plaintiff appealed AETNA’s decision and had the denial of claim overturned after a review. AETNA issued to the plaintiff on May 24th 2011 its "Final Level Appeal Determination Letter" which stated that "…we have determined that sufficient documentation exists which supports Mr. McNamara’s inability to perform the material duties of his occupation, effective 9/ 3/2010."

However, despite overturning its prior decision to deny the plaintiff his claim for disability benefits, the plaintiff stated that AETNA refused to reinstate his disability benefits payments due to him under the policy.

Relief sought by the Plaintiffs

In both legal actions filed by the Bank of America employees against AETNA, the plaintiffs were seeking the following relief:

  • Clarifications of their legal rights under the disability insurance plans
  • Payment of all disability benefits due to them under the disability insurance plans.
  • An award of attorneys’ fees and costs for the lawsuits.
  • Prejudgement and Post judgement interest
  • An award for any such other relief deemed just and proper 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:
Massachusetts Disability Attorney filed lawsuit against the Aetna Life Insurance Company on behalf of Biogen Idec, Inc’s IT Technical Ops Lead for denial long term disability benefits

In the disability lawsuit of Joseph Mcdonough Vs Aetna Life Insurance Company, HM Life Insurance Company, Biogen Idec, Inc. & Biogen Idec., Inc., Group Long Term Disability Plan filed at the District Court for the District of Massachusetts, the plaintiff filed a federal lawsuit against Aetna for violations of the Employment Retirement Income Security Act (ERISA.)

Disability Blog & Cases:
Registered nurse & her california disability lawyer sue Unum Life Insurance Company for failure to pay disability benefits

A California disability attorney recently filed a lawsuit in the District Court for the Central District of California against the Unum Life Insurance Company of America (Unum). In Marjorie McGill Vs Unum Life Insurance Company of America, Administrator of the HCA Management Services, L.P. On Behalf of HCA’s Affiliated Facilities (Los Robles Hospital and Medical Center) Long-term Disability Plan, the plaintiff brought the legal action under the Employment Retirement Income and Security Act (ERISA) to recover short and long term disability benefits that were wrongfully denied by Unum.

Disability Blog & Cases:
CIGNA denies disability insurance benefits to Engineering Manager with Stage 4 cancer

The plaintiff Bradley Erickson was employed as an engineering manager for BorgWarner. By virtue of his employment, he was entitled to coverage under an employee welfare benefits plan issued by LINA and administered by CIGNA. At the District Court for the Eastern District of Michigan recently, a Michigan disability attorney filed a lawsuit on behalf of a client against the Life Insurance Company of North America (LINA) and CIGNA for denial of disability insurance benefits and ERISA violations.

In the past week, The Liberty Life Assurance Company of Boston (Liberty Life) was recently sued for denying disability insurance benefits to claimants in the states of Florida, South Carolina and Michigan. The disability lawsuits were undertaken as a result of failure to comply with the provision of the Employee Retirement Income Security Act (ERISA). Let us examine the three separate Liberty Mutual cases in more detail.

Penny Menz Vs. Liberty Life Assurance Company Of Boston – Legal Action To Clarify Rights And Recover Disability Benefits Under Employee Welfare Benefit Plan

Filed at the District Court for the Middle District of Florida by a Florida disability attorney, the plaintiff Penny Menz was a covered participant of an employee welfare benefit plan sponsored by her employer, funded and administered by Liberty Life. Because Liberty Life was both underwritten and administered by Liberty Life, the plaintiff alleged that Liberty Life faces an inherent conflict of interest between its duties to the plaintiff as an ERISA fiduciary and its duties to its shareholders as a for-profit corporation.

According to the lawsuit filed by the plaintiff’s Florida disability attorney, Liberty Life failed to:

  • Comply with its’ own internal rules, guidelines, protocols, and other similar criteria relied upon in making the adverse determination.
  • Provide a copy its own internal rules, guidelines, protocols, and other similar criteria relied upon in making the adverse determination.
  • State that same a copy its own internal rules, guidelines, protocols, and other similar criteria relied upon in making the adverse determination will be provided upon request in its denial of the plaintiff’s appeal as required by the provisions of ERISA.

The plaintiff in the lawsuit is seeking the disability benefits due to her under the plan in addition to prejudgment interest, costs, attorney’s fees and such other relief as the Court may deem appropriate.

Dennis Johnson vs. Liberty Life Assurance Company Of Boston – Legal Action To Remedy Breach Of Fiduciary Duty And To Recover Full Disability Benefits

The case of Dennis Johnson vs. Liberty Life Assurance Company Of Boston was filed at the District Court for the Western District Of Michigan by the plaintiff’s Michigan disability attorney regarding the breach of the terms of an employee benefit plan and breach of Fiduciary Duty. The plaintiff was a former employee of HI-Lex America, Inc and was a participant in a welfare benefit plan issued by Liberty Life

On July 12th 2008, the plaintiff became entitled to payment of partial disability monthly benefits under the Plan. However, the said disability benefits to the plaintiff were terminated by Liberty Life on June 17th 2010 because the plaintiff allegedly no longer met the definition of disability under the abovementioned plan.

Although the plaintiff made an appeal to Liberty Life’s decision on March 30th 2011, the appeal was denied by Liberty Life on May 18th 2011. The plaintiff contended that the
discontinuation of the plaintiff`s disability benefits payments were in direct violation of the terms of the abovementioned plan. Hence, the plaintiff is seeking from the Court the following relief:

  • A declaratory judgment declaring that the plaintiff is entitled to the continuation of the group disability benefits.
  • A preliminary and permanent injunction to prevent Liberty Life from discontinuing, reducing, limiting, or terminating the disability benefits payable to the plaintiff under the Plan.
  • A full and accurate accounting by Liberty Life of all computations for Plaintiffs disability benefits, in sufficient detail so that Plaintiff may ascertain that his benefits are paid in the proper amount.
  • An order compelling Liberty Life to pay the plaintiff the full amount of disability benefits due him 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 that Liberty Life have obtained as a result of the wrongful action alleged in this complaint add equitable distribution of any profits or gain to the plaintiff.
  • Reasonable attorney fees and costs, pursuant to ERISA.
  • Any such other relief as may be just and appropriate.

David Hill vs. Liberty Life Assurance Company Of Boston – Legal Action For Judicial Review Of Claim For Disability Benefits

In the case of David Hill vs. Liberty Life Assurance Company of Boston, the plaintiff was working for Mead Westvaco. He was provided with long term disability coverage under a plan that was fully insured by Liberty Life. In addition, Liberty Life was also the Claims Administrator of the Plan.

The plaintiff stated in the lawsuit that after being disabled, he filed a claim for disability benefits under the abovementioned plan. Liberty Life, however, denied his claim for the disability benefits.

The plaintiff alleged that liberty Life was operating under an inherent conflict of interest when it made its decision to deny his claim for disability benefits. The plaintiff also alleged that Liberty Life ignored relevant evidence pertaining to his claim.

In the lawsuit, the plaintiff is seeking judicial review of his claim and specifically seeks from the court the following relief:

  • A declaration that the plaintiff is entitled to the disability benefits which he seeks under the terms of the plans.
  • Or alternatively remand the plaintiff’s claim for a "full and fair review."
  • An award of attorney’s fees and costs.
  • An award for prejudgement interest.
  • An award for other further relief deem just and proper 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:
Jean Pentecost and her Montana disability lawyer file a complaint against CIGNA

On June 6, 2011, Jean Pentecost sued CIGNA for her disability benefits under the Employee Retirement Income Security Act of 1974 (ERISA) in the United States District Court of Montana, Butte Division. Seeking long term disability benefits as well as attorney fees, Pentecost and her Montana disability attorney ask the Court in Pentecost’s disability insurance lawsuit to force CIGNA to pay her disability benefits as promised by her plan, award her reasonable attorney fees and Court costs, prejudgment interest and any other relief the Court sees as just and proper.

FAQ: IME Exams & Insurance Company Doctors:
Can a disability insurance company rely on a Functional Capacity Exam (“FCE”) to deny long-term disability benefits?

Unfortunately a recent Appellate court answered this question yes. Every disability case is distinguishable so for every case that says an FCE is reliable evidence of disability, there is another case that will say it is not reliable. Additionally, it is rare that an FCE on its own is enough to support a disability denial. Functional Capacity Examinations (FCE) requested by disability insurance companies are frequently used by disability insurance companies in an effort to deny disability benefits. There is no consistent law which states that if an FCE determines a person can work, then the claimant must not be disabled. To learn more about FCE exams and what to expect you should watch our video discussing FCE exams.

Disability Blog & Cases:
What is Liberty Life Assurance Company of Boston trying to hide in denial of disability benefits?

This disability insurance case against Liberty Life Assurance is an example of the type of fight that a disability insurance company will engage in once a disability lawsuit is filed. It is often surprising that disability insurance companies will claim they are acting fairly, yet when you ask them to provide claims handling information they will aggressively object.

FAQ: Disabling Conditions & Treatment:
Is it legal to limit disability insurance benefits to 24 months for mental nervous claims?

The question listed below was recently posted on our disability benefits blog, but since it is a question that we receive on a weekly basis, we decided to make it a frequently asked question.

Disability Blog & Cases:
Law office bookkeeper with lupus and fibromyalgia denied disability benefits by Unum Life Insurance Company of America in Indiana

Recently one disabled employee of Scopelitis Garvin Light Hanson & Feary PC filed a lawsuit against the Unum Life Insurance Company of America (Unum) and Scopelitis Garvin Light Hanson & Feary PC Plan for the wrongful denial of disability benefits under the Employee Retirement Income Security Act (ERISA).

Plaintiff Robert DeMoss appeals from an order of the district court in favor of the defendant, Matrix Absence Management, Inc. (Matrix).

As an employee of LSI Logic Corporation, Robert DeMoss was a participant in his employer’s LTD group insurance policy administered by Matrix. On May 10, 2002 Matrix found DeMoss eligible for LTD benefits based on a mental, emotional, or nervous illness. However, Matrix denied LTD benefits due to diabetes complications, cardiac neuropathy, and eye problems. After receiving notice of the decision, DeMoss requested administrative review of the decision, but Matrix never responded.

District Court review

More than seven years later, in December 2010, DeMoss sought review in district court asking the court to award him LTD benefits based on physical disability or to order Matrix to conduct further evidentiary review. The District court ordered Matrix to determine whether DeMoss was eligible for LTD benefits because of his claimed physical disabilities.

The court’s order specifically provided that:

Upon remand to the administrator, Defendant must provide Plaintiff a full and fair review. If Defendant denies Plaintiff’s request for physical long-term disability benefits, Defendant must set forth its reasons and rationale, and allow Plaintiff to submit additional evidence supporting his claim for physical disability benefits. After Defendant has provided its rationale and Plaintiff has submitted additional evidence, if any, Defendant should evaluate Plaintiff’s claim as it would an appeal from an initial denial of benefits. Matrix should render its decision within 120 days from the date of this Order and the decision shall be final for purposed of exhausting remedies.

Matrix denies DeMoss’s claim for LTD benefits for the second time.

The 120-day review period ordered by the court expired on October 8, 2009. By letter dated June 30, 2009 which DeMoss received July 6, Matrix denied DeMoss’s claim for LTD benefits based on physical disability.

DeMoss did not request administrative review or submit additional evidence during the duration of the review period. Instead, on August 20, DeMoss filed a motion with the court to extend the time to seek administrative review explaining that he was not prepared to complete. The court denied the motion on the grounds that it did not have authority to change the plan documents.

DeMoss argues that ERISA regulations required that he have 180 days in which to request an administrative review instead of the court ordered 120-period.

According to ERISA, which governed DeMoss’s group LTD policy, a claimant has 180-days in which to request an administrative review of a claim denial. Nevertheless, the district court denied DeMoss’s motion for further review by Matrix. The court reasoned that because DeMoss had failed to seek review of the adverse benefit determination during the court ordered review period, DeMoss was not entitled to further review.

Court finds DeMoss failed to request a review of Matrix’s benefit-denial decision or to provide Matrix with additional and/or updated medical evidence during the court-ordered 120-day review period.

In its order in favor of Matrix, the district court held that DeMoss had failed to exhaust his administrative remedies and that no exception to the exhaustion requirement applied.

DeMoss subsequently appealed to the United States Court of Appeals for the 10th Circuit arguing that:

  1. the district court was wrong in denying his request for an extension of time to seek administrative review;
  2. the district court was wrong to refuse his request for an order allowing him to exhaust his administrative remedies; and
  3. if he had failed to exhaust his remedies, such failure should be excused because further efforts on his parts would have proven useless.

The Court of Appeals refused to accept any of DeMoss’s arguments. Instead, it agreed with the district court in saying that DeMoss had failed, in the initial appeal of the adverse benefit determination, to argue that Matrix’s plan did not comply with federal regulations. The court therefore reasoned that DeMoss could no longer raise such an argument. Moreover, the court concluded that DeMoss had failed to convince it that his failure to exhaust his remedies should be excused. As such, the court found in favor of Matrix.

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:
Oregon Judge orders Standard Insurance Company to pay disability insurance benefits beyond the 24 month mental disorder limitation

In James F. Kitterman Vs Standard Insurance Company and Standard Select Trust Insurance Plans, the plaintiff, through his Oregon disability attorney, brought an ERISA action against the Standard Insurance Company (Standard) seeking to recover long term disability insurance benefits wrongfully denied under the terms of a group insurance plan (the Plan) issued by The Standard Insurance Company. This case is a victory for disability claimants and addresses an issue that is very common among thousands of claimants seeking disability benefits.

Disability Blog & Cases:
Bridgestone employee sues Liberty Life Assurance Company of Boston for long term disability benefits

Sandra Cotton-Lyons filed a lawsuit against Liberty Life Assurance Company of Boston (Liberty Mutual), Administrator of the Bridgestone Americas, Inc. Long Term Disability Plan in the United States District Court for the Eastern District of North Carolina. As an employee of Bridgestone Americas, Inc. (Bridgestone Firestone), Cotton-Lyons, a resident of Rocky Mount, North Carolina, is a qualified, vested member in her employer’s disability insurance plan with Liberty Life.

Disability Blog & Cases:
Cigna denies Herff Jones Inc. employee disability benefits after she is diagnosed with multiple sclerosis

Karen Kolesky has filed a lawsuit against Herff Jones Inc., Cigna Insurance, and Life Insurance Company of North America in the United States District Court of Utah, Northern Division in an effort to receive her long term disability benefits as promised in her employee insurance policy. In possession of an employee insurance policy from her employer Herff Jones, Inc., Kolesky applied for long term disability benefits when she became disabled in November 2009.

Disability Blog & Cases:
A phlebotomist employed by Quest Diagnostics and diagnosed with RSD sues Aetna for denial of long term disability insurance benefits

In Sheila Pannozzo v. AETNA Life Insurance Company, Quest Diagnostics, Inc., Quest Diagnostics Long Term Disability Benefits Plan, filed in the United States District Court of the Middle District of Pennsylvania, Pannozzo and her Pennsylvania disability attorney accuse AETNA of abruptly and improperly terminating her disability benefit payments in violation of the Employee Retirement Income Security Act (ERISA) and 29 U.S.C. § 1132(a)(1).

Disability Blog & Cases:
CIGNA entitled to recover social security disability benefit overpayment

The United States Court of Appeals for the Third Circuit recently reversed a district court’s decision denying CIGNA recoupment of overpaid benefits.

Disability Blog & Cases:
What is Liberty Life Assurance Company of Boston trying to hide in denial of disability benefits?

This disability insurance case against Liberty Life Assurance is an example of the type of fight that a disability insurance company will engage in once a disability lawsuit is filed. It is often surprising that disability insurance companies will claim they are acting fairly, yet when you ask them to provide claims handling information they will aggressively object.