Beneficiaries of disability insurance policies are seldom faced with an easy task when trying to claim disability benefits. Usually there are a long list of procedures with which claimants must follow before disability insurance companies approve their claim for disability benefits. Hence, it is advisable to have a disability attorney handle your claim for disability benefits at the very onset of your claim to ensure that your claim is handled properly. The case of Elizabeth Bailey as Administrator for the Estate of Adrian Douglas Bailey. Jr vs. Fortis Benefits Insurance Company (Fortis) is an example of why it is a prudent to have a disability attorney to represent you from the beginning of the claim process. Our law firm did not handle this disability lawsuit, however it is extremely strange why this case took more than 10 years to litigate.

The Alleged Facts Of The Case Against Fortis

The deceased participated in a Group Short Term Disability Insurance plan and an Accidental Death and Dismemberment Insurance Plan that was issued by Fortis. Due to severe depression, the deceased stopped working and applied for short term disability benefits. Fortis approved the deceased’s claim for short term disability benefits on January 24th 1997.

During the interim period leading up to the suspension of the deceased’s short term disability benefits by Fortis on June 6th 1997, the deceased was being treated by his attending psychiatrist. The deceased’s attending psychiatrist noted that the deceased was making some recovery and also that “he wanted to stay at home [with his children] rather than returning to work.”

Termination of Disability Benefits

Following the phone consultation by Fortis with the deceased attending psychiatrist on June 3rd 1997, Fortis suspended the deceased’s short term disability benefits pending a review by the in-house Clinical Service Department. Following the review, it was concluded by Fortis’s in-house psychiatrist that the deceased was no longer disabled. Hence, on August 4th 1997, following the completion of its review of the deceased’s claim, Fortis terminated the deceased’s short term disability benefits.

The Appeals

On September 17th 1997, the deceased’s wife filed a complaint with the West Virginia Office of the Insurance Commission complaining of Fortis’s decision to terminate the deceased’s short term disability benefits. Fortis regarded this complaint as an appeal then invited the deceased to submit additional information and medical records to support this appeal.

On March 12th 1998, Fortis reaffirmed its previous decision to deny the deceased his claim for disability benefits. Fortis reasoning was that the deceased was originally cleared to work for a few months before his condition took a turn for the worse. Another complaint was filed by the deceased on October 27th 1998 with the West Virginia Office of the Insurance Commission when the deceased learnt that he was awarded Social Security Benefits(September 1998).

Again, Fortis regarded this complaint as an appeal by the deceased. However, while the appeal was being considered, the deceased passed away due to an unrelated medical condition. Just before the deceased passed away, he filed a claim for long term disability benefits and was informed that such benefits were not available while the appeal for short term disability benefits was pending. Upon the deceased demise, the plaintiff Mrs Bailey, the deceased’s wife, filed a claim for life insurance benefits under the deceased’s Accidental Death and Dismemberment Insurance Plan.

The Lawsuit Against Fortis

In September 2001, the plaintiff Mrs Bailey filed an ERISA lawsuit against Fortis seeking an award short term disability benefits, long term disability benefits and life insurance benefits on behalf for the estate of the deceased.

The Opinions of the District Court

The District Court in this case denied the plaintiff’s motion for Summary Judgment but granted Fortis motion for Summary Judgment. There were two main issues for the Court to decide. One issue was the claim for short term disability benefits and the second issue was the claim for long term disability benefits together with the life insurance benefits.

The Short Term Disability Benefits

The Court reasoned that it is the burden of the plaintiff to submit satisfactory proof of his disability. The medical opinions relied upon by the deceased was insufficient to prove the deceased’s disability status while on the other hand, there was evidence on record to show that the deceased was able to return to work as early as May 22nd 1997. In addition, the plaintiff’s reliance on the Social Security Administration (SSA) determination of disability provided no basis for concluding that the deceased was disabled under the plan as the plaintiff failed to show that the Plan used a similar definition of disability as the SSA.

The Long Term Disability Benefits and Life Insurance benefits

According to Fortis, the plaintiff never filed a formal claim for long term disability benefits and life insurance benefits. As such, the plaintiff failed to exhaust all the administrative remedies before bringing the case to the Federal Court for judicial review. The Court ruled that the plaintiff’s affidavit attesting that she applied verbally for these benefits was problematic as the affidavit was not part of the administrative record. Hence, the affidavit cannot be considered in the judicial review process. Furthermore, even if accepted, the Court stated that it only goes to show that the plaintiff did not apply properly for the above mentioned benefits as required under the terms of the Plan and hence left no factual record to assist the Court in reviewing the plaintiff’s claim.

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

Disability Blog & Cases:
Office medical specialist suffering with fibromyalgia and CFS hires Arizona Disability Attorney to sue CIGNA for denial of disability benefits

Anita Barajas has taken her disability claim to the United States District Court of Arizona in an attempt to force University Physicians, Inc. (“UPI”), CIGNA Group Insurance, and Life Insurance Company of North America to provide her the disability benefits she is entitled to. An Office Medical Specialist 2 for UPI, Barajas became disabled on July 8, 2008 when “fibromyalgia and Chronic Fatigue Syndrome (“CFS”), Sjorgen’s syndrome, and depression with memory loss” prevented her from performing her duties as an office medical specialist or any other occupation.

Disability Blog & Cases:
Disabled engineer from Philips Electronics North America sue Sedgwick Claims Management Services Inc. for denial of long term benefits claim

In the case of Andrew Gary Sigai V Sedgwick Claims Management Services, Inc. and Philips Electronics North America Corporation, as Administrator of the Philips Electronics North America Long Term Disability Program, the plaintiff Gary Sigai, through a Kansas disability attorney, filed a lawsuit against Sedgwick Claims Management Services, Inc (Sedgwick CMS) at the District Court for the District of Kansas.

Disability Blog & Cases:
Disabled Goldman Sachs’s financial analyst filed lawsuit against Prudential Insurance Company Of America for denial of disability benefits following multiple seizures

Many disability insurance companies have developed a notorious reputation for the way they handle claims for long term disability (LTD) benefits. Regardless of the claimant’s background or medical conditions, the disability insurance companies will always try to have the last say in a claim application and reduce their obligation to pay out LTD benefits. A recent lawsuit filed by a New Jersey disability attorney at the District Court for the District of New Jersey is a very good example of how the Prudential Insurance Company of America (Prudential), as alleged in the lawsuit, “contrived a way to avoid paying those benefits…” Let us take a closer look at the case of Courtney A. Leone v Prudential Insurance Company of America.

Disability Blog & Cases:
New Jersey disability attorney filed lawsuit against Prudential Insurance Company of America to compel payment of long term disability benefits to disabled client

A lawsuit was filed recently at the District Court for the District Of New Jersey against the Prudential Insurance Company of America (Prudential) by a former employee of Horizon Blue Cross Blue Shield of New Jersey for unlawfully discontinuing benefit payments to the disabled plaintiff. In Denise Hodges V Prudential Insurance Company of America & Horizon Blue Cross Blue Shield of New Jersey (Horizon), the plaintiff Denise Hodges alleged that Prudential had contravened the provisions of the Employee Retirement Income Security Act of 1974 (ERISA) by failing to pay disability benefits to her.

Disability Blog & Cases:
Unum Life Insurance Company of America sued for claiming social security child benefits as part of the reimbursement for overpayment of long term disability benefits

Nowadays, it is standard practice for disability insurance companies to require claimants with long term disability (LTD) benefits to apply for Social Security disability benefits as well. Upon being approved for social disability benefits, the disability insurance companies will then deduct the amount of the monthly social security payment from the monthly benefit amount that was previously paid by the disability company. In most cases there are no disputes by the recipients as to this procedure by the disability insurance companies. However, problems arise when the disability insurance companies also try to claim those social security benefits like social security child benefits as offsets which are not meant for the claimants of LTD benefits. The case of William E. Sorrell V UNUM Life Insurance Company of America is an example of the above mentioned situation.

Disability Blog & Cases:
Disabled project manager for RTP Technology Corporation filed lawsuit against the Unum Life Insurance Company of America for refusal to pay disability benefits

A New Jersey disability attorney recently instituted a lawsuit against the UNUM Life Insurance Company of America (UNUM) at the District Court for the District of New Jersey of behalf of a disabled client. In Robert Garozzo v UNUM Life Insurance Company of America and RTP Technology Corporation long term disability plan, the plaintiff Robert Garozzo is seeking payment of disability income benefits from UNUM under the terms of a long term disability Benefit plan.

In the latter part of May, complaint after complaint was filed against Liberty Life Assurance Company of Boston from shore to shore.

Senior Administrative Analyst Sues Liberty Life Assurance Company of Boston For Disability Benefits And Seeks more than five million dollars in damages

In Margie Mauro v. Liberty Life Assurance Company of Boston, Mauro and her California disability lawyer filed her complaint against Liberty for damages as a result of Liberty’s Breach of Contract and Breach of the Implied Covenant of Good Faith and Fair Dealing in the United States District Court Eastern District of California on May 26, 2011. A senior administrative analyst, Mauro became totally disabled in August 2009 and was unable to continue performing her job due to conditions of and related to "lumbar radiculopathy with left leg radicular pain, and bilateral sacroilitis. She filed her disability application under her employee disability plan with Liberty and was awarded long-term disability benefits until January 29, 2011, when her disability benefits were terminated because Liberty decided that she no long qualified for benefits as they determined that she was capable of engaging in "occupations other than her own." Needless to say, Mauro appealed the decision, but Liberty denied her appeal in February 2011.

Mauro’s And Her California Disability Attorney File A Complaint

In her complaint Mauro and her California disability attorney allege that Liberty breached its contractual duties to pay Mauro’s disability benefits and breached "its duties of good faith and fair dealing owed to [Mauro] by other acts or omissions as well." Mauro claims damages in the form of non-payment of disability benefits which has caused her to suffer "anxiety, worry, mental and emotional distress, and other incidental damages and out-of-pocket expenses" which she should be compensated for. Mauro’s California disability lawyer states that Liberty’s treatment of his client "was despicable" and conducted with a "wilful and conscious disregard of the rights of [Mauro]." He further states that Liberty’s conduct "subjected [Mauro] to cruel and unjust hardship in conscious disregard of her rights, and was an intentional misrepresentation, deceit, or concealment of a material fact… with the intention to deprive [Mauro] of property and/or legal rights or to otherwise cause injury, such as to constitute malice, oppression, or fraud under California Code…" Thus, Mauro’s disability attorney asks for punitive damages as well.

In her complaint, Mauro asks for:

  • Damages in excess of $2700.00 per month for unpaid and future benefits, plus interest;
  • General damages in the amount of $1,000,000.00;
  • Punitive damages in excess of $5,000,000.00;
  • A trebling of any punitive damages as allowed by California Code;
  • Attorneys’ fees;
  • Court Costs; and
  • Any other relief the Court wishes to provide.

Michelin Employee Sues Liberty Life Assurance Company of Boston For Disability Benefits

In Robert Weathers v. Liberty Life Assurance Company of Boston, Robert Weathers an employee of Michelin North America, Inc. was declared disabled and applied for his disability benefits through his disability plan at Michelin. Liberty acknowledged that Weathers is disabled and agreed to pay some of his disability benefits, but denied Weathers his 60% buy up claim. Weathers appealed with no satisfaction, and filed a lawsuit on May 27, 2011 in the United States District of South Carolina Greenville Division to see what the Court has to say about Liberty’s decision.

Weathers Complaint

In his complaint, Weathers and his South Carolina disability attorney allege that Liberty made its decision about Weathers benefits claim under a conflict of interest in which the decision to deny Weathers his disability benefits "was not based upon substantial evidence or the result of a principled and reasoned decision-making process"; but instead, the insurer "ignored relevant evidence pertaining to [Weather’s] claim… relying on biased information and flawed expert opinions."

Weathers and his South Carolina disability lawyer ask the Court to determine if Liberty "abused its discretion" in the decision to deny Weather’s his disability benefits, and if so, to "remand [Weather’s] claim for a ‘full and fair’ review by the appropriate claim fiduciary," award Weathers attorney’s fees, and court costs, and any other relief the Court sees fit.

Bridgestone Employee Sues Liberty Life Assurance Company of Boston For Disability Benefits

In Charles Horne v. Liberty Life Assurance Company of Boston, Horne petitions the United States District Court of the Northern District of Georgia, Atlanta Division to assist him in procuring his disability benefits. Horne’s employer was Bridgestone Americas, Inc., where Horne worked as a machine technician and qualified under the company’s insurance plan to receive disability benefits should he require them during his employ.

In March 2008, Horne ceased work due to "steroid dependent sarcoidosis," and suffers "fatigue, severe breathing problems, sleep difficulties due to sleep apnea, dyspnea, wheezing and coughing, blurred vision and headaches." In addition, the side effects of his many medications include "fatigue, drowsiness, difficulty with concentration, attention and focus," resulting in Horne needing "to rest or lie down at unpredictable intervals during the day."

After Liberty’s six-month waiting period, Horne received long term disability benefits from September 18, 2008 until September 17, 2010, when Horne’s disability benefits were terminated because Liberty believed that Horne was not disabled from "any occupation." The Social Security Administration had previously found Horne to be "totally disabled," but Liberty ignored this fact.

Horne’s Complaint

At the time of the filing of Horne’s complaint, Horne had exhausted his administrative appeals and needs the Georgia Court to determine his financial fate. Horne has substantial medical documentation to evidence his disability as well as "lengthy treatment records, supportive opinion from [Horne’s] long-time treating physicians" and documentation of his declaration as being total disabled by the Social Security Administration.

Consequently Horne and his Georgia disability attorney ask the Northern District Court of Georgia for:

  • Horne’s long term disability benefits from September 18, 2010 and continuing, including interest;
  • Attorney’s fees, including litigation expenses, and Court costs;
  • Any further relief that "may be 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.

Disability Blog & Cases:
30 year veteran employee of 3M Company sues company and Sedgwick Insurance for disability benefit denial

An employee of 3M Company as a Key Account Manager for 30 years, Dominic D. LaPorta was shocked to find out that his security net disability insurance plan was not so secure when Sedgwick Claims Management failed to meet its obligations to provide him disability benefits should he become disabled while working at 3M Company. With no other options available to resolve his issue with 3M Company and Sedgwick, LaPorta engaged the services of a disability attorney and filed a lawsuit against 3M and Sedgwick, alleging ERISA violations, on May 27, 2011 in the United States District Court of Minnesota.

Disability Blog & Cases:
Insurance sales agent files a disability insurance denial lawsuit against Liberty Life Assurance Company of Boston

Ricky C. Hampton, an insurance sales agent with Alfa Mutual Insurance Company (Alfa) has filed a lawsuit against his own disability insurance company, Liberty Life Assurance Company of Boston. A position described as light, Hampton was required to work forty hours per week, five days a week and was frequently asked to perform the following duties, all of which were documented in his job description.

Disability Blog & Cases:
Sun Life Insurance Company is sued for disability benefits in two separate cases for arbitrary and capricious denial of disability claims

With disability insurance lawsuits occurring up and down the eastern US coastline, Sun Life Insurance Company has a lot of litigation to settle. Just in May 2011, Sun Life was hit with two complaints from disability insurance benefits claimants, one in the United States District Court District of New Jersey (Kevin Giblin v. Sun Life and Health Insurance Company et. al) and the other in the United States District Court for the District of South Carolina, Spartanburg Division (Duane Easler v. Sun Life Assurance Co. et al.).

Disability Blog & Cases:
Xerox employee is denied her long term disability benefits and sues Sedgwick and Xerox

An employee of Xerox Corporation files a lawsuit against Sedgwick Claims Management Services, Inc., Sedgwick Claims management Services, Inc., and The Prudential Insurance Company of America for disability benefits. An employee with Xerox for 10 years, Andrea Calhoun brought a lawsuit against her employer and Sedgwick under the Employee Retirement Income Security Act of 1974 (ERISA) 29 U. S. C. § 1001, et seq. "seeking to overturn a denial by the Defendant" of her long term disability benefits.

Disability Blog & Cases:
CIGNA Group Insurance and Subsidiaries sued in Alabama, New York and Michigan for allegedly acting arbitrarily and capriciously in denying claims for long term disability benefits

Recently, the CIGNA Group Insurance and its subsidiaries (CIGNA) faced a barrage of disability insurance lawsuits filed against the company and its subsidiaries across the country allegedly for denying long term disability (LTD) benefits by ignoring overwhelming medical evidences that supported the plaintiffs’ disabled condition.

Delicia Haynes, an employee of Commercial Metals Company has filed a lawsuit against Liberty Life Assurance Company of Boston to collect her long overdue disability benefits. A data entry clerical assistant at Commercial Metals Company, Haynes was denied her disability application for long term disability in a letter from Liberty Life Assurance, dated March 13, 2010. In the letter, Liberty Life denied Haynes claim but also failed to state "any material or information" that was necessary for Haynes to file an ERISA appeal. The insurer’s letter did reference some of Haynes general documents, without stating why her claim was denied.

Baffled Employee Appeals Disability Claim Without Adequate Information

Without the necessary information to do so, Haynes appealed Liberty Life’s denial of her disability claim on August 30, 2010 to no avail, as Liberty Life failed to respond to the appeal at all. Along with her appeal paperwork, Haynes provided Liberty Life with additional documentation to verify her disability and complied with all the requirements to file an ERISA administrative appeal under Liberty Life’s Plan.

Haynes And Her Texas Disability Attorney File Her Lawsuit Against Liberty Life

As a result of Liberty Life Assurance’s inaction to address Haynes administrative disability benefits appeal, Haynes engaged the services of a Texas disability lawyer and filed a lawsuit against Liberty Life Assurance in the United States District Court of the Northern District of Texas, Fort Worth Division to seek a judgment on her disability claim.

Haynes’s Complaint

In her complaint, Haynes and her Texas disability attorney allege that 47-year-old Haynes "is entitled to LTD benefits under her Policy," has complied with proof of her disability claim according to the Policy and is entitled to receive long term disability benefits until age 65. Haynes’s complaint also alleges that Liberty has violated several regulations of the Secretary of Labor by not giving Haynes adequate reason for its original denial of her disability benefits, failing to provide her with a full and fair review of her disability claim, failing to provide her with information to allow for an appeal of the denial, failing to administer Haynes’s plan in a way that benefits participants, operating under a conflict of interest, failing to have Haynes’s claim reviewed by a proper reviewer, and failing to act by responding to Hanes appeal.

In addition, Haynes and her Texas disability lawyer allege that Liberty Life violated ERISA regulations by failing to review her claim properly and being "arbitrary and capricious" in the handling of her claim. Haynes’s Texas disability lawyer points out that Liberty Life didn’t have Haynes’s claim reviewed by an appropriate healthcare professional but used a biased consultant instead, gave inappropriate feedback to Haynes’s claim making it virtually impossible for her to appeal, didn’t follow their own guidelines in the evaluation of Haynes’s claim, and in essence chastises the insurer for its handling of all claims.

What Haynes Asks The District Court To Do About Her Disability Benefits Claim

Haynes asked the District Court for the Northern District of Texas, Fort Worth Division to force Liberty Life to provide her with her entitled employee disability benefits, both past due and future, pre-judgment and post-judgment interest, Court costs, attorney’s fees and any other further relief the Court thinks is proper under the circumstances.

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:
Disabled Unisys network design engineer sue Aetna Life Insurance Company seeking payment of long term disability benefits

Through a Utah disability insurance lawyer, a lawsuit was filed at the District Court for the District of Utah by a disabled Network Design Engineer formerly working at Unisys. In the lawsuit, it was claimed that the Aetna Life Insurance Company’s (Aetna Life) failure and refusal to pay the plaintiff long term disability (LTD) benefits under an employee welfare benefit plan underwritten and insured by Aetna Life constituted a breach of the terms and provisions of the Plan and of the Employee Retirement Income Security Act of 1974 (ERISA).

Disability Blog & Cases:
Former Charles Schwab Corporation employee sues Liberty Life Assurance Company of Boston for denial of long term disability benefits

A Kentucky disability lawyer recently filed a lawsuit against the Liberty Life Assurance Company of Boston (Liberty Life) at District Court for the Eastern District of Kentucky. In Rita Dirks Vs Liberty Life Assurance Company Of Boston, The Charles Schwab Corporation Long Term Disability Plan And The Charles Schwab Corporation, it was alleged by the plaintiff Rita Dirks that Liberty Life had violated the provisions of the Employee Retirement Income Security Act of 1974 (ERISA) in the handling of her claim for long term disability (LTD) benefits.

Disability Blog & Cases:
Cigna denies disability benefits to former Healthsouth Corporation nurse after paying for 11 years

In Susan Sheehan Vs Cigna Group, Life Insurance Company of North America, a Massachusetts disability attorney filed a lawsuit at the District Court District Of Massachusetts claiming that the giant disability insurance company Cigna Group (Cigna), had contravened the provisions of the Employment Retirement Income Security Act (ERISA) in its handling of a client’s claim for disability benefits.

Disability Blog & Cases:
Prudential terminates disability benefits of traumatic brain injury claimant in a case of mistaken identity

James H. White filed a lawsuit against Prudential Insurance of America in the United States District Court For The Eastern District of Pennsylvania for the insurer’s termination of White’s disability benefits after paying him disability benefits for twenty-four (24) months. Claiming that White’s disability was the product of a pre-existing metal illness, Prudential Insurance terminated White’s disability benefits because his policy with Prudential only allows 24 months of disability benefits when the disabling condition is related to a mental illness.

Disability Blog & Cases:
Sunlife denies disability benefits to Wise Foods employee disabled by cancer and shoulder surgeries

John McGinnis has filed a lawsuit against Sun Life Assurance Company of Canada because the insurer denied him his disability insurance benefits and life insurance coverage as dictated by ERISA 29 U.S.C. § 1001 et seq. According to the Complaint that McGinnis and his disability attorney filed in the United States District Court of New Jersey when the insurance company denied him his disability benefits and life insurance benefits the insurer was fully aware of McGinnis’s history of longstanding medical conditions that entitled him to disability benefits when it denied him disability benefits.

In Lamont Philip Richardson Vs Unum Group Corporation And First Horizon National Corporation, the disability insurance claimant alleged that he was improperly denied of his claim for long term disability (LTD) benefits by Unum. A lawsuit was filed for the recovery of disability benefits under an employee benefits plan and for enforcement of rights under the Employee Retirement Security Act of 1974 (ERISA) at the District Court for the Eastern District of Tennessee by a Tennessee disability attorney.

The Nature of the Lawsuit Against Unum Insurance

The plaintiff Lamont Philip Richardson was employed at the First Horizon National Corporation through the First Tennessee Bank at Memphis, Tennessee. By virtue of his employment, the plaintiff was a participant of an employee benefits plan maintained by the First Horizon National Corporation for the benefit of its employees and in which Unum was the Claims Administrator. The disability plan provides LTD coverage in the event of disability.

According to the disability lawsuit, the plaintiff became eligible to receive LTD benefits on May 31st 2008. The plaintiff stated that his UNUM disability application was approved and he began receiving LTD benefits from Unum beginning from May 31st 2008 until June 15th 2010. From the period of June 16th 2010 to September 15th 2010, the plaintiff was paid "extra-contractual benefits” by Unum.

Denial of Long Term Disability Benefits by Unum

On June 16th 2010, the plaintiff alleged that he was improperly denied his claim for LTD benefits. Subsequently, the plaintiff appealed Unum"s decision to deny him his claim for LTD benefits and submitted additional medical documentation to support his appeal. In the lawsuit, the plaintiff also stated that, on November 10th 2010, he was determined to be disabled by the Social Security Administration (SSA). Nevertheless, on March 8th 2011, Unum upheld its prior decision to deny the plaintiff his claim for LTD benefits.

The plaintiff argued that Unum had failed to accord proper consideration to SSA Administrative Law Judge"s determination of disability. The plaintiff also alleged that Unum had arbitrarily disregarded the medical opinions of his attending physicians and instead relied upon opinions of non-examining medical sources engaged by Unum in making its determination to deny the plaintiff"s claim for LTD benefits.

The plaintiff contended that the plaintiff"s treating physician(s) opinions/ restrictions/limitations as well as the SSA Administrative Law Judge"s determination of disability indicated that he was/is unable to perform any occupation. The plaintiff argued that Unum had failed to provide disability benefits that was due to the plaintiff under the terms of the Plan and that this denial of benefits was a breach of the plan as:

  • The decision to deny benefits was wrong under the terms of the Plan.
  • The decision to deny benefits and the decision-making process was arbitrary and capricious.
  • The decision to deny benefits was not supported by the substantial evidence in the record, and failed to give substantial weight to the conclusions of the SSA Administrative Law Judge determination of disability in the plaintiff"s case.

Relief Sought By the Plaintiff

As a result of Unum"s actions, the plaintiff argued that this have resulted in him suffering damages. In addition, the plaintiff has exhausted all his administrative remedies and is seeking from the Court the following relief:

  • Damages for unpaid benefits in the amount equal to the disability income benefits to which he was entitled through the date of judgment.
  • An award of Prejudgment and post judgment interest.
  • An Order requiring the Plan, the Plan Administrator, or appropriate Plan fiduciary to pay continuing benefits in the future so long as the plaintiff remains disabled under the terms of the Plan.
  • An Order requiring the Plan, Plan Administrator, or appropriate Plan fiduciary to provide the plaintiff with ancillary benefits to which he may be entitled due to a finding of disability for so long as the plaintiff remains disabled under the terms of the Plan.
  • An award of reasonable attorney fees and costs.
  • Any other such relief deem by the Court as 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.

Disability Blog & Cases:
Disabled project manager for RTP Technology Corporation filed lawsuit against the UNUM Life Insurance Company of America for refusal to pay disability benefits

A New Jersey disability attorney recently instituted a lawsuit against the UNUM Life Insurance Company of America (UNUM) at the District Court for the District of New Jersey of behalf of a disabled client. In Robert Garozzo v UNUM Life Insurance Company of America and RTP Technology Corporation long term disability plan, the plaintiff Robert Garozzo is seeking payment of disability income benefits from UNUM under the terms of a long term disability Benefit plan.

Disability Blog & Cases:
Disabled interventional radiologist with sleep apnea and cardiac limitations sues Unum Provident and Hartford Life for denial of long-term disability benefits payments

For a disability insurance contract, one of the most important clauses in the contract will be the “own occupation” definition of what constitutes disability. The implication of this clause is that if you become “disabled” due to sickness or injury and are unable to work in your specific line of work, the insurance policy will pay you disability benefits even if you decide to work in another line of employment.

Disability Blog & Cases:
AT&T employee with back injury sues Sedgwick Claim Management Services, Inc. for denial of short term disability benefits

Florida Disability Lawyer Sues Sedgwick Claim Management Services

In the case of Richard Shane Burnett Vs Sedgwick Claim Management Services, Inc. D/B/A AT&T Integrated Disability Service Center, filed at the District Court for the Middle District of Florida, the plaintiff Richard Shane Burnett alleged that he is eligible for short term disability (STD) benefits under an employee benefit plan provided by his employer.

Disability Blog & Cases:
Unum Insurance claims no object evidence exist and denies disability benefits to St. Anthony Central Hospital nurse suffering from fibromyalgia

Colorado disability lawyer files lawsuit against Unum Life Insurance Company Of America for denying long term disability benefits and wrongfully asserting no objective test exist to diagnose fibromyalgia

In Kelly Ann Curtis vs Unum Life Insurance Company of America, a Colorado disability attorney filed a lawsuit on behalf of a disability claimant against the Unum Life Insurance Company of America (Unum) at Denver County District Court. The case is quite interesting as it illustrates how disability insurance companies can, by applying certain limiting clauses in disability insurance contracts, avoid paying out disability benefits to the insured.

Disability Blog & Cases:
Fifth Circuit Court Of Appeal denied Estate Of Pepsiamericas, Inc.’s employee motion to recover accidental death and dismemberment benefits from group disability insurance plan issued by Unum

Recently the Court of Appeal Fifth circuit rendered their opinion in the case of Mary Ann LETTER, Individually and as Executrix Administratrix of the Estate of Timothy D. Letter vs. UNUM PROVIDENT CORPORATION; Unum Life Insurance Company of America. They ruled that the plaintiff Mary Ann Letter, individually and as acting as the estate of her husband Timothy D. Letter was not entitled to recover Accidental Death And Dismemberment (AD & D) benefits from her deceased husband’s group insurance plan due to non payment of premium.

Disability Lawyer Files Lawsuit Against Liberty Mutual

In the case of Georgia Lewis Vs Liberty Life Assurance Company Of Boston, Wachovia Corporation And Wachovia Corporation Long Term Disability Plan, the plaintiff filed a lawsuit against the Liberty Life Assurance Company Of Boston (Liberty Life) at the District Court For The District Of New Jersey. In the lawsuit, the plaintiff alleged that Liberty Life had violated the provisions of the Employee Retirement Income Security Act of 1974 (ERISA). The lawsuit was brought against Liberty Life to recover disability income benefits that were due under an employee welfare benefit plan in which Liberty Life was designated as the Claims Administrator and Claims Fiduciary of the Plan.

The Alleged Facts of The Case Against Liberty Life

The plaintiff Georgia Lewis was a former employee of Wachovia Corporation. While as an employee of Wachovia Corporation, she participated in the Wachovia Corporation Long Term Disability Plan in which the Wachovia Corporation acted as the sponsor and plan Administrator. Liberty Life was the Claims Administrator for this plan.

The Claim For Disability Benefits

On January 5th 2006, the plaintiff ceased working as a result of disabling impairments due to suffering from fibromyalgia, ulnar neuropathy of the left arm, and cubital tunnel syndrome. The plaintiff later filed a claim for benefits claiming that she had met the Plan’s definition of "total disability" as she had been rendered unable to perform the material duties of a her occupation.

Initially her disability application for disability benefits was approved by Liberty Life and she received payment of benefits from Liberty Life until November 23rd 2009. On November 23rd 2009, Liberty Life terminated the plaintiff’s benefits on the ground that she did not meet the plan definition of being disabled anymore.

The Appeals To The Termination Of Benefits

In the lawsuit, the plaintiff alleged that her medical condition had not changed and that she has been totally disabled until the present time. She later submitted an appeal to Liberty Life’s decision to deny her disability benefits. Several medical documentations from her attending physicians attesting to her "total disability" condition were also submitted to support her appeal. Nevertheless, on July 14th 2010, Liberty Life informed the plaintiff of its decision to reaffirm the denial of benefits.

Another appeal was later submitted to the Wachovia Long Term Disability Appeal Committee which on November 9th 2010 informed the plaintiff of its final determination reaffirming the decision to deny benefits to the plaintiff.

Relief Sought By The Plaintiff In The Lawsuit

The plaintiff alleged that Liberty Life’s determination that the plaintiff was not totally disabled was not based on evidence and is contrary to the welfare of the plan. The plaintiff further alleged that Liberty Life’s actions in handling and determination of the Plaintiff‘s claim were arbitrary and capricious. Due to the final determination by Liberty Life, the plaintiff has exhausted all her administrative remedies and is asking the Court to review the matter and enter judgment in favor of her. The plaintiff is specifically asking the Court for the following relief:

  1. An Order to Liberty Life to pay disability income benefits to the Plaintiff in an amount equal to the contractual amount of benefits to which the Plaintiff is entitled.
  2. An Order to Liberty Life to pay the Plaintiff prejudgment interest on all benefits that have accrued prior to the date of judgment;
  3. An Order to Liberty Life to continue paying the Plaintiff benefits until such time as she meets the policy conditions for discontinuance of benefits;
  4. An Award of attorney’s fees pursuant to 29 U.S.C. §l l32(g); and
  5. Award any and all other relief to which she may be entitled, as well as the costs of suit.

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:
Washington disability attorney filed lawsuit against the Hartford Insurance Company for denial of long term disability benefits to mentally disabled woman

A Washington disability attorney recently filed a lawsuit on behalf of his client at the District Court for the Eastern District of Washington against the Hartford Insurance Company (Hartford). In the case of Robin (Hunt) Hankel v The Hartford Insurance Company /The Hartford Financial services Group, the plaintiff was a woman employed in the health Safety and Environmental Management/ Engineering field for Harpers. While employed with Harpers, she contributed to a disability insurance plan which was issued by Hartford.

Disability Blog & Cases:
Fort Dearborn Life Insurance Company faces disability denial lawsuit from disabled account clerk of Katz Insurance Group diagnosed with PTSD

Recently, a former account clerk of the Katz Insurance Group filed a lawsuit against the Fort Dearborn Life Insurance Company (Fort Dearborn Life) through a Maryland disability attorney at the District Court for the District of Maryland. In the case of Tosha Pederson v Fort Dearborn Life Insurance Company, the plaintiff alleged that Fort Dearborn Life had acted arbitrarily and capriciously in its decision to deny the plaintiff’s claim for long term disability (LTD) benefits.

Disability Blog & Cases:
Northwestern Mutual Life Insurance Company denies partial disability benefits to trial attorney resulting in lawsuit for violations of Washington Insurance Fair Conduct Act

The Northwestern Mutual Life Insurance Company (Northwestern Life) was recently sued by a Washington disability lawyer for the violations of the Washington Insurance Fair Conduct Act and Washington Consumer Protection laws. In Kurt D. Bennett v The Northwestern Mutual Life Insurance Company, the plaintiff alleged that Northwestern Life in denying the plaintiff’s claims for disability benefits was in violation of the above mentioned laws and breached the terms of the disability insurance policy.

Disability Blog & Cases:
Disabled employee of University Of California Davis diagnosed with fibromyalgia sues Liberty Mutual for denial of disability benefits and seeks punitive damages

Recently a California disability attorney filed a lawsuit against the Liberty Life Assurance Company of Boston (Liberty Life) at the Superior Court of the state of California. In the case of Cassie Ray v Liberty Life Assurance Company of Boston, the plaintiff alleged that by denying the plaintiff’s claim for disability benefits, Liberty Life, among other things, had caused the plaintiff to suffer damages. This disability policy is not governed by ERISA as the claimant is a government employee.

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