Debra Letvinuck sued Aetna in District Court after Aetna denied her short-term and long-term disability benefits. After the District Court concluded that Aetna did not abuse its discretion in denying Letvinuck benefits, Letvinuck appealed to the 9th Circuit Court of Appeals.

Aetna both funds and administers the Plan’s long-term disability benefits.

Aetna’s dual role rendered it subject to a conflict of interest when making claims determinations. Because of the structural conflict of interest, Aetna’s denial decision was reviewed while considering case-specific factors that may evidence a conflicted claim evaluation.

Failure to address a Social Security award of disability benefits offers support that the plan administrator’s denial was arbitrary.

When reviewing Letvinuck’s claim for benefits, Aetna gave no weight to the Social Security Administration’s (SSA) decision that Letvinuck was disabled, nor did it provide an explanation. Although Aetna was not bound by the SSA’s disability determination, the court noted that "not distinguishing the SSA’s contrary conclusion may indicate a failure to consider relevant evidence."

During the ERISA appeal process, Aetna and its hired doctors acknowledged that Letvinuck had received an SSA award but no further explanation was provided. Only when Letvinuck called after Aetna had denied her appeal did Aetna offer an explanation by trying to distinguish its standard for disability from the SSA’s.

Aetna failed to adequately tell Letvinuck what "additional material or information was necessary for her to perfect the claim, and to do so in a manner designed to be understood by the claimant.

Aetna based its denial of benefits substantially on the lack of recent neuropsychological testing that would objectively show Letvinuck’s disability. However, Aetna did not ask Levinuck for more recent neuropsychological test results that showed her disability. More importantly, it failed to do so "at a time when she had a fair chance to present evidence on this point.

In essence, Aetna denied Levinuck’s claim largely on account of the absence of objective medical evidence, yet failed to tell her what medical evidence it wanted.

Aetna’s communications with Letvinuck’s doctor asking for objective medical evidence was not sufficient.

Although Aetna presented evidence that it asked one of Levinuck’s doctors for "clinically objective findings demonstrating… a further decline in her disability," the court found it inconsequential because the request was not specifically communicated to Levinuck.

Conclusion

The court ultimately concluded that Aetna had abused its discretion in denying Letvinuck benefits. Aetna had based its denial on the absence of specific medical evidence—evidence that Aetna did not tell Letvinuck she should obtain and send to Aetna to perfect her claim. Moreover, Aetna failed to meaningfully explain why it disagreed with the SSA’s award of disability benefits.

The Court reversed Aetna’s denial of long term disability benefits.  

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.

Resolved Cases:
CIGNA denies benefits after paying for 10 years, but Disability Attorney Stephen Jessup wins benefits for 60 year old client with fibromyalgia

For ten years our client was receiving long term disability benefits from CIGNA under an ERISA governed Group Disability Policy (Jaycor) due to a litany of medical conditions, which included Adult Onset Still’s Disease, Chronic Pain, Fibromyalgia and Fatigue. During the course of his claim and well prior to CIGNA’s termination of benefits, he had already met and passed the own occupation to any occupation definition change, had been approved for disability benefits by the Social Security Administration, and had even been approached by CIGNA on several occasions for a lump sum buy out of his policy. For all intensive purposes it would seem that at the age of 60 and the decade long history of his claim that CIGNA would not challenge the claim. However, CIGNA proved the adage that disability benefits are never guaranteed benefits.

Disability Blog & Cases:
California Court orders CIGNA to disclose amount paid to MES Solutions for medical reviews

CIGNA Insurance Company can run but they can’t hide. Recently, the US District Court for the Central District of California granted Plaintiff Bradley Wojno’s Motion to Compel Defendant CIGNA Insurance to reveal the extent of it financial relationship with MES Solutions. Mr. Wojno’s California disability attorney sought information from CIGNA that could unveil potential conflicts and biases of CIGNA’s hired gun doctors relied upon to terminate Mr. Wojno’s disability benefits.

Disability Blog & Cases:
Federal Judge orders Sedgwick Claims Management to pay disability benefits to PNC Financial Services Group, Inc’s Collection/Recovery Team Manager

Disability claimants need to be extremely cautious when dealing with Sedgwick Claims Management Service Inc. (Sedgwick). From our law firms’ experience of handling thousands of disability insurance claims, Sedgwick is one of the top three most difficult companies to deal with. Unfortunately, Sedgwick will capitalize on any opportunity to deny a claimant their disability benefits. This case discusses the unreasonable conduct used by Sedgwick to wrongfully deny disability benefits.

Disability Blog & Cases:
Standard Insurance Company’s attempt to dismiss disability insurance lawsuit is denied in-part by Florida Federal Judge

Disability claimant challenges Standard Insurance Company’s attempt to limit disability benefits to 24 months under the “Other Limited Conditions” provision.

Disability Blog & Cases:
Life Insurance Company Of North America denies disability benefits and battles claimant for 4.5 years in Federal Court

LINA should be embarrassed and show some respect for a former payroll clerk that had no ability to work due to numerous medical conditions. After litigating for more 4.5 years since her wrongful denial of disability benefits, Ms. Dupree finally received a ruling in her favor from the United States Court of Appeal. LINA fought this disability claim until there were no more courts left for them to appeal to. While, Ms. Dupree eventually won her disability benefits, it is sad that she had to battle for 4.5 years without any payment from LINA. LINA essentially left Ms. Dupree out in the cold. Unfortunately, Dupree’s only remedy is payment of her benefits, interest and attorney fees. This case is a prime example of the wrongful conduct by LINA and the exact reason that punitive damages should be allowed.

Disability Blog & Cases:
California Judge grants disability claimant’s request to investigate Hartford Life And Accident Insurance Company’s relationship with hired doctors

In Mary Carten vs. Hartford Life and Accident Insurance Company, Group Long Term Disability Plan for Employees Of FMR Corporation, the plaintiff brought the civil lawsuit in a California Federal Court under the Employment Retirement Income Security Act (ERISA) to challenge a denial of disability benefits made by the Hartford Life and Accident Insurance Company (Harford). The plaintiff requested an opportunity to conduct discovery into Hartford’s claims handling practices in order to determine if Hartford’s wrongful denial her long term disability benefits was done with a conflict of interest. It is ironic that Harford denies disability benefits and then tries to do whatever they can to hide the existence of their financial relationship with the doctors they hire. Hartford is suppose to be the fiduciary of Ms. Carten. Hartford’s actions clearly suggest that they are not acting in the best interest of Ms. Carten.

Alleging that AETNA Life and Boeing have violated ERISA (Employee Retirement Security Act of 1974) by refusing to pay her earned disability insurance benefits, Deborah Rodriguez has filed a lawsuit in the United State District Court of Utah Central Division. Asking the Court to find in her favor against both AETNA and Boeing, Rodriguez and her Utah disability lawyer petitioned the United States District Court of Utah to order the defendants to:

  • Pay her damages in the "amount equal to the disability benefits to which she was entitled through date of judgment" as well as unpaid disability benefits provided by law;
  • Pay her pre- and post-judgment interest;
  • Both be required to pay her any and all present and future disability benefits and any other employee benefits that are included in the subject plan;
  • Pay her reasonable attorney fees and costs;
  • Any other relief the Court finds appropriate; and
  • Provide her with a "bound copy of the administrative record consecutively paginated."

Rodriguez and Her Utah Disability Lawyer Accuse AENTA of A Conflict of Interest

Rodriguez and her Utah disability lawyer allege that AENTA as the governing party for the payment of disability benefits as well as the denial of disability claims displays a conflict of interest when it comes to deciding who is awarded disability benefits under their policies and who is denied.

Aetna Denys Disability Benefits After Change of Definition from Own Occupation to Any Occupation

On May 25, 2008, Rodriguez ceased working at her job at Boeing as the result of a disability and was awarded disability benefits under her AETNA plan. Then, in October 2010, Rodriguez was informed that her benefits were terminated because AETNA’s reviewers had determined that Rodriguez was capable of performing work other than her own occupation. Rodriquez appealed the termination, arguing that she did, indeed, still meet the criteria of her disability insurance plan to continue receiving disability benefits. Inevitably, AETNA didn’t agree and in a letter dated March 10, 2011, informed Rodriguez that the decision to terminate her disability benefits would stand. With no other recourse, Rodriguez and her Utah disability attorney filed her complaint on June 13, 2011 claiming that AENTA was more concerned "over its own funds" and had allowed its decision-making to be influenced by that concern.

In her complaint, Rodriguez states her cause of action for plan benefits against Defendants AETNA and Boeing under 29 U.S.C. §§ 1132(a)(1)(B), pointing out that she qualifies to receive her disability benefits under her insurance plan until she reaches the age of retirement, that she remains disabled under her insurance plan requirements, and that AETNA and Boeing have breached their contractual agreement to provide her with those disability benefits.

Rodriguez and Her Utah Disability Lawyer Enumerate AETNA’s Violations in the Administering of Her Disability Benefits Plan

Rodriquez and her Utah disability attorney allege that AETNA was "wrong under the terms of the Plan," that the "decision to terminate benefits and the decision-making process were arbitrary and capricious," that the "decision to terminate benefits was not supported by substantial evidence in the administrative record," and that Rodriguez has suffered damages as a "direct and proximate result of" the insurance company‘s conduct in the evaluation of her 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.

If a claimant has a pre-existing condition they need to be aware of the pre-existing provision prior to filing an application for disability benefits and prior to stopping work. Almost all disability insurance policies contain pre-existing condition provisions.

Most pre-existing condition provisions state that if a claimant files a disability claim related to the same medical condition that existed within the 12 months prior to obtaining disability coverage, then the subject medical condition may be excluded from coverage.

In a recent lawsuit filed against Aetna Life Insurance in New York, the claimant’s disability benefits were denied due to a pre-existing condition. The claimant worked for Sunguard Data Systems, Inc. The New York District court agreed with Aetna’s denial of disability benefits due to a pre-existing condition and on Appeal the Second Circuit Court of Appeals affirmed the claim denial.

New York Disability Lawyer Argues that New York Law Should Apply

The court in this case applied Pennsylvania law even though the policy was delivered in New York. The policy stated that Pennsylvania law applied. The claimant’s New York Disability Lawyer was trying to argue that New York Law applied so that he could attempt to invalidate the pre-existing condition provision. New York has very specific laws which limit the scope of Pre-Existing condition provisions.

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-698-9162.

Disability Blog & Cases:
California disability attorney sues Standard Insurance Company for denial of long term disability benefits payments to paraplegic

In the case of D. Nielsen Pollock Vs Standard Insurance Company, filed at the District Court for the Southern District Of California, the plaintiff complained that the Standard Insurance Company (Standard Insurance) have breached the Employee Retirement Income And Security Act Of 1974 (ERISA) and suing for the recovery of disability benefits under the terms of an employee benefit plan for which Standard Life is the insurer of benefits under the “DILLINGHAM CONSTRUCTION HOLDINGS INC. GROUP LONG TERM DISABILITY INSURANCE POLICY.”

Disability Blog & Cases:
Hartford Life And Accident Insurance Company denies disability benefits and prevails in lawsuit filed by operator for Mohawk Inc.

When making a case for a claim of disability benefits, it is essential that a claimant has strong medical support from treating physicians. The disability insurance companies are not under any duty to help a claimant further his or her claim for disability benefits. It is the burden of the claimant to ensure that he or she had provided sufficient proof of his or her disability status. This case of Almetta T. Campbell Vs. Hartford Life And Accident Insurance Company is a good example of how a disability insurance company can easily win a disability denial if the administrative record does not have strong medical support. Disability claimants must anticipate and be prepared for a change of the policies definition of disability from own occupation to any occupation. ERISA governed policies can make it difficult for disability claimants to prevail.

Disability Blog & Cases:
Court Of Appeals agrees with Texas Judge that UNUM did not abuse its discretion in denying Accenture LLP’s employee’s claim for disability benefits

In the case of Gwendolyn Byrd vs. UNUM Life Insurance Company Of America, the plaintiff filed a lawsuit in Texas federal court to challenge the Unum Life Insurance Company’s (Unum) decision to terminate her long term disability benefits after paying for 5 years. In the review for the abuse of discretion, the District Court granted summary judgment to Unum. The plaintiff is appealing this decision by the District court.

Disability Blog & Cases:
Appellate Court denies Liberty Mutual’s attempt to recover $163,661.57 in disability benefits paid to disability claimant and business owner

After 5 years of receiving long term disability benefits, Robin Dolan suddenly receives a letter in 2006 from Disability Reinsurance Management Services stating that her disability benefits had been wrongfully calculated and she must repay $163,661.57. Approximately 5 years after receiving this dreadful letter and extensive litigation, Ms. Dolan has finally received an Appellate Court ruling stating that Liberty Mutual was wrong in their interpretation of the disability policy. Unfortunately Ms. Dolan has had to suffer through the unreasonable actions of Liberty Mutual and their third party administrator DRMS.

Connie White waited more than five years to file a lawsuit against MetLife for denial of her disability benefits. The law in Louisiana only provided Ms. White 5 years to file her legal action. The district court dismissed her disability claim and the 5th Circuit court of appeals affirmed the denial. Disability insurance claimants need to take timely action if a claim for disability benefits is denied. Failure to act within strict time lines can result in the inability to pursue a claim in court.

Failing to oppose Metropolitan’s Motion for Summary Judgment, White alleges that her case was decided on the basis of her failure as opposed to the merits of her case. And even though the Court ruled to approve the insurer’s motion, White was given a second chance to file her opposition. White had 10 days to file an opposing position to the original motion for summary judgment. Never filing anything acknowledging the motion, White, after the fact, claimed that the Court erred in its decision to uphold Metropolitan’s decision to deny her long-term disability benefits.

The Fifth Circuit Court of Appeals Agrees to Review White’s Case

As a result of her claim, the District Court of Appeals Fifth Circuit agreed to review the District Courts Summary Judgment de novo. White contended that the Court entered its ruling "solely because Metropolitan’s motion was unopposed." And while the Court disputed this contention, it claimed that it granted the insurer’s motion based on the evidence presented in Metropolitan’s summary judgment motion.

The Fifth Circuit ruled that "the district court’s ruling was correct on the merits." According to the terms of White’s insurance plan, legal action cannot be filed "more than three years after proof of Disability," unless "the area where you live allows a longer period of time to file proof of Disability." In White’s case, she let that time period expire. Consequently, her challenge to Metropolitan’s benefit denial "was filed too late."

Finding of the Fifth Circuit Court in Connie D. White v. Metropolitan Life Insurance Company

The Circuit Court pointed out that since ERISA doesn’t set a specific limitation period, state law applies. In Ms. White’s case the law in Louisiana allows 5 years for a lawsuit to be filed. Unable to present a case that proves that Metropolitan did not materially misrepresent itself or its decision to deny White disability benefits or that "extraordinary circumstances" existed, White did not prevail in her appeal. Consequently, the Fifth Circuit Court allowed the District Court’s ruling in White to stand. The lesson here is that timely filing of disability lawsuits and answers are imperative to a disability claimant’s lawsuit being favourably ruled upon.

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. To request a free legal consultation call 800-698-9162.

Disability Blog & Cases:
Arkansas disability attorney filed lawsuit against Sun Life and Health Insurance Company on behalf of disabled Buford Media Group, LLC’s Office Manager for denial of disability benefits

In Kathryn McDaniel-Bowen vs Sun Life and Health Insurance Company F/K/A Genworth Life and Health Insurance Company, filed at the District Court for the Eastern District of Arkansas, the plaintiff Kathryn McDaniel-Bowen alleged that the Sun Life and Health Insurance Company (Sun Life) had breached its contractual obligations by denying long term disability benefits payments to her.

Disability Blog & Cases:
Disabled IKA Works, Inc. employee sues the Prudential Insurance Company of America to compel payment of disability benefits under an ERISA plan

A North Carolina disability attorney recently filed a lawsuit at the District Court for the Eastern District of North Carolina on behalf of a client against the Prudential Insurance Company of America (Prudential). In Cynthia Grimsley Vs the Prudential Insurance Company Of America, the plaintiff filed the complaint to seek the recovery of disability benefits under the Employee Retirement Security Act of 1974 (ERISA) from a Prudential issued Disability Plan.

Disability Blog & Cases:
Claimants under HSBC North America Holdings, Inc. Group Long Term Disability Benefits Plan sue Unum Life Insurance of America in Illinois and Nevada

Recently, two disabled employees of the HSBC Bank in Illinois and Nevada filed lawsuits against the Unum Life Insurance of America (Unum) for the wrongful denial of disability insurance benefits under the Employee Retirement Income Security Act (ERISA).

Disability Blog & Cases:
Tenet Healthcare Corporation employee sues UNUM Life Insurance Company Of America under ERISA for wrongfully denying disability benefits by disregarding attending physician’s medical opinion

An Alabama disability attorney recently filed a lawsuit at the District Court for the Northern District of Alabama against the Unum Life Insurance Company of America (Unum). In Joan Allred vs. Unum Life Insurance Company of America, the plaintiff Joan Allred sued Unum for the recovery of long term disability benefits due under her disability insurance plan sponsored by Tenet Healthcare Corporation.

Disability Blog & Cases:
Appellate Court upholds Prudential’s decision denying disability benefits to insured when he refused to attend an IME Exam

Recently, the 8th Circuit Court of Appeals ruled that veteran career consultant, Anthony Polich, was not entitled to Long Term Disability (LTD) benefits after he refused to attend an Independent Medical Exam (IME) and to release relevant medical data requested by the LTD Plan administrator, Prudential Financial.

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.