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?

In two recent separate cases, an employee of Wells Fargo & Company (Wells Fargo) and an employee of Filtrona Greensboro, Inc. filed lawsuits in California and North Carolina respectively, through their disability attorneys, against the Liberty Life Assurance Company of Boston (Liberty Life) for violations of the provisions of Employee Retirement Income Security Act (ERISA).

California disability Lawyer Sues Liberty Mutual

In the case of Melinda Martinez v Wells Fargo Long Term Disability Plan & Liberty Life Assurance Company of Boston, the plaintiff’s California disability attorney filed the lawsuit at the District Court for the Southern District of California. The lawsuit alleged that Liberty Life contravened the provisions of ERISA and the plaintiff is seeking relief from the Court for the violations of her legal rights under an employee benefit plan issued by Liberty Life.

The Nature of the Complaint

The plaintiff Melinda Martinez was an employee of Wells Fargo and participated in a Long Term Disability (LTD) plan issued by Liberty Life. While employed with Wells Fargo, the plaintiff became disabled as defined by the LTD plan and hence was entitled to the benefits under the LTD plan. The plaintiff attempted to make a claim for LTD benefits under the LTD plan but was denied by Liberty Life on the grounds that the plaintiff was not disabled. Pursuant to the denial of the claim, the plaintiff made an appeal to Liberty Life’s decision to deny her LTD benefits. However, despite overwhelming evidence indicating that the plaintiff was disabled, Liberty Life upheld its decision to deny LTD benefits to the plaintiff. At the same time, Liberty Life also informed the plaintiff that her rights to appeal under the LTD plan had been exhausted.

The plaintiff alleged that the Wells Fargo Long Term Disability Plan and Liberty Life had wrongfully denied her claim for LTD benefits by:

  • Failing to pay LTD benefit payments to the Plaintiff while knowing that her disability was not a pre-existing condition and she was entitled to those benefits under the LTD plan.
  • Withholding the LTD benefits from the plaintiff while aware that the plaintiff’s claim was valid.
  • Failing to provide a reasonable explanation for the denial of LTD benefits
  • Failing to properly advise and explain to the plaintiff any additional material or information necessary for the Plaintiff to perfect her claim.
  • Failing to properly investigate the plaintiff’s claim.

Request for Relief

Having exhausted her administrative remedies, the plaintiff is seeking the following relief from the Court:

  • All disability benefits due to the plaintiff including any and all prejudgment and postjudgment interest;
  • Interest on past due benefits at the rate of 10% per annum as stipulated by the California Insurance Code;
  • A declaration that the plaintiff is disabled under the terms of the LTD plan and entitled to receive benefits for the same while the plaintiff is, was and continues to remain disabled;
  • Or, in the alternative, an order overturning the denial and remanding the case to Liberty Life and the LTD plan for further adjudication under the correct legal standard;
  • An award of Attorney Fees and Costs;
  • And other and further relief as the Court deems just and proper.

North Carolina Disability Lawyer Sues Liberty Mutual

In the case of Barbara Newkirk-Davis v Liberty Life Assurance Company of Boston and FIL Holdings Corporation Group Disability Income Policy, the lawsuit was filed at the Superior Court for County of Guilford, North Carolina by a North Carolina disability attorney for the plaintiff Barbara Newkirk-Davis.

The Alleged Facts of the Case

The plaintiff Barbara Newkirk-Davis was employed as a Quality Assurance Auditor for Filtrona Greensboro, Inc. While employed with Filtrona Greensboro, Inc., the plaintiff participated in an employee welfare benefit policy known as "FIL HOLDINGS CORPORATION GROUP DISABILIY INCOME POLICY" (hereinafter "FIL Policy") that was sponsored by Filtrona Greensboro, Inc and issued by Liberty Life.

FIL Policy acted as the plan administrator while Liberty Life provided claims administration and services for the FIL POLICY and its beneficiaries. On November 11th 2009, due to severe depression, the plaintiff stopped working. She filed a claim for LTD benefits and was approved for payment of LTD benefits in the amount of $2318.00 per month until August 9, 2010.

On August 9th 2010, the plaintiff alleged that FIL Policy and Liberty Life, without any basis, and disregarding the conclusions of the plaintiff’s doctors, terminated the plaintiff’s LTD benefits effective from August 10th 2010. The plaintiff timely appealed the decision to terminate her LTD benefits but however was unsuccessful in her appeal on October 27th 2010.

The plaintiff argued that FIL Policy and Liberty Life had acted arbitrarily and capriciously and purposely ignored the qualified opinions, findings and conclusions of Plaintiff’s doctors in their handling of Plaintiff’s claim for LTD benefits. She further claimed in the lawsuit that that they had abused their discretion and acted with self interest whilst administrating her claim for LTD benefits. The plaintiff alleged that she remains disabled and based on her doctors’ findings "is unable to perform the duties of any gainful occupation for which she is reasonably qualified by education, training or experience."

Relief sought by the Plaintiff

Having exhausted her administrative remedies, the plaintiff is bringing a "…civil action to recover benefits due to her under the terms of the Policy, to enforce her rights under the terms of the Policy and/or to clarify her right to benefits under the terms of the Policy" under ERISA. As such, the plaintiff is asking the Court for the following relief:

  • A declaration that FIL Policy and Liberty Life have violated the terms of the Policy denying and refusing to pay Plaintiffs long term disability benefits under the Policy;
  • An order to compel FIL Policy and Liberty Life to pay Plaintiffs long term disability benefits pursuant to the terms of the Policy;
  • A declaration of the plaintiff’s rights to receive future LTD benefits;
  • An award of prejudgment interest on all damages requested;
  • An award of reasonable attorney’s fees and costs;
  • Any other and further relief as the Court deems necessary 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.

June 22, 2011 – A recent opinion from the Ninth Circuit United States Court of Appeals has helped clarify the rules as to who you can sue in actions for benefits under a long term disability policy See Cyr v. Reliance Standard & Channel Technologies, 2011 WL 2464440, June 22, 2011. The Court concluded that under appropriate circumstances, an entity other than the plan itself or the plan administrator may be sued under 29 U.S.C. § 1132(a)(1)(B).

Laura Cyr was employed by Channel Technologies, Inc. ("CTI") as a vice president. CTI provided its employees with long term disability benefits under a program insured by defendant Reliance Standard Life Insurance Company ("Reliance"). CTI was the plan administrator, and Reliance effectively controlled the decision whether to honor or deny a claim for benefits. In October 2000, Cyr filed a claim for long term disability benefits based on a back condition. Reliance approved the benefits and based her monthly payment on her salary of $85,000/year.

Ms. Cyr later filed suit against her employer, CTI, alleging gender discrimination. A settlement agreement was eventually reached which awarded Cyr a retroactive salary of $155,000/year. When Cyr asked Reliance to increase her monthly benefit amount in accord with her adjustment in salary, Reliance declined. Cyr was forced to file suit to pursue her claim for the increased benefits.

Cyr filed suit against Reliance, the CTI Group Long Term Disability Benefit Program (the ‘Plan’), and CTI as the plan administrator for the Plan. Reliance moved for summary judgment, arguing that only the plan or plan administrator could be held liable under the statute. Initially, the district court agreed with Reliance, but later the court changed its mind and ruled in favor of Cyr. Cyr was awarded fees, costs and interest on the money owed. In light of this ruling, Reliance appealed.

The issue for the Appellate Court was whether Reliance was a proper defendant in a suit for benefits under 29 U.S.C. § 1132(a)(1)(B) even though it was neither a plan or plan administrator. The Court first noted that neither 29 U.S.C. § 1132(a)(1)(B) nor 29 U.S.C. § 1132 stated any limits about who could be sued. Additionally, the Appellate Court looked to a United States Supreme Court ruling for guidance. In Harris Trust & Savings Bank v. Salomon Smith Barney, Inc., 530 U.S. 238 (2000), the Supreme Court addressed a similar question of who can be sued under a similar statute, 29 U.S.C. § 1132(a)(3). In that case, the Supreme Court noted that 29 U.S.C. § 1132(a)(3) makes no mention at all of which parties may be proper defendants. The Court then ruled that there was no limit in 29 U.S.C. § 1132(a)(3) as to who could be sued.

Similarly, in the case at hand, the Appellate Court felt that because 29 U.S.C. § 1132(a)(1)(B) contained no limitation as to who could be sued, the Court could not read a limitation into the statute. The Court concluded that parties other than plans can be sued for money damages as long as that party’s individual liability is established. The Court looked to related section 29 U.S.C. § 1132(d)(2) which provides that ‘any money judgment under this subsection against an employee benefit plan shall be enforceable only against the plan as an entity and shall not be enforceable against any other person unless liability against such person is established in his individual capacity under this subsection.’

In the case at hand, the Court determined that Reliance, as plan insurer who is responsible for paying legitimate benefits claims, is a logical and proper defendant for Cyr to recover benefits due, along with the plan and the plan administrator. The Court denied Reliance’s appeal.

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:
Anesthesiologist files lawsuit against Paul Revere Life Insurance Company alleging wrongful deduction of social security retirement benefits

On April 29, 2011, Dr. Phillip W. Watson and his disability attorney filed a lawsuit in the United States District Court Southern District of Florida as a last resort to settle Watson’s claim that in violation of ERISA, Title 29, United Stated Codes 1000-1461, Paul Revere Life Insurance Company arbitrarily decided to deduct part of his disability benefits payments when Watson applied for his early Social Security retirement benefits (SSR).

Disability Blog & Cases:
A former HCBS sales manager diagnosed with lyme disease sues UNUM Life Insurance for disability claim denial

Mark Linder filed a lawsuit against UNUM Life Insurance Company of America (UNUM) in the United States District Court for the Middle District of Pennsylvania under ERISA, 29 U.S.C. § 1132. Linder was forced to seek Court mandated relief when his disability claim was denied by UNUM even though he was classified as totally disabled by his medical provider.

Disability Blog & Cases:
UNUM denies disability insurance benefits to disabled nurse with fibromyalgia and osteoarthritis

Claiming four counts of misconduct by UNUM Life Insurance Company in the denial of her disability claim, Cynthia A. Keller filed a lawsuit on May 2, 2011 in the Eastern District of Michigan Southern Division. After exhausting all her administrative appeals to the insurance provider, Keller hired a Michigan disability lawyer who prepared her complaint stating that UNUM is guilty of breaching its obligations under ERISA, asking for injunctive and declaratory relief, requesting pre-judgment and post-judgment interest, and reimbursement for her attorneys’ fees.

A Michigan disability attorney, on behalf of a disabled Michigan client, filed a lawsuit against the Unum Life Insurance Company of America (UNUM) at the District Court for the Western District of Michigan. In Kristina M. Arbelius V Unum Group D/B/A Unum Life Insurance Company of America, the plaintiff Kristina M. Arbelius alleged that UNUM committed a breach of a disability insurance policy that the plaintiff participated in.

The Statement of Facts in the Lawsuit

The plaintiff Kristina M. Arbelius was formerly a pacemaker technician working for the Marquette General Hospital. And as an employee of the Marquette General Hospital, she was covered by a disability insurance policy that was issued by UNUM. Under the disability insurance policy, the plaintiff was to be paid monthly long term disability (LTD) benefits in the event that the plaintiff was prevented from doing her job due to an injury or a sickness.

On September 18th 2007, as a result of pain associated with fibromyalgia and behavioral health symptoms, the plaintiff stopped working. The plaintiff, at the time of stopping her employment, was also suffering from diarrhea, fatigue, nausea and vomiting. As a result, the plaintiff was approved for LTD benefits on December 17th 2007. The plaintiff was also informed that she was subjected to a 24 month mental and nervous limitation.

On March 4th 2010, the plaintiff was sent for an independent medical examination conducted by UNUM’s hand-picked physician. Subsequently after the medical examination, the plaintiff’s LTD benefits were terminated by UNUM on June 15th 2010. According to the lawsuit, the discontinuation of LTD benefits was despite the fact that the plaintiff was having physical conditions and limitations confirmed by her treating physicians which rendered her unable to perform any type of employment. In support of the plaintiff’s argument, the Social Security Administration had also classified the plaintiff as being disabled with physical limitations and restrictions which are permanent and prevented her for from ever working again in any capacity.

As such, the plaintiff alleged that as a result of UNUM’s unlawful action, UNUM had:

  • Breached the terms of the disability policy
  • Acted in Bad Faith

The plaintiff further alleged that UNUM had caused her to suffer damages in the form of disability benefits not paid but should have been paid by UNUM under the terms of the policy in addition to the interest on that amount.

Relief Sought By the Plaintiff

Because of UNUM’s action, the plaintiff is seeking from the Court the following relief:

  • For an amount of money which will fully compensate her for losses sustained;
  • For costs, disbursements, and attorney fees;
  • For such other and further relief as the court deems just and equitable;
  • For an award of punitive damages;
  • For a determination outlining her future rights under the terms and conditions of the disability policy from Unum Group, d/b/a Unum Life Insurance Company of America.

In addition to the above mentioned relief sought, the plaintiff is also demanding a trial by a twelve person jury.

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:
Former Zurich Insurance employee diagnosed with crohn’s disease sues Liberty Life for denial of disability benefits

Carol Snyder and her Missouri disability lawyer filed a civil complaint against Liberty in United States District Court in the Western District of Missouri because Liberty denied her claim for short-term disability benefit payments.

Disability Blog & Cases:
Missouri disability lawyer files ERISA lawsuit against Lincoln National Life Insurance Company for denying LTD benefits

From 1997 to 2003, Bobby Nelson worked as a buyer for AMCOM until he became completely and totally disabled due to the displacement of a lumbar intervertebral disc in his lower back. Mr. Nelson’s last day of working full-time at AMCOM was December 26, 2003. Three days later, he had posterior and anterior fusion of the L4 and L5 vertebrae performed on his lumbar spine. The surgeon also placed bilateral pedicle screws and a disc fixator device in Mr. Nelson’s lumbar spine to maintain the integrity of the lumbar vertebrae. However, Mr. Nelson experienced chronic and continuing lower back and leg pain following surgery.

Disability Blog & Cases:
Podiatrist sues Northwestern Mutual seeking disability insurance benefits and bad faith damages

The case of Gaby Kafie v. Northwestern Mutual Life Insurance Company, commenced in the United States District Court of the Southern District of Florida on April 8, 2011 when Northwestern Mutual refused to pay Gaby Kafie’s disability benefits as specified in a Northwestern Mutual Life (NML) disability insurance policy.

Disabled since March 12, 2008, Gayle Bennett initially received her disability benefits from Prudential Life Insurance until February 27, 2010, when Prudential ceased paying Bennett’s disability benefits and refused to continue paying her disability benefits as required by her Plan. Consequently, Bennett and her disability attorney filed a six count lawsuit in the United States District Court in the Northern District of Texas, Dallas Division against the insurance company.

Bennett Alleges That Prudential Has Breached Its Contract With Her To Provide Her Rightful Disability Benefit Payments

In her complaint, Bennett and her disability attorney allege that Prudential breached its contract with her by denying her disability benefits even though Bennett had met all the requirements for receiving said benefits. Bennett also alleges that Prudential denied her benefits with malice, which caused Bennett mental anguish. Bennett’s disability attorney enumerates several instances of misconduct by Prudential in its dealing with Bennett that includes:

  • A violation of chapter 541 of the Texas Insurance Code by intentionally and knowingly engaging in unfair methods of competition and unfair and deceptive acts of practices in the business of insurance by misrepresenting Bennett’s material fact and/or policy provisions for coverage, failing to give Bennett a fair equitable settlement as required by Texas Code, and failing to provide a reasonable explanation of why Prudential denied Bennett her disability benefits.
  • A violation of §541.061 of the Texas Insurance Code by making an untrue statement of material facts, failing to state a material fact necessary to make other statements made not misleading, making a statement that would mislead a reasonable prudent person to conclude a false impression, making a material misstatement of the law.
  • Prudential didn’t acknowledge Bennett’s claim within the 15-day period required by the Texas Insurance Code.
  • Prudential didn’t provide Bennett with an acceptance or rejection of her claim in writing within the 15-day period required by the Texas Insurance Code.
  • Prudential didn’t notify Bennett of the reasons for accepting or rejecting her disability claim.
  • In violation of the Texas Deceptive Trade Practice – Consumer Protection Act, Bennett’s disability attorney also alleges that Prudential intentionally and knowingly:
    • Represented themselves as providing goods and service that they don’t have;
    • Represented their insurance plan as an agreement that confers or involves rights, remedies, or obligations that it doesn’t actually provide; and
    • Misrepresented the quality and grade of their services and plan.
  • Bennett states in her complaint that she relied on the promises Prudential made to her detriment, that her claim was handled in an untimely manner, and that she has suffered anguish over the situation.
  • Prudential negligently and intentionally misrepresented Bennett’s policy as being governed by ERISA.
  • Bennett was forced to hire an attorney to get Prudential’s attention.
  • Bennett has evidence showing that "more than 60 days have passed since Prudential received all required and requested document."

Stating that Prudential’s conduct was "unconscionable," Bennett’s disability attorney seeks several remedies to compensate Bennett for her financial damages and her emotional damages and wants to present Bennett’s case before a jury.

What Bennett Requests In Relief From Prudential

Bennett requests relief from Prudential according to the dictates of Teas Insurance Code for the following:

  • The amount of actual damages;
  • The amount not more than three times the actual damages due to Prudential’s conduct being committed knowingly;
  • Court costs and attorney’s fees; and
  • 18 per cent annum on her claim for her injuries, damages and attorney’s fees. 

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:
Hartford reverses disability benefit denial after previously paying 62 year old sales rep for 6 years

Our client, a 62 year old former pharmaceutical sales rep, had been receiving long term disability benefits with Hartford Insurance Company for nearly six years due to chronic back pain, which had resulted in six surgeries in a span of several years, when Hartford abruptly terminated his claim for long term disability benefits.

Disability Blog & Cases:
Guardian Life Insurance seeks overpayment of disability benefits for child social security disability benefits awarded to disabled claimant’s daughter

A recent lawsuit filed against Guardian Life Insurance Company highlight an issue that comes up regularly for disability insurance claimants that have minor children and are approved for Social Security Disability Benefits. Monica Johnson has been receiving long-term disability benefit payments from Guardian Life (Guardian) since August, 2003 as result of her becoming completely and totally disabled in April, 2003. Under the terms of the group long-term disability benefit plan Monica purchased while working for EBE Office Source, Inc., Guardian is allowed to offset her monthly benefit payment according to the amount of Social Security disability income she receives.

Disability Blog & Cases:
CIGNA Life Insurance Company denies disability benefits yet social security disability benefits are approved

Lily Rubinstein filed suit against CIGNA Life Insurance Company of New York, Griffon Corporation Long Term Disability Plan, and Griffon Corporation Life Insurance Plan in the United States District Court of the Eastern District of New York when the insurance provider abruptly denied her disability benefits after approving short term benefits six previous times. The insurer took away Rubinstein’s disability benefits even though her condition remains the same as when they approved her claim the last six times and even though medical opinion is that Rubinstein risks a stroke if she goes back to work.

Disability Blog & Cases:
Nevada disability lawyer and COX Enterprises Inc’s customer service rep sue AETNA Life Insurance Company for denial of disability benefits

A former Customer Service Representative (CSR) for COX Enterprises Inc. (COX) recently filed a lawsuit through a Nevada disability attorney against the AETNA Life Insurance Company (AETNA Life) at the District Court for the District Court of Nevada. In Sandra Rada v Cox Enterprises Inc as Plan Administrator & AETNA Life Insurance Company as Claims Administrator, the plaintiff Sandra Rada alleged that AETNA Life had not provided the plaintiff with a full and fair review of her claim for long term disability (LTD) benefits and thus seek the Court to review Aetna Life’s decision under a de novo standard.

Disability Blog & Cases:
Prudential Insurance sued by disabled HNI Corporation employee for denial of disability insurance benefits after 7 years

A 49 year old woman said to be suffering from degenerative disc disease and disabling pain recently filed a lawsuit at the District Court for the Southern District of Iowa against the Prudential Insurance Company of America (Prudential). In the case of Kimberly Maserang v The Prudential Insurance Company of America, the plaintiff’s Iowa disability lawyer alleged that Prudential has wrongly denied payments after paying her disability benefits for 7 years. Despite a worsening of the plaintiff’s medical condition, Prudential determined that the plaintiff is no longer disabled.

Recently a lawsuit was filed at the District Court for the District of New Jersey against the Prudential Insurance Company of America (Prudential) for failure to pay long term disability (LTD) benefits to a disabled teacher for West Orange Board of Education. In Janel Braun v The Prudential Insurance Company of America, the plaintiff Janel Braun alleged that Prudential had wrongfully denied the plaintiff her claim for LTD benefits.

The Nature of the Complaint

The plaintiff Janel Braun was a school teacher employed by the West Orange Board of Education. Whilst employed by the West Orange Board of Education, the plaintiff participated in a health and welfare plan that was offered by the New Jersey Education Association Member Fund, a plan underwritten and administered by Prudential. Under the plan, disability was defined as a person who is unable to perform the material and substantial duties of their regular occupation due to injury or sickness and suffered a 20% or more loss in monthly earnings as a result of that sickness or injury.

Due to severe pain relating to her sinus thrombosis, the plaintiff stopped working on April 29th 2005. The plaintiff’s medical records were said to support the fact that she was unable to perform the material and substantial duties of her occupation. Subsequently, due to her disability, the plaintiff filed a claim for disability benefits with Prudential and was approved for LTD benefits on May 30th 2005. The LTD benefits were paid out to the plaintiff until May 29th 2007.

Disability Definition changes After 24 Months

Under the policy, the plaintiff was be subjected to a review of eligibility after receiving 24 months of LTD benefits. The review was to determine if the plaintiff satisfied the definition of disabled by not being able to perform the duties of any gainful employment for which she is reasonably suited by education, training or experience. To be considered gainfully employed, the plaintiff had to earn at least 66.33% of her pre-disability income. In the plaintiff’s case, she had to earn at least $14.55 per hour to be considered gainfully employed. Upon conducting an employability assessment, Prudential determined that the plaintiff could be employed as an information clerk, a tutor, a telephone solicitor or as a routing clerk. It was asserted by Prudential that these occupations have an hourly wages of $15.00 to $18.00 which exceeded the plaintiff’s minimum threshold to be considered gainfully employed.

Thus, on April 9th 2009, the plaintiff was informed that she did not meet the definition of disability under the plan and hence was not eligible for further payment of LTD benefits effective May 30th 2009. The plaintiff in response submitted an appeal to Prudential on November 16th 2009, together with further medical documentations supporting her claim. She also submitted details of her eligibility for Social Security Disability Benefits. Nevertheless, the plaintiff’s appeal was rejected on March 18th 2010. Further to this rejection, another appeal was submitted to Prudential by the plaintiff on September 2nd 2010. This appeal was also denied by Prudential.

According to the lawsuit filed, the plaintiff contended that she had been disabled since 2005. In addition since November 2007, the plaintiff had been receiving Social Security Disability Benefits as the Social Security Administration had deemed her disabled and unable to be gainfully employed based on the same medical documentations provided to Prudential. The plaintiff further alleged that the chronic daily pain associated with her disability rendered it impossible for her to be gainfully employed as an information clerk, a tutor, a telephone solicitor or as a routing clerk. Due to Prudential’s decision to terminate her LTD benefits, the plaintiff argued that Prudential had:

  1. Acted in contravention of the provisions of the Employee Retirement Income Security Act of 1974 (ERISA)
  2. Committed material breaches of its contractual obligations under the plan
  3. Breached the Covenant of Good Faith and Fair Dealings
  4. Breached its Fiduciary duty to act solely in the interest of the Plaintiff

Claim for Relief

Due to the above mentioned breaches, the Plaintiff is seeking the following relief from the Court:

  • Reinstatement of LTD benefits under the plan
  • Payment of all retroactive benefits
  • Payment of ongoing benefits
  • A determination that the plaintiff is entitled to future benefits
  • An award of attorney fees and costs
  • Compensatory damages
  • Interest
  • Punitive Damages
  • Any 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:
Aetna fails to review Bank Of America employee’s ERISA disability benefit appeal timely resulting in lawsuit by an Illinois disability lawyer

Brian Woulfe of northern Illinois worked as a mortgage loan officer for Bank of America until he was no longer able to work with reasonable continuity because of complications that arose from being treated for non-Hodgkin’s lymphoma.

The exact nature of Mr. Woulfe’s non-Hodgkin’s lymphoma isn’t specifically stated within the civil complaint he and his Illinois disability attorney filed against Aetna Life Insurance Company (Aetna) and Bank of America Group Benefits Program…

Disability Blog & Cases:
Aetna Life Insurance Company denies disability benefits and claims physical therapist with back disorder can perform “reasonable occupation”

Sandy Brooks Scott filed a lawsuit against Aetna Life Insurance Company in the Circuit Court of the City of St. Louis, Missouri requesting that she be awarded long term disability benefits as well as attorneys’ fees and court costs.

Disability Blog & Cases:
Georgia disability lawyer sues Aetna for terminating disability benefits to Georgia woman with rectal cancer

Many long-term disability companies have a clause in their disability plans which change the definition of disability after 24 months. For the first 24 months of complete and total disability, a long-term disability insurance company pays the claimant if the claimant is unable to perform the material duties of his or her “own occupation.” Once the initial 24 months have elapsed under the “own occupation” standard, it’s not uncommon for long-term disability insurance companies to review and reevaluate cases in which they pay long-term disability benefits to find out whether or not the claimant meets the “any occupation” standard. Such is the case with Hellen Owens, a Business System Analyst at Fulton Paper Company.

Disability Blog & Cases:
Sun Life denies disability insurance benefits to Alabama man with heart problems

An Alabama disability lawyer recently filed a civil complaint on behalf of Philip Linville in United States District Court for the Northern District of Alabama in the Northeastern Division against Sun Life Assurance Company of Canada (Sun Life). Sun Life denied Mr. Linville’s claim for long-term disability benefit payments and is allegedly in violation of the terms of the group long-term disability plan held between Sun Life and Mr. Linville’s employer — Cherokee Nitrogen Company, a subsidiary of LSB, Inc. The long-term disability plan under which Mr. Linville was a participant is governed by the Employee Retirement Income Security Act of 1974 (ERISA).