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.

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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).

Recently, the Prudential Insurance Company of America (Prudential) was sued by an SAIA truck driver for denial to pay long term disability benefits under the SAIA’s ‘Hourly Employees Long Term disability plan’. A Texas disability lawyer filed the lawsuit on behalf of the plaintiff Mitchell Stiles at the District court for the Northern District of Texas as an action under the Employee Retirement Income Security Act (ERISA).

Prudential Disability Claim Denial Background

In the case of Mitchell Stiles v Insurance Company of America, the plaintiff was a 53 year old man who was formerly employed as a truck driver for the LTL carrier, SAIA, Inc.  "Truck Driver" is classified under the Dictionary of Occupational Titles (DOT) as unskilled work and medium occupation with a Specific Vocational Preparation (SVP) of 3. While under the employment of SAIA, Inc. the plaintiff participated under the SAIA’s ‘Hourly Employees Long Term disability plan’. The plan was underwritten and administered by Prudential. 

Claim for Prudential Short Term disability Benefits

On July 6th 2007, due to the plaintiff suffering from degenerative and traumatic injuries, the plaintiff ceased working for SAIA, Inc. in the lawsuit filed, the plaintiff alleged that he is suffering from Cervical Stenosis and became disabled on July 9th 2007. As a result of his disability, the plaintiff filed for short term disability benefits with Prudential and was granted short term disability. 

Filing for Prudential Long Term Disability Benefits

Subsequently, the plaintiff filed long term disability benefits with Prudential and his claim was approved on November 5th 2007. However, on October 7th 2009 through a letter sent to the plaintiff, Prudential denied further disability benefits to the plaintiff on the ground that the plaintiff did not meet the definition of disability in the plan for "Any Occupation". According to disability lawyer Gregory Dell, "the majority of disability insurance claim denials take place when the definition of disability changes from own occupation to any occupation". 

According to the lawsuit filed, under the administrative remedies set forth in the plan, the plaintiff appealed Prudential’s decision to deny him further disability benefits. Further medical records were submitted by the plaintiff to support his appeal. At the same time, the plaintiff was determined as being disabled by the Social Security Administration and issued a favorable decision on his claim for disability benefits. 

Prudential on February 1st 2010 informed the plaintiff that it was reaffirming its original decision to deny the plaintiff his claim for long term disability benefits. A second appeal requesting administrative review of the decision to deny disability benefits was filed by the plaintiff with Prudential on July 31st 2010. Additional documentations were also submitted by the plaintiff to support the appeal. Nevertheless, a final denial was issued by Prudential on August 10th 2010. 

The Medical Facts

It was stated in the lawsuit that the plaintiff suffered from several medical conditions. He has the following documented medical conditions:

  • Multi Level Cervical Fusion
  • Cerebral Palsy
  • Shortness of breath due to a paralyzed diaphragm, 
  • Knee Problems
  • Abnormalities in the lungs and chest
  • Limb Impairment
  • Spinal Condition
  • Neurological Abnormalities
  • Disk Space Narrowing
  • Multilevel Disk Osteophyte Complexes
  • Central Canal Narrowing
  • Cord Compression
  • Severe Servical Stenosis at C5-6
  • Proterolateral Traction Osteophyte
  • Neural Foraminal Stenosis
  • Back and Joint Pains
  • Insomnia
  • Neuropathy
  • Residue Myelopathy

It was alleged that the overall result of the plaintiff medical conditions was a severely limited range of motion, a restriction in activities and chronic pains. The plaintiff argued that he suffered from the above mentioned symptoms and they were not based merely on his own allegations. Because of these symptoms, the plaintiff argued that he was unable to maintain the concentration and the pace required to partake in competitive employment on full time basis hence satisfying the plan definition of being disabled for "any occupation". The plaintiff contended that despite his condition, Prudential persistently denied the plaintiff’s claim for disability benefits. 

Relief sought in the Legal Action

Having exhausted all his administrative remedies, the plaintiff therefore has no choice but to file an action under ERISA with the court to seek the following relief:

  • Declaratory and injunctive relief finding that the plaintiff is entitled to all prior short term and long term disability benefits not yet paid;
  • An order for Prudential to pay all future short term and long term disability benefits;
  • An award of reasonable attorney fees and cost;
  • Any other relief that is just and appropriate.

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

Disability Blog & Cases:
20 years of receiving disability insurance benefits and CIGNA denies woman’s benefits three separate times

A federal lawsuit recently filed in Pennsylvania against Cigna Insurance Company portrays a woman’s 21 year on and off battle with Cigna in order to maintain her long term disability benefits. When dealing with disability insurance companies, it is always a good move to have a disability attorney to handle your monthly disability payments. This is because the disability insurance companies are constantly reviewing your case and will try to look for a reason to terminate your long term disability (LTD) benefits. To them, you represent a “leak” in their bottom line, their profitability. So no matter how flimsy the reason maybe, disability insurance companies are not beneath their stations in trying cut off your long term disability payments. The case of Teann J. Scoggins v Life Insurance Company of America/CIGNA filed recently at the Distinct Court by the plaintiff’s Pennsylvania disability attorney alleges malicious behavior on the part of the disability insurance companies.

Disability Blog & Cases:
Pizzeria owner suffering from Celiac disease filed lawsuit against Berkshire Life Insurance Company of America for breach of contract in refusing to pay disability benefits

Recently a lawsuit was filed against the Berkshire life Insurance company of America at the Circuit Court for the County of Wayne in Michigan by an owner and operator of several pizzerias through his Michigan disability attorney. The disability lawsuit was filed after Berkshire evaluated the disability claim and made a determination that the claimant was not disabled.

Disability Blog & Cases:
Former security guard of the Children’s Hospital of Philadelphia alleges CIGNA Insurance engaged in fraudulent and malicious disability claims practices

Recently, a CIGNA claim denial lawsuit was filed in District Court for the Eastern District of Pennsylvania by a disabled individual who was a former cop and ex security guard of the Children’s Hospital of Philadelphia through his Pennsylvania disability lawyer. The details of the lawsuit were somewhat disturbing as it alleges how, CIGNA also known as Life Insurance Company of America (LINA), fraudulently and willfully victimized the plaintiff in its quest to rid itself of an unprofitable policy account.

Disability Blog & Cases:
Former Aegon USA employee suffering with multiple sclerosis sues CIGNA for denial of disability insurance benefits

A recent disability insurance lawsuit filed at the District Court for the Eastern District of Wisconsin can serve as an eye opener to the kind of claims handling practices that CIGNA will employ in order to evaluate a CIGNA disability claim. In Laura McBrien v CIGNA Life & Health Insurance/Life Insurance Company of North America, the plaintiff Ms. McBrien filed a lawsuit under the Employee Retirement Income Security Act of 1974 (ERISA) through her Wisconsin disability lawyer to try and recover long term disability (LTD) benefits which she was and is legitimately entitled to. Allegedly, CIGNA Life had been relentless in denying the critically ill woman her claim despite the overwhelming medical evidence supporting her claim.

Disability Blog & Cases:
City University Of Medicine & Bioscience former employee disabled by back disorder sues Reliance Standard Life Insurance Company for denial of disability benefits

Back pain is one of the leading causes of claims for long term disability benefits against disability insurance companies. However, claimants of disability insurance benefits who are suffering from back disorders often have an uphill task in trying to claim their disability benefits from Disability Insurance Companies. This is because disability insurance companies can try to deny the claims of individuals who are suffering from back disorders by claiming there is no objective medical evidence to support a claimant’s subjective complaints of back pain. Hence, it is not surprising that we often see lawsuits filed against disability insurance companies from individuals disabled by chronic back pain…

It’s not unusual for a long-term disability insurance company to ask a claimant to apply for Social Security Disability Income (SSDI) benefits. Why? When claimants receive SSDI benefit payments, the disability insurance company will offset the monthly benefit payment paid to the claimant by the amount of money the claimant receives from SSDI.

Most disability insurance companies  hire a third-party to help the claimant obtain SSDI – especially if the claimant is experiencing difficulty obtaining Social Security disability income benefits alone. 

In what appears the win–win–win situation for the claimant, the ultimate winner is the  disability insurance company because they end up saving money in this well-calculated business decision.

Here is an example of what can happen.

Due to unspecified disabling conditions that precluded her from working on her own and, presumably, any occupation, Anita James of Kentucky was able to receive the maximum amount of short-term disability benefit payments from Prudential Insurance Company of America (Prudential). Ms. James also received long-term disability benefit payments during the first two years of her being completely and totally disabled. After that, however, Prudential terminated Ms. James’ disability benefit payments.

With the help of a Kentucky disability lawyer, Ms. James filed a civil complaint against Prudential in United States District Court in the Western District of Kentucky, the Louisville Division for terminating her long-term disability benefits governed by ERISA.

Under the terms of the policy, if the claimant is approved for Social Security disability income, Prudential can subtract the amount the claimant receives as SSDI from the amount Prudential pays in disability benefit payments to the claimant. In Ms. James’ case, Prudential hired and paid a company named Allsup, whose main focus is to assist disability claimants with SSDI claims, to obtain SSD I benefits for her stating, "[she] was totally disabled from any gainful occupation."

According to the civil complaint, "Prudential compensated Allsup for obtaining the SSDI benefit (which resulted in a reduction in Prudential’s LTD benefit payments to Ms. James – the substantial financial savings) and for obtaining reimbursement of prior LTD payments (which resulted in an additional financial windfall to Prudential)."

Shortly after receiving SSDI Benefits,  Prudential decided to terminate Ms. James’ long-term disability benefit payments. This comes on the heels of Allsup successfully obtaining Social Security disability income payments for Ms. James at Prudential’s request. 

Prudential’s decision to terminate Ms. James’ LTD benefit payments, according to Ms. James and her disability lawyer, stemmed from "Prudential’s internal policy of requiring claims personnel to follow the recommendations of its own physician recommendations, without regard to the participants treating physicians, precludes any participant from receiving a full and fair review."

In conjunction with that conclusion, Ms. James and her disability lawyer state that Prudential:

  • disregarded the recommendations of Ms. James’ treating physicians, Allsup, Social Security findings, and Ms. James’ medical records
  • did not question the recommendation of medical experts who did not examine Ms. James
  • gives claims personnel incentives foreclosing claims including terminating LTD benefits
  • enjoyed and benefited from the financial gain from the reimbursement of Ms. James’ long-term disability benefit payments to them
  • employs these practices regularly

For her relief, Ms. James seeks the following:

  • for Prudential to disgorge itself of all profits gained on the long-term disability benefit payments
  • long-term disability benefit payments she is due under the terms of the policy
  • prejudgment interest
  • attorney’s fees
  • all other costs associated with litigation

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:
Standard Insurance Company reverses disability insurance denial for a disabled lawyer

Disability Insurance Lawyers Dell & Schaefer prevailed in an ERISA appeal filed on behalf of their client when The Standard Insurance Company wrongfully denied her long term disability benefits. The client was suffering multiple gastro-intestinal conditions, chronic intractable abdominal pain, visceral hypersensitivity syndrome, nausea, vomiting secondary to a neuroma, migraines, fibromyalgia, severe weight loss, fatigue, syncope, and secondary diagnoses of anxiety, post traumatic stress disorder, major depressive disorder, panic disorder with agoraphobia, inability to concentrate and memory loss, all of which prevented her from performing the material duties of her occupation as an attorney…

Disability Blog & Cases:
Unum sued for denying disability benefits to florida woman with fibromyalgia, neuropathy, and hepatitis

Elaine Carr wasn’t getting anywhere with her claim with Unum Life Insurance Company of America (Unum) for long-term disability benefit payments for which she was eligible under the group plan she had while she was an employee of Ronald J. Mueller, Inc., d/b/a Volvo Village. Having exhausted her administrative remedies with Unum, Ms. Carr filed an ERISA lawsuit against Unum in United States District Court in the Middle District of Florida with the help of her Florida disability attorney.

Disability Blog & Cases:
Wisconsin man sues Liberty Life for termination of disability insurance benefits

Jeffrey Barr has not been able to work with any continuity and has been completely disabled since 2007. Hypertension and cerebral micro vascular disease of the brain have prevented Mr. Barr from working as an active employee of Danaher Corporation in Wisconsin. As result of his being completely and totally disabled, Mr. Barr was eligible to receive long-term disability insurance benefits from his long-term disability insurance company – Liberty Life and Mutual (Liberty). Mr. Barr was able to claim long-term disability benefit payments because he fit the definition of being disabled since he could not perform the material duties of his own occupation and, eventually, any occupation, according to his long-term disability plan.

Disability Blog & Cases:
Prudential Insurance pays disability benefits for 12 years to former Prudential employee then denies claim

Robert Bankston worked for Prudential Insurance Company of America from 1988 to December 1997 as an insurance and financial services agent. Mr. Bankston became completely and totally disabled as a result of severe mental illnesses in 1998 which included: bipolar disorder, major depressive disorder, panic disorder with agoraphobia, and obsessive-compulsive disorder.

Disability Blog & Cases:
Washington attorney sues CIGNA for denying disability benefits during any occupation stage and seeking to collect SSDI overpayment

Disability Insurance companies do not have a reputation for being sympathetic towards their clients. They will usually put themselves in the most favorable position that they can be at in order to minimize paying out to disability claims. The Employee Retirement Income Act of 1074 (ERISA) was enacted in an effort to limit the abuses and discrimination that insurance companies will impose on claimants for disability benefits. While ERISA has essentially become a pro-insurance company law, there are some protections in the law for disability claimants…

Disability Blog & Cases:
UNUM Life Insurance Company sued by California Disability Lawyer after denial of benefits for a school custodian

The UNUM Life Insurance Company of America (UNUM) is one of the largest providers of long term disability insurance in the United States; however, UNUM is not only well known for its size. This disability insurance company has a checkered history with regard to its handling of Unum disability Claims. In 2004, Unum was the subject of an investigation by state regulators which resulted in a reassessment of 200,000claims and a fine in excess of $15 million…

Disability Blog & Cases:
Former Aetna employee sues Aetna for denial of short-term disability benefits

It is not out of the ordinary to come across a case in which a former employee of an insurance company is denied disability insurance benefits by the same company that they were employed by. Aetna Insurance recently determined that one of their own employees was not disabled and therefore denied her claim for short term disability benefits.