Disability Insurance Law TV:
Who makes the final decison to approve or deny disability insurance benefits?

Is it the disability insurance claim representative or hired insurance company doctor that makes the decisional to approve or deny benefits?

FAQ | Overpayment Issues:
Can Veteran Disability Benefits be deducted from my monthly long term disability insurance check?

The answer to this question depends on the language contained within your long term disability insurance policy. In most disability claims that are governed by ERISA there is an offset provision for other disability related benefits such as SSDI, Worker Compensation or Veteran Benefits.

Disability Blog & Cases:
Pennsylvania class action disability insurance suit against Reassure and Swiss Re dismissed due to lack of subject matter jurisdiction

A federal district court in Pennsylvania recently dismissed Claimant Barry Sunshine’s complaint for lack of subject matter jurisdiction. Alleging that Reassure America Life Insurance and Swiss Re Life & Health America, Incorporated prematurely terminated his and other similarly-insured individual’s disability insurance benefits, Sunshine and his disability attorneys were attempting to right a wrong for not only Sunshine but for others in a similar situation. Unfortunately, the Eastern District Court of Pennsylvania dismissed Sunshine’s disability insurance class action lawsuit because the suit lacked federal subject matter jurisdiction. Fortunately, the dismissal was filed as a dismissal without prejudice, making it possible for Sunshine to file an amended complaint when his disability attorneys establish proper subject matter jurisdiction.

Disability Blog & Cases:
LINA and CIGNA need to listen to the Federal Courts and stop denying disability insurance claims for people disabled by fibromyalgia

An affirming opinion from the Fourth Circuit United States Court of Appeals shows how Administrators of ERISA long term disability benefits can’t abuse their power of discretion in North Carolina. This case against LINA also known as CIGNA, is a great victory for claimants suffering from fibromyalgia. In the appeal of Rebecca DuPerry v. Life Insurance Company of North America, Appellee Rebecca DuPerry prevailed in her quest to receive long-term disability benefits from her group long term disability insurance provider, Life Insurance Company of North America (LINA).

Disability Blog & Cases:
Lincoln Nebraska man suffering from fibromyalgia and chronic fatigue syndrome sues UNUM when he is denied disability benefits

UNUM Life Insurance Company of America has refused to honor its obligation to provide Scott A. Boles with his disability insurance benefit income even though Mr. Boles qualifies for benefits stipulated in two UNUM Life Insurance Company disability insurance policies. UNUM denied Mr. Bole’s disability insurance benefits on both his individual disability policy, on which he has paid all premiums on time and in full since 1994, as well as an employee group disability policy from his employer that has been in effect since 2006.

Disability Blog & Cases:
Sun Life deducts veteran disability benefits from claimant’s monthly long term disability check

Most long term disability insurance policies allow the insurance company to offset the monthly disability payments to an insured if the insured is receiving “other income” from certain sources. Often, these other sources include any Social Security disability or retirement benefits, workers’ compensation benefits, retirement plan benefits from the employer, or even earnings the insured receives from any other occupation or form of employment. The specific policy language governs exactly what the insurance carrier can consider an “offset” to reduce the claimant’s monthly benefit. Sometimes, however, the insurance policy is not crystal clear on what specifically may be used as an offset. Such a situation occurred in the case of James Riley v. Sun Life Insurance Company. In this case, the issue was whether Sun Life was allowed to reduce Riley’s monthly benefit because of veteran disability benefits he received from Veterans Affairs. The Court ultimately upholds Sun Life’s decision to reduce Riley’s monthly long-term disability benefits. Let’s take a closer look to see why the Court ruled the way it did.

Disability Blog & Cases:
Disability benefits lawsuit against Fortis Benefits Insurance Company dismissed by West Virginia Federal Court

Failing to comply with administrative requirements in a timely manner as specified by Fortis Benefits Insurance Company resulted in Elizabeth A. Bailey being denied benefits from her deceased husband’s short-term disability benefits, long-term disability benefits and life insurance policies. Having neglected to follow proper ERISA procedures in pursuing long-term disability and life insurance benefits from Fortis Benefits Insurance Company (a wholly owned subsidiary of Assurant) as specified in Fortis’s policy requirements, Elizabeth Bailey forfeited her opportunity to present her case to a federal court when her complaint was dismissed by the Court’s ruling on two motions for summary judgment filed by Fortis’s disability defense attorneys.

FAQ: Attorney Fees & Representation:
Can a disability attorney manage all aspects of my long-term disability insurance claim?

What amounts to a business decision for your disability insurance company is a life decision for you as a disability benefit recipient. Your disability insurance company views you as a piece of paper, some medical documents, a persistent headache, and a drain on their bottom line. Your monthly disability payment is your home, your groceries, your health care—your livelihood; and you don’t trust your disability insurance provider to make sure that your interests are being taken care off. Consequently, much of your precious time may be spent dealing with your disability insurance provider to make sure you receive your monthly disability payment.

Disability Blog & Cases:
Disability lawsuit against MetLife alleges insurance company refuses to pay disabled claimant

The Metropolitan Life Insurance Company, known as MetLife (NYSE: MET), is being sued in United States District Court, Southern District of Florida, for refusing to honor its contractual obligation to pay long term disability insurance benefits to a psychologically impaired woman.

Disability Blog & Cases:
Liberty Mutual sued in Tampa Federal Court for denying long term disability insurance benefits

An ERISA disability lawsuit was filed against the Liberty Life Assurance Company, this time in Federal Court in the Middle District of Florida. Andrea Medders was forced to file suit after her administrative appeals were denied and Liberty Life, also known as Liberty Mutual refused to pay her long term disability benefits.

Disability Blog & Cases:
CIGNA/LINA sued for denying waiver of life insurance premium to caretaker of disabled and mentally challenged adults

After repeated appeals asking CIGNA / LINA to change their decision regarding denial of waiver of life insurance premiums due to total disability, Wendy Magee was recently forced to hire Michigan disability attorneys and file an ERISA disability lawsuit in the Federal Court of the Western District of Michigan.

Disability Blog & Cases:
Federal Court provides 5 reasons CIGNA wrongfully denied disability benefits to man suffering from chronic fatigue syndromes

Citing a financial incentive to cheat, the United States Court of Appeals for the Ninth Circuit recently overruled the decision of CIGNA (CI) to deny disability benefits to a man suffering from chronic fatigue syndrome. For anyone disabled by chronic fatigue or fibromyalgia this is a very supportive case and great law. The court provided five reasons that Cigna abused its discretion by denying disability insurance benefits. Let’s take a close at the case history and the court’s reasoning.

Disability Blog & Cases:
Hartford Financial’s mental nervous disorder limitation clause in disability insurance policy held ambiguous

The United States Court of Appeals for the Ninth Circuit recently ordered a lower court to reconsider its decision that had affirmed Hartford Financial Insurance Company‘s denial of a woman’s claim for disability benefits. Although the claimant has not yet been awarded her requested disability benefits, the Appeals Court’s decision leaves her one step closer to achieving this goal.

Disability Blog & Cases:
Life Insurance Company of North America, part of CIGNA Corporation, sued for refusing disability insurance benefits for mentally ill teacher

Disability Insurance Attorneys Dell and Schaefer filed a Federal Lawsuit against Life Insurance Company of North America (LINA), which is part of CIGNA Corp (CI.N). The lawsuit was filed after Cigna refused to pay disability benefits to a Florida teacher forced to stop working due to mental health issues such as depression, bipolar disorder and schizophrenia.

Disability Blog & Cases:
Federal lawsuit against Hartford Insurance alleges company refuses to pay disabled Patriot Act analyst

A Federal lawsuit filed in United States District Court Southern District of Florida accuses the Hartford Life and Accident Insurance Company of breaching its contract with Branch Banking and Trust (BB&T) and a BB&T employee. Filed by noted disability insurance law firm of Dell & Schafer, the suit states that Hartford is refusing to pay benefits to the employee, a U.S. Patriot Act/Anti-Money Laundering Analyst. The refusal by The Hartford violates the Employee Retirement Income Security Act of 1974, commonly referred to as ERISA.

Disability Blog & Cases:
Disability insurance lawsuit against Guardian Life Insurance serves as warning to doctors

A lawsuit filed in the United States Southern District Court of New York reveals that The Guardian Life Insurance Company of America is refusing to pay long term disability insurance benefits to a New Jersey OB/GYN critically injured in a car accident.

Disability Blog & Cases:
Disability insurance benefits lawsuit against Prudential Insurance Company is dismissed by Pennsylvania Judge

A Federal District Court in Pennsylvania recently dismissed the case of a long-term disability claimant who claimed damages resulting from Prudential Insurance Company‘s delay in the approval of her claim for long-term disability insurance benefits. Although the claimant was eventually awarded disability benefits by Prudential Insurance Company, she still filed a lawsuit for the damages she allegedly suffered due to the carrier’s delay in approving her disability benefits. The Court ultimately dismissed all of her claims against the carrier for the delay. As a disability insurance law firm that handles cases nationwide, it appears that the lawyer who filed this lawsuit was not a Pennsylvania disability insurance attorney. This case provides a good summary of how restrictive and unfair ERISA can be, but an experienced disability insurance lawyer would not have filed this disability lawsuit against Prudential. Check out our video on why ERISA is an unfair law. To understand the Court’s ruling, let’s take a look at the case of Carolyn Jobe v. Prudential.

Disability Blog & Cases:
Michigan Court determines Sedgwick wrongly terminated woman’s disability benefits and awards Michigan disability attorney his fees

A recent opinion from the United States District Court in the Eastern District of Michigan shows how difficult it can be get a court to award disability benefits instead of just remanding a wrongful termination decision back to the plan administrator. Although the Court in this action remanded the case back to the plan administrator for a new review, it did award the claimant’s Michigan disability attorney partial attorney’s fees. To understand the Court’s decision, lets take a closer look at the case of Luda Blajei.

Disability Blog & Cases:
Ohio National Life Insurance loves to tell disabled doctor “no”

As disability attorneys we deal with long term disability insurance carriers such as Ohio National Life Insurance Company on daily basis. Most insurance companies do not have good reputations for fair claim handling so it is not unusual for our attorneys to encounter some opposition while handling a disability insurance claim. The conduct of Ohio National in a long term disability claim our lawyers are handling on behalf of a family medicine physician is disturbing. The conduct is even more disturbing because Ohio National’s most recent letter states, “Ohio National has acted reasonably and fairly in the handling of [Dr. X’s] claim.” While our client continues to be paid disability insurance benefits each month, Ohio seems to thinks that by paying disability benefits they are acting reasonably.

Disability Blog & Cases:
UNUM class action filed by New York disability insurance attorneys is dismissed by Federal Judge

A Federal District Court in New York recently dismissed the class action lawsuit of four individuals whose disability insurance claims were denied or terminated by the Unum Provident Corporation. The individuals filed the lawsuit because they believed that Unum denied or terminated their claims to meet expectations as to revenue and profit for the corporation. To understand the Court’s decision, we must look at the underlying facts of the case. It is unfortunate that after several years of litigation, the New York disability insurance lawyers and their clients were unsuccessful in obtaining long term disability insurance benefits. The court did not dispute Unum’s unreasonable claims handling tactics, rather the court dismissed the case because the Judge felt that any further action against UNUM in light of the RSA agreement would be moot. Let’s take a closer look at the facts.

Disability Blog & Cases:
Disability insurance claimant’s allegation of bad faith against Unum Provident is disallowed due to ERISA regulations

A federal district court in California recently ruled that a disability claimant could not recover on his state-law claim for breach of implied covenant of good faith and fair dealing. This specific count is also known as “Bad Faith”. The court found that the disability plan at issue fell under the federal ERISA statute, and, as such, his state-law claim was preempted by ERISA. ERISA prohibits bad faith claims, which is why every insurer always wants a claim to be governed by ERISA. Check out our video on why ERISA is an unfair law. This case is a good summary of the law in California regarding when a disability policy may be exempt from ERISA. The California disability insurance attorneys that filed this ERISA disability lawsuit did a good job in trying to make this case exempt from ERISA. Let’s take a closer look to understand why the court found that the disability plan fell under the ERISA statute and why they ruled that his bad faith allegation was dismissed. .

FAQ | ERISA Information:
Can my disability insurance policy be exempt from ERISA?

One of the first things our disability insurance attorneys will do with every disability claim is to determine whether or not the disability insurance policy is governed by ERISA. The analysis to determine if a disability plan is exempt from ERISA is complicated when a disability claimant received their policy through their employer. If you purchased your disability policy from an insurance agent or through an organization that is not your employer, then your disability policy is Exempt. If you are a government or church employee, then your disability plan is exempt from ERISA.

Disability Blog & Cases:
Disability insurance companies challenge heart disease disability insurance claims

According to the American Heart Association, one out of three, or approximately 81 million Americans have heart disease. In 1963 Congress proclaimed February as “American Heart Month” in order to raise awareness and fight the battle against heart disease. Millions of Americans each year are unable to work as a result of heart disease and are forced to file for either disability insurance benefits or social security disability benefits. Heart disease, also known as cardiovascular disease, includes high blood pressure, coronary heart disease, stroke, heart failure, and congenital heart defects. More than 5.8 million Americans have heart failure. Disability lawyer firm Dell & Schaefer participates each year in multiple events to help raise funds to battle heart disease.

Disability Blog & Cases:
Principal Life denies disability benefits to a physician and then seeks attorney fees after physician’s disability denial is affirmed by Texas Judge

Dr. Bruce Leipzig had been denied long-term disability benefits by Principal Life Insurance Company, and brought his ERISA case before the District Court covering the northern part of Texas. After hearing the case, the Court issued summary judgment in favor of the disability insurance company.

Disability Blog & Cases:
CIGNA destroys copy of accidental disability insurance policy but claimant is able to prove existence of policy and obtain benefits

An interesting disability claim arose in 2008 that highlights the challenges a disabled individual can face when a span of time exists between the time of a covered event and the manifestation of an injury associated with that event. This case against CIGNA is rare because it is an accident and sickness policy rather than a traditional disability insurance policy. It is also rare, because most disability insurance companies will not lose a copy of your policy. A disability claimant should make every effort to keep the original copy of their disability insurance policy. A New York ambulance volunteer, George Glew, discovered this when he sought to claim disability benefits under a CIGNA Life Insurance Company of New York (CIGNA) policy that covered accidents and sickness for employees and volunteers in the Shirley Community Ambulance Company. This case is rare because it is an accident and sickness policy rather than a traditional disability insurance policy.

Disability Blog & Cases:
Sun Life Insurance Co. wrongfully denies disability insurance benefits following disability claimant’s failure to respond timely

It isn’t always the claimant who appeals a District Court decision. The District Court may rule in favor of the claimant and have its decision challenged by the disability insurance provider. Wenner v. Sun Life Assurance Company of Canada is just such a case. Arguments were heard in the U.S. Court of Appeals, Sixth Circuit, located in Cincinnati, Ohio. The case arose from Nashville, Tennessee. This entire disability claim could probably been avoided had the claimant hired a disability insurance attorney to manage his disability claim on a monthly basis. The denial of this claimant’s claim resulted in more than 4 years of delay before the claimant was able begin receiving monthly benefits again.

Disability Blog & Cases:
Missouri Court reverses Prudential Insurance Company’s wrongful denial of disability insurance benefits for former pharmacy technician

A Missouri Federal Court determined that Prudential was wrong to terminate a man’s disability insurance benefits by relying on a vocational expert who was not given enough information and a doctor who failed to explain why he disagreed with the claimant’s treating physicians. Let’s take a detailed look at the Court’s opinion to understand its ruling.

Disability Blog & Cases:
Liberty Mutual ordered to pay interest & attorney fees following disability insurance claim denial

A recent Federal Court decision from New Jersey sided with a disability claimant who filed an ERISA suit after her disability insurance benefits were wrongfully denied by Liberty Mutual Life Insurance Company. The Court held that the claimant was both entitled to a fair and equitable rate of interest as well as reasonable attorney’s fees under the circumstances of the case. The issue that I find frustrating about this case is that after the claimant proved that Liberty was wrong in denying disability benefits, they continued to battle the claimant by refusing to pay attorney fees and the interest on the money that Liberty saved over a 5 year period. Liberty probably spent more in battling against paying attorney fees than they could have paid the claimant by agreeing to pay her attorney fees and interest.

Disability Blog & Cases:
Pennsylvania Court rules that CIGNA disability insurance policy allows for offset of lost wages from auto insurance policy

A District Court ruling issued in Scranton, Pennsylvania highlights the importance of understanding the terms of a long-term disability insurance policy. It is common for these disability insurance policies to reduce monthly disability benefits by other benefits or income a claimant receives. This case is a good example of the complex language in disability insurance policies which can be subject to multiple interpretations.

Disability Disability Insurance Law TV:
10 things to expect when your disability insurance company asks for an IME exam

Almost all disability insurance policies provide a disability insurance company with the right to have the insured examined by a physician of their choice. The disability insurance companies can select any physician and a claimant must attend. These exams are commonly referred to as Independent Medical Exams (IME EXAM); however many courts refer to them as Compulsory Medical Exams (CME EXAM) since the claimant’s benefits will be denied if they fail to appear. Disability Insurance attorneys Gregory Dell and Stephen Jessup discuss what a claimant should expect if asked to attend a CME exam.

Disability Blog & Cases:
CIGNA / LINA wrongfully relies upon surveillance video to deny long term disability insurance benefits

CIGNA Insurance Company, the parent company of Life Insurance Company of North America (LINA) has relied on video surveillance to deny thousands of claims for disability insurance benefits. This case is another classic example of CIGNA wrongfully relying upon video surveillance to justify its disregard of the claimant’s medical evidence. A Federal Court in California found that CIGNA / LINA abused its discretion when it denied Todd Nash’s claim. Let’s take a closer look at the Court’s reasoning.

North Carolina disability attorney is unsuccessful in obtaining disability insurance benefits for former TYCO employee

This short term disability insurance case originated from North Carolina and involved a claim that was denied under the TYCO short term disability plan. This North Carolina disability claim was not governed by ERISA as the TYCO short term disability plan is self-funded. The theory for filing a lawsuit in this claim was breach of contract, but in an unusual argument the North Carolina disability insurance attorney attempted to argue that ERISA should apply to the case. This case is an unusual disability insurance claim.

Guardian disability insurance denial is upheld by Ohio Federal Court & Sixth Circuit Court of Appeals

A federal court of appeals upheld Guardian Insurance Company’s denial of disability benefits. The claimant in this case was paid disability insurance benefits for several years, but when he returned to work for more than 40 hours a week, Guardian was convinced he was no longer eligible for benefits. The disability claimant disagreed as he did not think he was capable of working and earning the same amount of money he earned pre-disability. The court disagreed with the claimant’s argument.

Cytec Industries and Broadspire Services discontinue disability insurance benefits for army veteran suffering from PTSD

This disability insurance case was a short term disability insurance claim that was denied by Broadspire. The disability claimant was denied on multiple occasions and was finally forced to file an ERISA disability lawsuit against Broadspire Services and Cytec.

ReliaStar reduces monthly disability insurance benefits to veteran due to VA benefits

FAQ (ERISA Information):
What is the discretionary clause in a disability insurance policy?