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?

Disability Blog & Cases:
The evolution of denying fibromyalgia and chronic fatigue syndrome claims in group long term disability policies

As a disability claimant it is important to be aware of any limited benefit periods which may unfairly limit your benefits to two years. Once considered “fringe” conditions not commonly understood by many- especially Group Long Term Disability insurance companies, Fibromyalgia and Chronic Fatigue Syndrome (CFS) have become more prevalent, spurning widespread acknowledgment and recognition of these debilitating conditions. The medical communities acceptance of Fibromyalgia and CFS as disabling conditions have resulted in Long Term Disability insurance companies looking for ways to combat paying claims for these conditions.

Disability Blog & Cases:
Reliance Standard terminates long-term disability benefits after receiving the results of an IME and FCE

A recent federal court opinion upheld Reliance Standard’s decision to terminate a claimant’s long-term disability benefits. The Court stated that the existence of both an Independent Medical Examination (“IME”) and a Functional Capacity Examination (“FCE”) was evidence of a thorough investigation. The Court concluded that the results of those exams and the inconsistent documentation from the claimant’s physicians were sufficient proof to show that that Reliance Standard’s decision was not arbitrary or capricious.

Disability Insurance Law TV:
MetLife disability denial reversed by court for unreasonable claim handling

In this episode disability insurance attorney Stephen Jessup discusses a recent 7th Circuit Court of Appeals case in which MetLife’s ERISA disability denial was reversed for numerous reasons. This opinion is a great tool for disability insurance claimants…

Disability Blog & Cases:
Broadspire Services terminate long-term disability benefits after paying for 8 years

A Federal Appellate Court recently upheld the decision by Eaton Corporation and Broadspire Services to discontinue the long-term disability benefits to Janice Curry after paying for 8 years. In Curry v. Eaton, the Court ruled that Eaton and Broadspire were not “arbitrary and capricious” in denying continuation of her long-term benefits. The Court found that the review of the treating physicians’ reports conducted by Boroadspire’s companies’ independent physicians was sufficient for their conclusion that Curry was not “disabled” within the terms of the disability plan, even though Curry had been previously approved for Social Security disability benefits. Let’s take a closer look at the background of the case to understand why the Court sided with Eaton and Broadspire Services.

Disability Blog & Cases:
Texas Insurance Commissioner eliminates discretionary clauses in disability insurance policies

On December 6, 2010 the Texas Commission of Insurance adopted a new rule which prohibits discretionary clauses in disability insurance policies. This is a major victory for disability insurance claimants and hopefully a trend that will continue in every state…

Disability Blog & Cases:
Companion Life wrongfully relies on 22 minutes of video surveillance to deny disability insurance benefits 

This long term disability insurance case against Companion Life is another classic example of a disability insurance company’s wrongful use of video surveillance to deny disability insurance benefits.  This claimant won her court battle with Companion Life, but she was forced to survive for more than 4 years without receiving any long term disability benefits. Let’s take a closer look at the case of Gail Lewandowski.

Disability Insurance Law TV:
Unum / Provident / Paul Revere Long & Short Term Disability Claims

In this episode disability insurance attorneys Gregory Dell, Stephen Jessup and Cesar Gavidia of Attorneys Dell & Schaefer discuss Unum and their handling of long term disability insurance claims. Unum has taken over all disability polices sold by Paul Revere, Provident, Unum Provident, and Colonial Life. Unum is the world’s largest provider of disability insurance company and this video is short summary of the company and their disability claim handling tactics.

Disability Blog & Cases:
Pennsylvania Federal Judge orders Prudential Insurance Company to pay disability benefits to woman diagnosed with RSD

Since 2001, Prudential Insurance Company of America has approved and denied the long term disability benefits of Donna Elms on numerous occasions. Despite the approval of SSDI benefits and support from her treating physicians, Prudential wrongfully denied disability benefits. This case is a classic example of the continuous difficulties that a disability company can give a claimant throughout the duration of their disability claim. Fortunately, Ms. Elms did not give up and was successful in making Prudential pay her the disability benefits she was owed. Let’s take a closer look at the Ms. Elms’ 8 year battle with Prudential.

Disability Blog & Cases:
MetLife denies benefits to stockbroker disabled by depression, yet Pennsylvania Federal Judge awards disability benefits

When the Court sends a claim back to the long-term disability insurance company for another review, it is no guarantee that the insurance company will grant long-term disability benefits, as the case of Cheryl Schwarzwaelder demonstrates. In a recent case against Metropolitan Life Insurance Company (MetLife), the court remanded the case back to Metlife for further review, which resulted in another claim denial and years of further delay. Unfortunately, there are numerous cases against Metlife in which the company has repeatedly ignored the recommendations of a disability claimant’s treating physician. Let’s take a closer look at the long term disability insurance claim of this previously successful Pennsylvania stock broker.