Lynda Sacks worked as a mortgage loan underwriter for Countrywide Home Loans, Inc. Her employer offered both short-term and long-term disability plans issued by Standard Insurance Company (Standard) effective January 1, 2005. Standard was responsible for funding both disability plans and making the claims determinations.

→ Click here to continue reading Standard Insurance denies disability claim to a wheelchair bound woman

After Hans-Gerd Rasenack was struck by a hit-and-run driver he applied for benefits under the accidental death and dismemberment insurance he paid for through employee deductions. The policy was issued through AIG Life insurance Company (AIG) and administered by AIG Claim Services. The policy provided an accidental paralysis benefit which covered hemiplegia.

At issue before the U.S. Court of Appeals for the Tenth Circuit was the decision of the U.S. District Court for the District of Colorado. The matter before the court arose under the Employee Retirement Income Security Act (ERISA) which lays out the procedures the court must follow in evaluating a case.

→ Click here to continue reading Accidental death & disability dismemberment; AIG reversed by Colorado Court

Our client, a general surgeon with chronic back pain, will finally receive the long-term disability benefits that he has been denied since October 2004. The United States District Court for the Central District of Illinois entered a final judgment of $402,268.00 against UNUM (formerly known as Paul Revere Life Insurance Company).  In addition to the $402,000 our client’s disability policy will pay him more than $3.9 million over his lifetime.

→ Click here to continue reading $4.3 million in disability benefits for general surgeon following UNUM jury verdict

Disability Attorneys Dell & Schaefer win a long-term disability appeal on behalf of a psychologist whose disability benefits were denied by Liberty Mutual. Our client’s benefits were re-instated and she will now receive several hundred thousands of dollars throughout her lifetime. 

→ Click here to continue reading Liberty Mutual reverses decision to terminate disability benefits

On February 18, 2010, Disability Attorneys Dell & Schaefer and lead trial attorney Gregory Dell filed a nationwide class action lawsuit against Prudential Insurance Company of America (“PRUDENTIAL, NYSE:PRU”), in the Eastern District of New York Federal Court. This lawsuit was filed to protect the potentially thousands of long-term disability claimants that filed a second/voluntary appeal after November 14, 2005 in which their second/voluntary appeal was denied by the same Prudential employee that denied the claimant’s first appeal. Dell & Schaefer is seeking to stop Prudential from conducting unlawful voluntary appeal reviews which violate ERISA. Additionally, the class action seeks an order requiring Prudential to re-evaluate thousands of voluntary appeals which were denied by Prudential after November 14, 2005.

The class is currently represented by four individuals that have each had their voluntary appeals denied by the same person that denied their first appeal. The Employee Retirement Income Security Act “ERISA” requires that the decision maker on a second appeal must be an independent person who was not involved with any previous denial of a disability claim. Unbeknownst to the Plaintiffs, Prudential had instituted an undisclosed cost-saving method of appeals review that blatantly violates federal ERISA law.

“This process is manifestly unfair, and we contend, not legal,” said attorney Gregory Dell. “The whole point of the ERISA-governed appeals process is to substantially reduce lawsuit expenses and create an environment where claim denials will be objectively evaluated. Prudential’s actions are a breach of their fiduciary duty to all disability claimants,” he said.

Through the nationwide representation of multiple claimants with Prudential long-term disability claim denials, our law firm obtained internal email communications which confirms Prudential’s unilateral decision to cut administrative cost by not providing a “full and fair review” of all voluntary appeals,” said Dell.

The reassessment of denied claims could result in millions of dollars of past due benefits. Prudential is one of the country’s largest group long-term disability insurers, with coverage in force for more than two million individuals.

→ Click here to if you believe you may have a potential claim against Prudential Insurance Company of America

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.

Another case appeared in the U.S. Court of Appeals that highlights the importance of exhausting all the administrative options available before taking a case to court. Additionally, this case demonstrates the importance of a treating physician responding to all requests from a disability insurance company.

What happened here? And what can you learn from this case that could help you win your claim for disability insurance benefits?

First, we will look at the history of the case. Then we will look at the law as the court interpreted it.

→ Click here to continue reading US court of appeals upholds denial of disability benefits by Metlife

When Rosemary McGahey was denied long-term disability benefits after 24 months, she appealed Harvard University’s decision. She had been approved by Social Security for disability coverage. But Harvard claimed that their standards were different than Social Security’s. At Harvard’s request, she had seen numerous physicians and psychologists, physical therapists and occupational therapists. Did the evidence from these visits validate Harvard’s decision?

→ Click here to continue reading Harvard University Ordered By Massachusetts Federal Court To Pay Long-Term Disability Benefits To A Former Employee

The case we are going to discuss here highlights one of the ways an insurance company attempts to justify discontinuance of benefits after they have begun paying them.

George Nevitt, a practicing attorney fell down a flight of stairs on June 19, 2001. His injuries were so severe, that The Standard Insurance Company (Standard), the company that provided his company’s employee welfare benefit plan, initially approved Nevitt’s claim for disability benefits. In April 2007, Standard terminated Nevitt’s coverage claiming that he no longer qualified because of the mental disorder limitation of the plan.

→ Click here to continue reading Federal Court Reverses Standard Insurance Company’s Denial Of Long-Term Disability Benefits To An Attorney

When Richard Geroux brought a long-term disability insurance underpayment complaint before the Tribal Court of the Keweenaw Bay Indian Community, L’Anse Reservation, Mich., the insurance companies involved, Assurant, Inc (Assurant) and Union Security Insurance Company (Union Security) immediately sought to remove his case to the United States District Court for the Western District of Michigan, Northern Division. The insurance companies claimed that Geroux’s case fell under ERISA jurisdiction and should be considered in Federal Court.

What is at stake here? Whether the tribal court had jurisdiction. Geroux moved on August 8, 2008 to have his case sent back to tribal court, arguing that his complaint should be decided in tribal court. The Assurant and Union Security filed a counterclaim on August 21, 2008 seeking to move action to Federal Court. They also opposed Geroux’s motion to review the case at tribal council on August 25. In response, Geroux moved to dismiss Union Security’s counterclaim.

→ Click here to continue reading Tribal Court Retains Jurisdiction For Tribal Member’s Disability Insurance Lawsuit Against Assurant And Union Security

Many long-term disability cases revolve around the issue of what constitutes the ability or inability to work in any gainful employment for which you “are reasonably fitted by education, training or experience.” The following case is another example.

In July of 2001, Linda Gardner stopped working as an operating room nurse. She had been diagnosed with avascular necrosis (AVN) in both of her knees, explaining the severe pain she had been suffering from. One of the symptoms of AV is its progressive nature. Temporary or permanent loss of blood supply to affected bones destroys the bone tissue and causes collapse. The resulting pain in an affected joint can limit movement severely.

→ Click here to continue reading Appellat Court Reverses Unum’s Denial Of Disability Benefits To A Registered Nurse ("RN") And Trial Court Victory