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

A ruling in U.S. District Court for the Southern District of New York found Reliance Standard Life Insurance Company (“Reliance”) acted in an arbitrary and capricious manner when it denied Elizabeth Diamond long-term disability benefits. Here is her story.

Ms. Diamond worked for Paine Webber as a desktop publisher. Coverage from Reliance through a Group Long Term Disability (LTD) Insurance Policy paid for by her employer was included in her benefits package. Ms. Diamond fell ill and ceased working on September 9, 2000. She first applied for long-term disability benefits in early March of 2001.

→ Click here to continue reading Disability Claimant Takes Reliance Standard To Court Twice Within 5 Years

An opinion issued by the United States District Court for the Middle District of Pennsylvania in November 2009 highlights the challenges an attorney faces when a complaint for denial of disability insurance benefits involves parties from different jurisdictions. An attorney must be very knowledgeable regarding insurance contract law in their state, because the laws of the state in which the contract is signed are the laws that will apply unless preempted by ERISA.

The case we are going to consider involves Edward J. Zaloga, a doctor of osteopathy. He filed his complaint originally in the Court of Common Pleas for Lackawanna County, Penn. in December 24, 2008. Because the claim exceeded the value of $75,000 and neither Provident Life & Accident Insurance Company (Provident Life) nor Unum Group (Unum) had corporate offices in Pennsylvania, jurisdiction over the case resided with the U.S. District Court.

→ Click here to continue reading Unum’s Attempts To Dismiss A Physician’s Bad Faith Disability Lawsuit Are Denied By Pennsylvania Federal Court

After 18 years of work as a management assistant at Raytheon Company, Dorothy Whitehouse suffered a psychotic episode in the workplace triggered by an experience with her boss and co-workers. The severity of the attack prompted her to immediately schedule an emergency appointment with her therapist, a licensed social worker on August 23, 2007.

→ Click here to continue reading Court Finds MetLife’s Denial Of Short-Term Disability Benefits Arbitrary And Capricious

Dr. C, a podiatrist / podiatric surgeon, was successfully practicing in Texas prior to the injury which caused his disability. During a routine blood draw, the phlebotomist taking Dr. C’s blood sample mistakenly injected the needle too deep into Dr. C’s right arm. Dr. C immediately felt shooting and burning pain radiating down his right arm and into his hand. In the weeks that followed, Dr. C experienced severe burning and tingling in his right arm. Dr. C consulted with a colleague in the hospital, a hand specialist, who explained that it was likely that the phlebotomist had injured his median nerve during the blood draw. The hand specialist advised Dr. C that if his symptoms did not resolve within a few weeks to come back and see him.

→ Click here to continue reading Attorneys Dell & Schaefer Files Lawsuit And Obtains Lump-Sum Buyout Of Disability Policy For Podiatrist With Median Nerve Injury