Our client was a former officer in the United States Marine Corp with combat service in both Iraq and Afghanistan, who upon retiring from the USMC began working as a medical device sales representative in an operating room setting. For two years he experienced no problems entering operating rooms as part of his occupation. However, in April of 2009, he witnessed a surgical procedure that led him to experience an extreme panic attack, which forced him to leave the operating room. He sought treatment for the panic attack and was ultimately diagnosed with Post Traumatic Stress Disorder.

→ Click here to continue reading Reed Group Overturns Its Decision To Terminate Short Term Disability Benefits To Retired Marine Corp. Officer Suffering From Post Traumatic Stress Disorder

Once again the Ninth Circuit U.S. Court of Appeals has upheld a state’s rights to protect employees that have long-term disability insurance policies issued by their employers. In an opinion filed on October 27, 2009, three circuit judges on the ninth circuit reached a unanimous decision that a state’s practice of disapproving insurance policies that contain clauses that vest insurers with discretion in how they process long-term disability claims and who they issue these claims to is legal and does not conflict with Federal law. The court agreed that a discretionary clause in a long-term disability plans is not valid. This is a major victory for disability claimants; however this ruling is only binding in the following states: Washington, Oregon, Montana, California, Arizona, Idaho and Nevada.

→ Click here to continue reading The Standard Insurance Company Loses Court  Battle To Enforce Discretionary Clauses In Long-Term Disability Insurance Policies

On November 4, 2009, a ruling was handed down in the Sixth Circuit Court of Appeals that will surely have insurance companies looking at how they define ”pre-existing condition”. Ruth Mitzel is certainly happy that the court affirmed the lower court’s decision that Anthem Life Insurance Company, her employer and insurer, had wrongfully denied her long-term life insurance benefits.

When Mitzel was diagnosed on June 18, 2004 with Wegener’s granulomatosis (WG), an auto-immune disease that is life-threatening. Her diagnosis came just five days after she qualified for her employer’s long-term disability plan. She continued working until her condition required hospitalization on June 3, 2005, just shy of a year later.

→ Click here to continue reading Court Rules That An Undiagnosed Pre-Existing Condition Will Not Result In Denial Of Long-Term Disability Benefits

After receiving disability benefits for more than 10 years, the Reliance Standard denied disability benefits. After a 4 year legal battle, the Arizona district court determined that Melisa Gemmel was disabled by fibromyalgia. Melissa Gemmel was employed at Systemhouse, Inc. and covered under her employer’s long-term disability plan, issued by Reliance Standard (NYSE:DFG). In 1989, it was discovered that Gemmel suffered from osteophytes in the neural canal at C5-6, a posterior osteophyte at C5-6, and a C7-T1 abnormality.

→ Click here to continue reading Arizona Court Reverses Reliance Standard And Awards Disability Benefits to Woman Suffering From Fibromyalgia

It is vital that you hire the right long-term disability firm to represent you. Debra Swanson had to learn this the hard way, as a recent ruling in the Fifth Circuit court of Appeals in the Southern District of Texas demonstrates. How did Swanson’s attorney fail her? Her counsel failed to file a proper appeal.

Swanson’s story begins in January of 2002, when she was approved for long-term disability benefits through her employer’s plan with Hartford Life Insurance Co. (“Hartford”). The following year, on April 4, 2003, Hartford notified Swanson that her benefits would be terminated because she had been cleared to return to full-time work. She had 180 days to appeal this determination.

→ Click here to continue reading Texas Court Rules That Hartford Wins Long-term Disability Case, Claimant Failed To Exhaust Administrative Remedies

Aside from the fact that many disability insurance companies already have a conflict of interest for being both the administrator of benefits and the entity that decides whether or not an employee qualifies for disability insurance, there are some cases in which it appears that insurance companies simply decide they don’t want to pay disability benefits.

→ Click here to continue reading Texas Court Reverses Hartford’s Unreasonable Denial Of Disability Benefits To A Hospital Employee

Alvin Hintz was an employee of CCL Custom Manufacturing, Inc. as Director of Information Systems for more than a decade. The company was purchased prior to Hintz’s termination, by KIK Custom Products, Inc. On August 8, 2005, Hintz was terminated along with eight other employees. In the separation agreement, there was a ‘general release of claims’ that Hintz signed. The long term disability plan was administrated by Prudential.

→ Click here to continue reading After Denial Of Long-Term Disability Benefits, Director Disabled By Heart Disease Takes Prudential To Illinois Court

Donna Blake was an employee of Express Scripts, covered under both a long term disability plan and a short term disability plan, when she applied and was denied for short term disability coverage. After internal appeals, Mrs. Blake brought her claim to the United States District Court, Missouri Eastern Division. Upon the settlement of Mrs. Blake’s claim for short term disability, she claimed that she would be prevented from filing for long term benefits, because the denial of her short term disability claim, “prevented her from applying for LTD benefits from the LTD Plan, as she was required to satisfy the applicable period of STD before becoming eligible for LTD benefits.”

→ Click here to continue reading MetLife’s Motion To Dismiss Long-Term Disability Claim For Failure to Exhaust Administrative Remedies Is Denied By Missouri Court

When you apply for a disability policy, it is very important to answer all questions as truthfully as you can. The courts generally will not render a summary judgment in favor of the disability insurance company if the company can’t prove that you answered a question with the intent to defraud. If you don’t have a solid explanation for why you answered a question falsely, you may find yourself losing your coverage or facing a jury trial to determine whether you should receive your long-term disability benefits or not.

This is what happened to Richard Koch. Northwestern Mutual Life Insurance Company filed a motion in the U.S. District Court for the Western District of Washington for a summary judgment against Mr. Koch and rescission of his disability policies.. At issue? Three disability insurance policies that Koch had purchased from Northwestern Mutual.

→ Click here to continue reading After Claimant Paid Premiums For 15 Years, Northwestern Mutual Rescinds Disability Policy

When Vickie Costello left work on May 19, 2006, after a stressful encounter with one of her co-workers, she had no idea that her problems were going to get even worse. In order to return to her job at Logan Aluminum, Inc., her employer required her to sign a “last chance agreement.” Already suffering from debilitating pain for which she had been under a physician’s care since 1999, Ms. Costello felt that this event marked the time to claim disability through her employer’s long-term disability plan with Sun Life Assurance Company.

Sun Life’s policy stated that if Costello became disabled and could not perform the “material and substantial duties of her occupation” that she would be entitled to disability benefits for 24 months. At the end of 24 months, she would have to prove that she was “unable to perform the material and substantial duties of ‘any gainful occupation” in order to remain eligible for disability benefits.

→ Click here to continue reading Sun Life Ordered To Re-Evaluate Long-Term Disability Benefit Denial By Federal Judge