Dr. Z, a chiropractor, suffered an injury to both of his wrists while performing work in his backyard. As a result, Dr. Z was forced to discontinue his profession as a chiropractor and file disability claims under his three long-term disability insurance policies. Wanting to insure his financial future in the event that he became disabled, Dr. Z maintained three individual disability policies with three different insurance companies. Initially, the disability carriers approved Dr. Z’s claims and began paying him monthly disability benefits.
Court Finds CIGNA Failed To Follow Proper Claim Denial Procedure, Nurse’s Right To Pursue Disability Law Suit Under ERISA Supported
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Linda Chavis filed a complaint against Cigna Group Insurance and Life Insurance Company of North America (LINA) on June 24, 2009, alleging that the insurance company had breached two disability insurance contracts by refusing to pay her claims for short-term disability (STD) insurance and for long-term disability (LTD) insurance. While Cigna filed a motion to dismiss the complaint, Chavis stated in her complaint that she and her employer had paid all the required premiums for both policies, but she had been wrongfully denied benefits for both policies.
Prudential’s Failure To Produce Documents Weighs In Long Term Disability Claimant’s Favor
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Posted in Disability Insurance Cases Nationwide, Prudential
In a ruling filed on November 17, 2009, the United States Court of Appeals for the Eighth Circuit found that Prudential Insurance Company of America (Prudential) had failed to provide Barbara Brown adequate information with which to appeal their decision to deny her long term disability (LTD) benefits. As a result, the court did not apply a common court-approved practice which demands that all administrative options must be exhausted before filing suit.
Third Circuit Court of Appeals Upholds Hartford’s Denial Of Long-Term Disability Claim Based on Pre-Existing Condition Defense
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Posted in Disability Insurance Cases Nationwide, Hartford
The Third Circuit Court of Appeals recently rendered a very difficult decision in favor of Hartford Insurance Company dealing with the interpretation of pre-existing condition clauses in long-term disability income policies. The three judge panel ruled 2-1 in favor of upholding Hartford’s denial of disability benefits. The law in each state is different for pre-existing conditions, therefore a disability claimant should consult with a disability insurance attorney prior to filing a claim for benefits.
In the case we are going to consider here, Jay Doroshow v. Hartford Life and Accident Insurance Company, two judges found Hartford had been neither capricious nor arbitrary when the insurance company denied Doroshow’s claim for long-term unemployment. The third judge disagreed, arguing in his dissent that Doroshow had not received treatment for the condition that precipitated his claim with Hartford. We will have to look at the backdrop against which this case developed.
A General Surgeon And His Legal Team At Attorneys Dell & Schaefer Win Disability Insurance Jury Trial Against Unum
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Posted in Resolved Disability Insurance Cases
In a federal court in Peoria, Illinois, a jury ruled against Unum Company (NYSE: UNM)and awarded more than $300,000 in disability insurance benefits the insurer withheld from a general surgeon it had claimed was capable of conducting major surgeries, despite the surgeon’s difficulty standing for more than one hour at a time.
The eight-person jury, which included an employee from State Farm Insurance, headquartered nearby, ruled that Dr. Yogihn Parikh, who was a general surgeon at Hammond Henry Hospital in Genesco Il, was partially disabled, and as such was entitled to long-term disability benefits Unum had withheld under the disability insurance policy that Parikh purchased from them.
Berkshire Approves Total Disability Benefits For Litigation Attorney Following Multi-Level Fusion Of Cervical Spine And Surgery To Remove A Cancerous Tumor
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Posted in Resolved Disability Insurance Cases
Our client was a litigator with his own successful practice. Early in 2009 he began to experience increasing pain in his upper back and neck. Thinking it was just a result of stress, he continued to try to work through the pain. As the pain worsened he sought medical treatment and later learned he had a life-threatening Chordoma in his cervical spine. The slow growing, highly dangerous Chordoma had to be removed, and in doing so would result in the fusion of multiple discs in his cervical spine and radiation treatment. In June of 2009 he underwent his surgery.
Reed Group Overturns Its Decision To Terminate Short Term Disability Benefits To Retired Marine Corp. Officer Suffering From Post Traumatic Stress Disorder
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Posted in Resolved Disability Insurance Cases
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.
The Standard Insurance Company Loses Court Battle To Enforce Discretionary Clauses In Long-Term Disability Insurance Policies
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Posted in Disability Insurance Cases Nationwide, Standard
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.
Court Rules That An Undiagnosed Pre-Existing Condition Will Not Result In Denial Of Long-Term Disability Benefits
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Posted in Anthem, Disability Insurance Cases Nationwide
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.
Arizona Court Reverses Reliance Standard And Awards Disability Benefits to Woman Suffering From Fibromyalgia
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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.