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

When Dr. Beatriz Martinez received a letter from MetLife denying her claim for long-term disability insurance, her only remaining option was to file a lawsuit. Unfortunately for her, the court upheld Met Life’s denial for one primary reason, she filed her claim for disability benefits four months too late. No arguments put forth by her attorneys could change that fact, and in the end, her appeal was denied, and she lost her lawsuit.

This issue arises far too frequently. Let’s look at Dr. Martinez’ story. There are important lessons for all of us.

→ Click here to continue reading Late Application Filing Results In MetLife Denying A Physician’s Long-Term Disability Claim

Mrs. Pettigrew was an employee of Pioneer Automotive Technologies, Inc from December 8, 2003 until May 15, 2006. Her most recent position was that of a senior engineer. Mrs. Pettigrew had been experiencing increasing pain and symptoms of Chronic Fatigue Syndrome (CFS), Fibromyalgia and Radiculopathy. Because of the increasing problems Mrs. Pettigrew was facing, she was finally forced to stop working. On May 25, 2006 Mrs. Pettigrew submitted a claim for short-term disability benefits, claiming that she was unable to work due to fatigue, severe pain causing lack of concentration, difficulty sitting as well as standing.

→ Click here to continue reading Prudential Ordered To Re-evaluate Long-Term Disability Claim of Engineer Suffering From Chronic Fatigue Syndrome and Fibromyalgia By Court

For several years, Elizabeth Black was the executive director of Milwaukee World Festival, Inc. (MWF), the organization that governs Summerfest, a music festival in Milwaukee. Black was covered under the company’s disability insurance plan, underwritten and administered by Standard Insurance Company. Black was diagnosed with multiple aortic aneurysms bulging and weak areas in the aorta. In 2001, Black had surgery to repair the aneurysms and was recommended by her doctor to medically manage a third aneurysm in the descending aorta.

→ Click here to continue reading Standard Insurance Company’s Denial Of Disability Benefits Is Upheld By Court, Despite Claimant’s Approval Of Social Security Disability Benefits

Mrs. Kaufmann was employed as a senior project manager by Siemens Corporation. Mrs. Kaufmann was a member of the long term disability plan through MetLife who was both the administrator and payor of disability benefits. On May 26, 2006, Mrs. Kaufmann stopped working on advice from her treating physician, Dr. Daniel T. Rubino. Because of an unsuccessful diskectomy and laminectomy, Mrs. Kaufman suffered from severe chronic pain. Mrs. Kaufman suffered from progressive back pain, disc protrusion and herniation, stenosis and radiculopathy which led her to seek help from those unsuccessful surgeries.

→ Click here to continue reading MetLife’s Denial Of Long-Term Disability Benefits to a Senior Project Manager Suffering From Back Pain Is Reveresed By A Federal Judge