Our client, a window coverings salesman, began developing significant vision loss in November 2006 and approached Attorneys Dell & Schaefer for assistance in applying for long-term disability benefits with Unum. His policies stated that he would be entitled to benefits for the rest of his life if he were totally disabled prior to his 65th birthday or if he qualified as totally disabled under the “Presumptive Total Disability” provisions of his polices. The policy defined total disability as “inability to perform the substantial and material duties of your occupation.” Through the efforts of Attorneys Dell & Schaefer, our client will now receive total disability benefits for the rest of his life.

→ Click here to continue reading Unum Challenges The Long Term Disability Claim Of A Blind Salesman

Robin Doyle was a registered nurse working for ChoicePoint Services, and filed a claim for short-term disability benefits on January 30, 2004. She based her disability on a number of conditions, including anal fissure, enlarged internal hemorrhoids, and external anal skin tags. She underwent surgery on February 10, 2004, in an effort to solve these health problems.

→ Click here to continue reading Nurse Wins Opportunity For Reassessment Of Claim With Liberty Life For Long-term Disability Benefits Based On Her Fibromyalgia

Medical Condition and Occupational Duties

Our Client, an OBGYN (hereinafter referred to as “Dr. OBGYN”), was employed by a hospital when he began to experience anxiety and depression following the filing of a malpractice lawsuit. Our client began drinking alcohol on a daily basis and was subsequently hospitalized for three months as a result of alcoholism, anxiety, depression and suicidal thoughts. Prior to claiming disability Dr. OBGYN’s substantial and material duties involved the delivery of babies, gynecological surgeries and on-call requirements.

→ Click here to continue reading Prudential Reverses Denial on Second Appeal & Pays $260,000 In Past Due Disability Benefits To OBGYN

On June 19, 2008, the Supreme Court of the United States finally issued their opinion in the case of Wanda Glen v. Met Life. In a 6 to 3 decision announced Thursday, the US Supreme Court ruled that benefit denials by such companies must be examined with caution when circumstances suggest a high likelihood that financial considerations affected a benefits decision. While Ms. Glenn won her case and Met Life was ordered to pay long-term disability benefits, the Supreme Court did not make any significant findings that will change the way that Federal courts must interpret disability benefit denials.  The Supreme Court had an opportunity to modify the standard of review to "de novo" (complete review)  in all conflict of interest disability claim denials, however they did nothing to give employees a better chance of securing disability benefits that have been denied.

→ Click here to continue reading US Supreme Court Attempts To Clarify The Standard Of Review In Denial Of Long-term Disability Benefits

Carolyn Kinser, an employee of Associates First Capital Corporation filed a lawsuit against Met Life for wrongful denial of disability benefits. Ms. Kinser was disabled from her occupation due to bipolar disorder and major depressive order. Ms. Kinser had been under continued care and treatment with the same psychiatrist for more than ten years.

→ Click here to continue reading Federal Judge Reverses MetLife’s Denial of Disability Benefits

Daniel J. Rochow, the former president of Arthur J. Gallagher & Co., was insured under Life Insurance Co. of North America’s disability plan. The Sixth Circuit affirmed that a disability insurer’s denial of benefits to a former employee who was terminated because his symptoms prevented him from performing his duties was arbitrary and capricious, even though the employee’s diagnosis was not made until after he stopped working.

→ Click here to continue reading Diagnosis of Insured’s Medical Condition After Termination of Employment Does Not Preclude Disability Claim

Pamela A. Ray, an attorney, was insured under a UNUM disability policy. A Denver trial court ruled recently ruled in her favor that working in a large office building was a material duty of a disability claimant’s occupation as an attorney specializing in major real estate, oil and gas and mining transactions. The court determined that UNUM Life insurance Company of America’s denial of benefits was arbitrary and capricious.

→ Click here to continue reading Unum Ordered to Pay Disability Benefits to Attorney Suffering From Sick Building Syndrome

Carol Shepherd, a fork-lift operator for Daramic, was insured under the company’s group disability plan with Reliance Standard Life Insurance Company. In 2004, Ms. Shepherd had an anxiety attack at work and Daramic suspended her and required that she participate in anger management before returning to work. During her suspension, Ms. Shepherd was receiving treatment at Owensboro Medical Health System Outpatient Counseling Center where she was diagnosed with major depression and anxiety disorder.

→ Click here to continue reading Court Upheld Standard’s Decision to Deny Disability Benefits

Jenny Eberle, an employee of Purdue University, was initially approved for long-term disability benefits by the Prudential Insurance Company of America. Shortly after her claim was approved, a new claims examiner and registered nurse reviewed Ms. Eberle’s medical records and decided to terminate her long term benefits in November 2004.

→ Click here to continue reading Prudential’s Motion to Dismiss Claimant’s Disability Benefits is Denied

Larry Mack claimed that he is totally disabled from his occupation as a marriage and family therapist due to diabetes. He sued his disability insurer, Unum Life Insurance Company, after being denied his claim for long-term disability benefits. Unum argued that Mr. Mack is not entitled to long-term benefits because he did not receive “appropriate care” as required by his policy. Mr. Mack admitted to not seeking help from his internal medicine doctor for long periods of time but argued that during these months he was “self-treating” his diabetes by taking Glucophage daily and by monitoring his diet.

The court said such “self-treatment” does not meet the policy requirement that the claimant be under medical treatment in order to receive benefits. The court reasoned that Mr. Mack failed to abide by the standard of care his internal medicine doctor prescribed for diabetic patients, U.S. Judge Linnea R. Johnson granted partial summary judgment to Unum.

Larry B. Mack v. Unum Life Insurance Company of America, No. 06-80308, S.D. Fla.; 2007 U.S. Dist.

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.