James Linnen, a powerhouse operator for Goodyear, Tire and Rubber Company, was insured under his company’s group disability plan issued by Continental Casualty Company. Mr. Linnen began collecting long-term disability benefits for narcolepsy and cataplexy in 2001. In 2004, Hartford Life and Accident Insurance Company purchased Continental and reviewed Mr. Linnen’s disability status. After the treating physician admitted Mr. Linnen was capable of sedentary work, Hartford terminated Mr. Linnen’s benefits in April 2005. Hartford found alternate occupations Mr. Linnen could perform such as cage boss and order parts clerk. Hartford upheld its decision in appeal and Mr. Linnen sued, seeking benefits under the Employee Retirement Income Security Act. (ERISA)

Judge David S. Dowd Jr. of the Northern District of Ohio reviewed Hartford’s decision to terminate benefits and ruled that Hartford used the wrong standard in assessing if Mr. Linnen was entitled to long-term benefits. The policy states the claimant must be unable to “engage in any substantially gainful occupation for which you are, or may reasonably become, qualified by your education, training or experience”. Judge Dowd ruled the term “substantially” alters the definition and Hartford should have assessed whether Mr. Linnen was able to obtain “substantial gainful employment” before terminating benefits. However, if employment is available that pays nearly the same wages and benefits, benefits could possibly be terminated.

James Linnen v. Hartford Life and Accident Insurance Co., No. 05:06CV0141, N.D. Ohio; 2006 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.

Ms. Deborah Donovan, an input shift operator for Eaton Corp, was insured under the company’s self-funded group disability plan. Due to degenerative disk disease, chronic back pain and leg pain, Ms. Donovan filed a claim for total disability benefits in 1993.

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Mr. Mark J. Schwartz, an accountant, was insured under his employer’s group disability plan, sponsored by Metropolitan Life Insurance Co. (MetLife), which limits disability benefits for mental illness to 24 months, but to age 65 for a physical disability.

→ Click here to continue reading MetLife Ordered to Pay Disability Benefits Beyond 24 Months For a Claimant with Both Mental and Physical Disabilities

Sandra Mikolajczyk, an employee of ABN AMBRO North America Inc., was awarded disability benefits for her depression, fatigue, chronic C6 radiculopathy, carpel tunnel syndrome, cholloid brain cyst, multivalve prolapse, cervical disc surgery, anterior cervical neural decompression and other disorders. Ms. Mikolajczyk was insured by her company’s group disability policy with Broadspire Services, Inc.

→ Click here to continue reading U.S. Judge Orders Broadspire to Reinstate a Former Bank Employee’s Disability Benefits

June 23, 2006, U.S. District Judge Joe B. McDade of the Central District of Illinois Ruled in favor of Susan Svejda, an employee of Mercantile Bancorp. Ms. Svedja was employed with Mercantile until 2002. After several visits to physicians and her neurologist, Dr. Douglas Sullivant, M.D., Ms. Svedja was diagnosed with MS, Chronic imbalance, depression and bowel problems including IBS (Irritable Bowel Syndrome) which require her to frequently rush to the bathroom, often times not making it due to other infirmities. As a result of these conditions, Ms. Svedja stopped working and applied for long-term disability benefits from Mercantile’s insurance contract with Continental. 

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Rosa Wood had carpel tunnel syndrome and left work in 1999 because of it. After receiving short term disability benefits and undergoing back surgery, Ms. Wood applied for long term benefits. Initially, Ms. Wood’s claim for benefits was denied however her plan eventually agreed to pay benefits for the first phase of long term disability. Under the first phase, claimants are entitled to benefits for seven to twenty-nine months based on their ability to perform any substantial gainful work. Prudential then denied long-term disability benefits to Ms. Wood during the second phase which would continue benefits beyond the twenty-nine months. After two internal appeals, Ms. Wood sued Prudential in Federal Court.

→ Click here to continue reading California Federal Court Rejects Prudential’s Attempt to Limit Claim

Lawrence Levy, M.D., insured under two disability policies with Minnesota Life Insurance Co., became disabled in March 1996 and has been receiving total disability benefits due to osteoarthritis in his right knee. Dr. Levy claims his disability is an “injury” rather than a “sickness” because the osteoarthritis is due to a basketball injury. The policy provides disability benefits to the age of 65 if the disability is caused by “sickness”, disability benefits will be paid for life is the disability is caused by an “injury”.

U.S. Magistrate Judge Sidney I. Schnekier said the best interpretation of the policy is the term “immediate cause”. Under the immediate cause standard, Dr. Levy’s disability is due to sickness. The Judge stated the knee pain is due to degenerative arthritis and should characterize as a “sickness” under the long-term disability policy. Dr. Levy’s benefits will terminate at age 65.

Lawrence B. Levy, M.D. v. Minnesota Life Insurance Co., No. 03-C-5141, N.D. Ill.; 2006 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.

Robert Clarke, a market sales manager for Allstate Insurance Company, stopped working in 1992 due to lumbar spinal stenosis, claiming he was unable to sit, stand, or walk for more than 10 minutes. Mr. Clarke was insured under his company’s group disability plan administered by Metropolitan Life Insurance Co. and was paid total disability benefits as of 1992. After several back fusion surgeries in 1990, 1992, and 1994, MetLife approved Mr. Clarke’s initial claim for benefits. In 2002, after paying total disability benefits for more than 10 years, MetLife decided to terminate Mr. Clarke’s disability benefits and claim that Mr. Clarke could perform sedentary work.

→ Click here to continue reading MetLife’s Attempts to Stop Paying Total Disability Benefits After Paying Claimant for 10 Years is Denied