In Pamela Fleming v. Unum Life Insurance Company of America (Unum), Plaintiff, a litigation attorney, was in a car accident in 1994 and suffered serious injuries to her spine. She never fully recovered and by July 2005, she was only able to work four hours a day and eventually had to completely stop working.

In December 2005, Unum approved Plaintiff’s claim for LTD benefits. Through the years, she periodically submitted updated medical records and continued to receive benefits until September 26, 2016, when Unum informed her by letter that her benefits were terminated. Unum stated that it believed she was no longer disabled and could return to work. After exhausting her administrative remedies, Plaintiff filed this ERISA lawsuit.
Continue Reading Court Rules Unum Life Insurance Company Wrongfully Terminated LTD Benefits

In Micha v. Sun Life Assurance Company of Canada and Group Disability Benefits Plan (Sun Life v. Group Disability), plaintiff John Paul Micha, M.D., was covered by a disability benefit policy through Sun Life which had been purchased by Group Disability, an employee welfare plan maintained to provide disability benefits to the employees of the medical group of which Micha was a part.
Continue Reading Court Orders Sun Life Assurance Company to Pay Appellate Attorney’s Fees

In a case not handled by Attorneys Dell & Schaefer, but which can be utilized to our clients’ advantage in the future, a Long Term Disability (LTD) Claimant has earned a partial victory against Standard Insurance Company.
Continue Reading California Federal Court Finds that Standard Insurance Company’s Review of LTD Claim was Insufficient; Remands Claim Back to the Plan Administrator

A California federal Judge recently reversed Hartford’s denial of long term disability benefits to a former manager that was initially approved from 2008 until July 2011. Hartford once again relied on their use of video surveillance and an IME report to wrongfully deny LTD benefits. Thankfully the claimant in this case took Hartford to court and won. While our disability attorneys have handled hundreds of cases against Hartford, this case was not handled by our law firm. The Judge’s opinion in this case was outstanding as it addresses all of the wrongdoing done by Hartford.
Continue Reading Hartford Approves Disability Benefits At Any Occupation Stage and Then Denies LTD Benefits, But Court Reverses

A recent ruling in a California ERISA lawsuit against Hartford discusses 2 interesting issues: 1) retroactive benefit awards when a case is remanded back to the carrier for a full and fair review; and 2) awards for attorneys fees and costs.

Continue Reading California Court Denies Retroactive Benefit and Attorneys Fees Awards Despite Remand Back to Hartford for a Full and Fair Review

Many companies offer short and long-term disability insurance coverage to protect a portion of an employee’s monthly income in the event the employee is unable to work as a result of a sickness or injury. Employees pay the premiums for this insurance on a monthly basis so they’ll have something to fall back on if they ever become sick or injured. Of course, many individuals have a sense of security because of this. However, most employees are unaware that once a claim for disability benefits is submitted, the disability insurance company has a “structural conflict of interest”, as it is usually the long-term disability insurance company that both administers and pays any approved claim. This structural conflict is significant as a claim denial allows the insurance company to keep the money for itself and increase its profits. Fortunately for disability claimants, the courts are required to consider this structural conflict of interest as one of many potentially bias factors that inappropriately motivate a disability insurance company to deny disability benefits.

As a disability insurance attorney that has handled thousands of claims against every major disability insurance company, I am constantly trying to educate potential claimants about the tactics of disability insurers. A recent case is a victory for disability policyholders as it exposed the “signs of bias” exhibited by Hartford Life and Accident Insurance Company throughout its decision making process.

Click here to continue reading California Court Orders Hartford To Pay Long-Term Disability Benefits To A Telecommunications Manager

Recently, the California Department of Insurance settled with LINA, a daughter company of CIGNA to the tune of $600,000. What was this penalty for? According to California Insurance Commissioner Steve Poizner, LINA was apparently ignoring certain claims that might have been valid disability claims.

Between January 1, 2005 and December 31, 2007 LINA improperly handled insurance claims. It seems that not only did LINA deny many cases before ever receiving the medical proof those clients were entitled to their insurance payouts but LINA ignored important information that may have reversed the denied claim on a number of accounts.

Click here to continue reading CIGNA/LINA Penalized By The California Department Of Insurance

The recently decided case of Barteau v. Prudential, 2009 WL 1505193 (C.D. Cal.) is a reminder of what ends Prudential will go to in denying a claim for benefits. Carl Barteau was an Assistant Professor of Mathematics at DeVry Institute of technology for almost eight years before becoming disabled. Mr. Barteau had suffered problems with his right eye since childhood. In 2002 he underwent surgery for glaucoma, which was complicated by a scratched cornea. As a result of the scratched cornea he was instructed to wear a replaceable contact lens and was reassured the eye would heal on its own. Soon after he began experiencing excruciating pain, and on January 7, 2003 he began treatment at UCLA. Biopsies of the eye were taken and showed evidence of eye fungus. On January 17, 2003, he became hospitalized and underwent surgery to remove a large part of the infection from his right eye. On February 22, 2003, he underwent a second surgery on his right eye. Following the second surgery he began to experience a lack of vision in his right eye and disabling light sensitivity in both eyes.

Click here to continue reading Prudential Denies Long-Term Disability Benefits To A College Professor, But The California District Court Reverses the Claim Denial

In, Lona v. Prudential, 2009 WL 801868 (S.D. Cal)., the Court determined that the opinions of three doctors hired by the insurance carrier to review the insured’s medical records did not carry as much weight as the opinions of three other doctors that physically examined the insured. This case shows that Prudential will continue to hire doctors to review a claimant’s disability file, until they have found the right doctor to provide the opinion they are looking for.

Click here to continue reading Judge Orders Prudential To Pay Account Manager $90,416 In Long-Term Disability Benefits

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