Insurance companies are notorious for relying on file reviews when reviewing disability claims and, unlike claims for social security disability benefits, insurance companies are often allowed to rely on file reviews even in spite of conflicting opinions by treating physicians who are arguably in a better position to assess the functional limitations of an individual. However, insurance companies cannot arbitrarily dismiss the opinions of credible treating physicians without providing an explanation and in certain circumstances courts have found that mere file reviews are insufficient to serve as a basis to deny a claim for benefits.
Continue Reading Liberty Life was wrong for relying on a mere psychiatric file review in reviewing mental health claim for disability benefits

In Stupar v. Metropolitan Life Insurance Company (MetLife), plaintiff, an icer with the Kroger Company, received 24 months of long term disability benefits due to her diagnoses of post-traumatic stress disorder (PTSD), major depression, panic and anxiety disorder. At the end of the two-year period, MetLife terminated her benefits on the grounds that she was limited to 24 months of benefits under the Mental or Nervous Disorders clause of the policy. She objected, exhausted her administrative remedies, then filed this ERISA lawsuit.
Continue Reading MetLife Properly Limited Plaintiff’s Disability Benefits Under the Mental/Nervous Limitations Clause

Annette Engel was employed with Harborcreek Youth Services as a Clinical Director, where she performed duties such as providing leadership and vision, developing proposals, overseeing interviews and recruits of other clinicians, consultation and more. On September 5, 2007, Mrs. Engel applied for long term disability benefits under her employer’s plan with Jefferson Pilot (aka Lincoln National), claiming fibromyalgia, chronic fatigue, stress, and depression resulting from working long hours.
Continue Reading Disability Benefits Ordered To Paid By Jefferson Pilot To A Clinical Director Suffering From Fibromyalgia, Chronic Fatigue And Depression

Our client was a top selling account manger in the advertising department of one of the country’s largest companies, in one of the company’s most demanding regional markets.
Continue Reading Liberty Mutual Reverses Denial Of Short-Term Disability Benefits And Approves Long-Term Disability Benefits For Advertising Account Manager

Our client, a Texas resident, contacted Attorneys Dell & Schaefer following her initial application denial and first appeal of her disability denial by a prior law firm. This woman, suffering from chronic neck and back problems, a stroke, depression, headaches, and memory loss, had been a quality control manager for a large corporation. The client was unable to perform an work and was seeking total disability benefits.
Continue Reading Jefferson Pilot’s Denial of Long-Term Disability Benefits To A Quality Control Manager Is Reversed

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.
Continue Reading Prudential Reverses Denial on Second Appeal & Pays $260,000 In Past Due Disability Benefits To OBGYN

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.
Continue Reading Court Upheld Standard’s Decision to Deny Disability Benefits