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In 2002, Mrs. C was forced to stop working and file a claim for disability benefits under her long-term disability policy provided through her teacher’s association. After reviewing her claim and giving careful consideration to the medical evidence, the disability insurer approved Mrs. C’s claim and began paying total disability benefits.
Continue Reading Teacher Suffering From Sjorgen’s Syndrome, Fibromyalgia And Other Conditions Receives Lump-Sum Buyout Following Denial Of Long-Term Disability Benefits

In 1989, The US Supreme Court declared that if ERISA plans contain language giving plan fiduciaries discretion to interpret the terms of the plans and to make benefit determinations, courts will generally yield to that discretion.
Continue Reading Insurance Industry Loses Lawsuit Challenging the Abolishment of Discretionary Clauses In ERISA Long-Term Disability Policies

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.
Continue Reading Diagnosis of Insured’s Medical Condition After Termination of Employment Does Not Preclude Disability Claim

Donald Holman, a maintenance technician for Tyson Foods Inc., was insured under Tyson’s group disability plan with Hartford Life and Accident Insurance Co. In April, 2001, Mr. Holman began experiencing headaches and blurred vision. After a cranial MRI, Mr. Holman’s neurologist diagnosed him with a Chiari malformation. Mr. Holman’s neurologist stated he was disabled and Mr. Holman stopped working and filed a claim for long-term benefits.
Continue Reading Hartford Ordered to Pay Disability Benefits