On a regular basis our disability lawyers write about disability insurance cases and other related disability claim issues around the country which we believe are education and informative for disability insurance claimants. Please contact us if we can assist you. Check out our Blog, Frequently Asked Questions, Insurance Company or Disabling Conditions pages to learn more.
February 1, 2019 —
In a recent case out of Massachusetts, a federal district court addressed several often contested issues in the area of ERISA including how insurance companies are supposed to evaluate disability claims that are based on conditions like fibromyalgia which are based primarily on subjective complaints and who has the burden of proof when a policy...
December 10, 2018 —
In a recent Florida case not handled by our law firm a claimant’s untimely submission of his ERISA appeal proves fatal to his claim. The case was decided by the United States District Court in the Middle District of Florida and reminds us of the importance of properly submitting an appeal in ERISA governed cases.
Mr. Applegate had received...
November 28, 2018 —
Mr. Paquin became disabled in 2003 after contracting encephalitis from a mosquito infected with the West Nile virus. The infection resulted in brain damage and cognitive impairment rendering Mr. Paquin unable to continue working as a business development director for his employer, Transistor Devices. He qualified for short term...
June 13, 2018 —
When it comes to ERISA governed claims, no circuit is more plaintiff friendly than the 9th Circuit. A recent ruling by a Washington district court reminds us of that although the behavior by the disability insurer, Aetna Life Insurance Co., in Gorena v. Aetna deserved a strong reprimand.
Ms. Gorena worked as a staff analysist for Boeing for...
June 1, 2018 —
Disability Insurance companies are criticized often for failing to perform independent medical evaluations and instead relying exclusively on file reviews performed by in house doctors. The tendency to perform reviews in this fashion is more common with some carriers than others. Such is the case with Life Insurance Company of North America (LINA)...
May 11, 2018 —
Attorneys with Attorneys Dell & Schaefer have handled thousands of Long Term Disability claims with all the major insurance companies and have seen the changes that have occurred over the years. Below are some recent trends seen with 10 of the major companies:
Aetna: Aetna’s U.S. group life and disability business was recently acquired by...
April 25, 2018 —
A common question we receive is, How can an insurance company rely on their own doctors over the opinions of treating physicians? Or, How can an insurance company rely on doctors who merely review a paper file and never see the claimant in person?
Unfortunately, insurance companies are allowed to do this as long as they have a good reason for...
February 7, 2018 —
A common question we receive from claimants is how one can be approved for social security disability benefits but denied private disability insurance benefits. A recent case decided by the 11th Circuit Court of Appeals touched on this issue and reminds us that different disability programs have different standards of determining disability and it...
December 18, 2017 —
In Johnson v. Life Insurance Company of America, a Colorado District Court ruled in favor of the claimant finding LINA’s decision unsupported by any reasonable basis. The case dealt with a denial of long term disability benefits at the change in definition from own occupation to any occupation. After paying 24 months of benefits to Ms. Johnson...
November 30, 2017 —
The answer to this question is NO and a recent case brought by a FEDEX employee against Aetna insurance company is an example of an SSDI approval and a long term disability denial. In a recent case, a Fed-Ex employee filed a lawsuit against AETNA following the denial of long term disability benefits. Aetna paid long-term disability benefits for 24...
November 29, 2017 —
Mental health conditions such as anxiety and depression are two of the most common causes of disability. In a recent case against Liberty Mutual, a pediatrician claimed he was unable to work due to anxiety and depression. Liberty Mutual evaluated the doctors claim by hiring a doctor to review the medical records submitted. Based exclusively on...
November 13, 2017 —
This case was decided by a district court in Illinois and involved United of Omaha Life Insurance Company. An ERISA action was filed by the Plaintiff, Gina Tassone, after her LTD benefits were terminated. She had been paid two-years of regular-occupation benefits for her inability to work as a Finance Manager and like many group disability...
March 21, 2017 —
Thousands of long term disability claimants receive both social security disability benefits and long term disability benefits. In this recent video with Attorney Victor Peña and Gregory Dell we discuss a great legal decision in which Liberty Mutual's long term disability benefit denial was reversed for failure to properly consider the SSDI...
June 22, 2016 —
In McKenna v. Hartford Life & Accident Insurance Co., the Minnesota federal court remanded to the Hartford plan administrator for reconsideration of its termination of McKenna's long term disability benefits. The court held that since Hartford failed to inform McKenna, who was representing herself, of "what type of objective evidence she needed to...
February 10, 2016 —
In this video disability insurance attorneys Gregory Dell and Victor Pena discuss the recent trends they have observed with regard to Unum Insurance Company's denial of long term disability benefits. We offer some tips that can either help you to avoid a claim denial or possibly improve your chances to stay on claim. Contact any of our disability...
February 19, 2015 —
We get many calls involving claims denied based upon exclusions for losses or disabilities resulting from certain excluded conditions. Common excluded losses are those resulting from pre-existing conditions, suicide or attempted suicide, acts of war, or criminal acts.
In a recent case out of Kansas, a federal court was faced with determining...
November 5, 2014 —
This question is addressed in a recent case decided by the 10th Circuit Court of Appeals. More specifically, the case addresses what a claimant may NOT do when the insurer fails to render a decision on the claimant's appeal within the time frame set out by ERISA—a claimant may not rely on the insurer's said failure as a reason to not exhaust all...
October 9, 2014 —
Claimants often ask if their award of SSDI benefits means that their LTD claim will be approved by their insurance company. As we have discussed in other articles and videos, an SSDI award does not guarantee that your LTD claim will be approved by your insurance company. However, in reviewing your claim, the insurance company should consider the...
October 7, 2014 —
The short answer to this question is, yes. However, whether the claim will be approved depends on a number of factors. The crux of the claim would hinge on whether you were disabled under the terms of your policy before you were fired.
Under most group disability policies the date of termination from employment would mark the end of the...
August 26, 2014 —
The answer to this question of course, is, it depends...
Many plans explicitly define disability as an inability to engage in employment for which the applicant is "reasonably qualified by training, education or experience." This language typically defines the "any occupation" definition of disability. Plans containing this language require...
August 14, 2014 —
Disability Attorneys Dell & Schaefer have handled thousands of long term disability insurance claims. Naturally we have seen a wide array of reasons by insurers for denying claims. Below are 10 of the most common reasons such claims are denied:
1. Surveillance: Insurance companies often hire private investigators to take surveillance videos of...
July 15, 2014 —
In an unpublished opinion summarizing a decision of the Sixth Circuit Court of Appeals the court awarded benefits to a Michigan machine operator finding the plan administrator's decision that the claimant could perform a job, which the court described as "[existing] only in theory," to be arbitrary and capricious.
Mr. Kennard operated machines...
June 25, 2014 —
Anyone with experience with ERISA lawsuits knows the term "arbitrary and capricious." The term, which describes the standard employed by courts in reviewing most ERISA governed claim denials, acts a shield for insurers and protects their decisions to deny claims as long as they are found to be "rational in light of the plan's provisions." So what...
June 12, 2014 —
Many claimants are unaware that disability carriers continue to monitor claimants' applications for Social Security disability benefits even after the carrier has ceased to pay benefits.
A recent case out of the Middle District of Florida, which did not involve the law firm of Dell & Schaefer, serves as a reminder that your disability carrier...
May 20, 2014 —
The short answer, as you may have already learned, is no. Under ERISA, the opinions of treating physicians, despite the physicians often having the closest contact with the patient/claimant under review, despite arguably having the most "accurate" medical information on the claimant and despite being perhaps the only physicians who have had the...
March 25, 2014 —
In a recent ruling by the Eighth Circuit the surviving husband of a mother of two was awarded accidental death benefits following his wife's death. The deceased wife was covered by an ERISA governed accidental death policy insured by Unicare Life and Health Insurance Company. The autopsy reported listed the cause of death was "mixed drug...
March 18, 2014 —
In a recent case out of New York, the court found that the Plaintiff did not provide a good enough reason for failing to timely file his ERISA action.
New York in Viti v. The Guardian Life Insurance Company of America, the plaintiff's disability was not disputed; both parties agreed that his disability was genuine and prevented him from...