We monitor the actions of every disability insurance company nationwide. We constantly report on the latest disability insurance lawsuits, claim handling trends and answer frequently asked questions in order to help disability insurance claimants secure their benefits. Feel free to either leave a comment on any of our articles or privately contact us should you have any questions.
June 20, 2019 —
In Sue Ray v. Reliance Standard Life Insurance Company, W.D. Washington, July 31, 2018, Plaintiff filed suit under the Employee Retirement Income Security Act of 1974 (“ERISA”) to recover long-term disability (“LTD”) benefits, which Reliance Standard denied on the ground that plaintiff could perform her “Regular Occupation” and was therefore not “disabled” within the meaning of the LTD policy at issue. The parties disagreed as to...
May 21, 2019 —
The case of Dionisio Santana-Diaz v. Metropolitan Life Insurance Company (MetLife) demonstrates how important it is for claimants to present as much medical evidence as possible to the plan administrator who is evaluating the claim for Long Term Disability (LTD) benefits. Despite many opportunities to do so during the initial evaluation and subsequent administrative appeal, Santana failed to provide the requested medical documentation to support...
April 30, 2019 —
It won't happen to me.
When it comes to disabilities, that's often the mindset we take. However, according to the "2019 Ultimate Guide to Physician Disability Insurance", roughly 25 percent of American workers will experience a form of disability at some point in their career.
Whether your condition is long-term, short-term, or recurring, disability insurance is the most effective way to protect your source of income. To help you better...
March 14, 2019 —
The action by Ohio National means that they will no longer pay commissions on existing VA annuities as the agents and brokers claim was promised to them in their servicing agreements. As a result of the insurance company's letter terminating commissions, numerous lawsuits across the country have been filed by its brokers and agents.
The Lawsuits: Background
Between 2012 and 2018, brokers and agents sold Ohio National's variable annuities...
March 6, 2019 —
In James Ampe v. The Prudential Insurance Company of America, et al., Plaintiff Ampe worked for several years for the Massachusetts Institute of Technology (MIT) as a senior development and test engineer. In August 2011, Ampe slipped and fell in his bathroom, hitting his head.
He noticed some cognitive decline over the next few months and took intermittent FMLA leave. Meanwhile, his performance reviews deteriorated. The 2014 review...
February 27, 2019 —
In Kelly Ann Tyler v. United States Life Insurance Company in the City of New York, et al., United States Life Insurance and American General Life Insurance company (together, “American General”), terminated Plaintiffs total disability benefits. Instead of filing a second administrative appeal, Plaintiff filed this ERISA lawsuit alleging, among other things, American General breached the disability contract and the covenant of good...
February 11, 2019 —
In Craig Robertson v. Principal Life Insurance Company, Plaintiff, a National Account Sales Manager with XPO Logistics in Phoenix, Arizona, became disabled in July 2016 after severely injuring his left foot. His request for short-term disability benefits was granted. In October 2016 he filed a claim for long-term disability (LTD) benefits, but in November 2017, that claim was denied.
Plaintiff argued on administrative appeal that he...
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 limitation comes into play.
Terminated after receiving nine years of benefits
January 23, 2019 —
It is important to point out that this case was not handled by Dell & Schaefer. However, we wanted to write about this case as there is much to learn from this ruling out of the United States Court of Appeals for the Eighth Circuit. First, this case is an example that demonstrates that just because you win summary judgement of your disability claim in District Court, it does not mean that the fight is over. Secondly, this case also stands...
January 2, 2019 —
In Paula Le v. Unum Insurance Company of America, plaintiff was severely injured in an automobile accident and was unable to return to her job. She was covered by an employee welfare benefit plan (the plan) through her employer, Opelousas General Health System (OGHS). She was awarded long-term disability benefits beginning in September 2013.
In January 2017, Unum informed her it was terminating her benefits. Plaintiff insisted the termination...
December 19, 2018 —
In a recent case out of Massachusetts, a Court sided with a disabled claimant and found that Aetna’s decision to deny the claim for benefits was wrong. Aetna justified its denial as it believed the disabling medical condition to be a “pre-existing” condition and the policy governing this claim, like most Long Term Disability (“LTD”) policies, contained a provision that states that benefits will not be paid for pre-existing conditions...
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 benefits for 24 months for his inability to perform the material duties of his own occupation before...
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 and long term disability benefits under his employer sponsored disability plans and received benefits...
November 1, 2018 —
Prior to disability, David Do was employed as an Analyst-Desktop services for IVZ, Inc. He was responsible to resolving and handling “all support calls relating to desktop software/hardware installation and maintenance.”
Mr. Do was insured under an employer sponsored long-term disability plan administered and funded by Metropolitan Life Insurance Company. In February 2013, Mr. Do injured his neck, back and shoulders while moving computer...
October 10, 2018 —
In Lopez v. Standard Insurance Company, the U.S. Court of Appeals for the Eleventh Circuit upheld Standard’s termination of long-term disability benefits to Plaintiff who, according to Standard, was not disabled from performing “any occupation.”
Plaintiff went to work as a sheetrock applicator for Palm Harbor Homes, Inc. in May 2003. In late September 2005, he had to leave work due to groin pain and cramping. He returned to work for one...
September 26, 2018 —
In Scott Griffin v. Hartford Life & Accident Insurance Company, Plaintiff was a medical transcriptionist who was initially awarded long term disability benefits in 2010 due to arm and wrist pain and a herniated cervical disc. He ultimately underwent surgery for the bad disc.
Plaintiff’s initial benefits were awarded based on his inability to perform the regular duties of his own occupation. After 24 months, the definition of disability...
September 3, 2018 —
In Wayne Torpy v. Unum Life Insurance Company of America, both Unum and Plaintiff Torpy appealed a ruling of the New Mexico District Court. Although several issues were presented, since the one resolved by the Court of Appeals vacated the lower court decision, the resolution of the other issues were left to the District Court to resolve on remand.
Overview of Relevant Facts
Plaintiff Torpy was a police officer who retired from the City of...
August 15, 2018 —
Dell & Schaefer Chartered is proud to announce that Best Lawyers in America© the oldest and most respected peer-review publication in the legal profession, has named for the 7th year in a row Managing Partner Gregory M. Dell "Best Lawyers in America" for 2019 in the field of Insurance Law. In addition, for the time, Rachel F. Alters is also recognized as "Best Lawyers in America" for 2019 in the field of Insurance Law. Since it was first...
August 3, 2018 —
In reviewing long term disability denial letters we find that there are a handful of industry wide arguments made by insurance companies to minimize the nature of one’s occupation. The most common being the downplaying of the cognitive demands of a given occupation in favor of focusing solely on the physical demands of the occupation. This often occurs when (1) the nature of the disability is due to a medical condition related to or caused by...
July 11, 2018 —
The case of Lani Kyle Moar v. Cigna Corporation, et al., demonstrates the lengths insurance companies will go to avoid paying long term disability benefits. This Plaintiff’s perseverance resulted in the Court ordering Cigna to pay past due benefits, but also gave Cigna a new chance to deny benefits in a way that will not be arbitrary and capricious.
It began in 2000 when Plaintiff, a flight attendant with United Airlines, was first awarded...
June 29, 2018 —
In Fiorentini v. Paul Revere Life Insurance Company, Plaintiff Henry Fiorentini, CEO and owner of his own information-technology company Panatech, was granted total disability in 2009 due to problems he had when basal cell carcinoma attacked his right ear. The ear was amputated in 2008.
In 2014, Paul Revere learned Plaintiff had returned to work full-time, assuming his position as CEO, so it terminated his benefits. Plaintiff filed a lawsuit...
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 more than 10 years before leaving work due to her worsening multiple sclerosis. She had been diagnosed...
June 6, 2018 —
In Daniel T. Derichs v. AT&T Services, Inc., plaintiff, an employee of AT&T who suffered from post-traumatic stress disorder (PTSD), applied for short-term disability benefits. The plan administrator, Sedgwick Claims Management Services, Inc. (Sedgwick), denied Derichs’ claim. After exhausting his administrative appeals, Derichs filed this ERISA lawsuit.
At issue was the correct definition of total disability under the clause of the policy...
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) also known as Cigna.
In Guest-Marcotte v. Life Insurance Company of North America the 6th...
May 24, 2018 —
The Centers for Disease Control and Prevention (CDC) provides indirect evidence that the little bloodsucking mosquitoes, ticks, and fleas are becoming more numerous.
These findings are in the latest Vital Signs report by the Centers for Disease Control and Prevention. According to the CDC, "Illnesses from mosquito, tick, and flea bites have tripled in the U.S., with more than 640,000 cases reported during the 13 years from 2004 through...
May 16, 2018 —
In July 2016, Kimberly Garner, suffering from urinary incontinence, left her job with Amazon, and filed a claim for long-term disability benefits with Amazon’s long-term disability insurer, Aetna Life Insurance Company.
The Amazon Long-term Disability Plan required that in order to receive monthly benefits, the employee insured must be unable to “perform the material duties of [their] own occupation solely because of an illness, injury or...
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 Hartford and will make Hartford the second largest group life and disability insurer according to...
May 9, 2018 —
In Barbara J. Nylander, M.D. v. Unum Life Insurance Company and Paul Revere Life Insurance Company, Dr. Nylander, a board-certified physician whose practice included gynecological surgery, was injured on April 21, 2015, when another doctor with whom she was performing an operation accidentally cut her index finger, severing a tendon. The injury was so serious, surgery was required to try and repair the damage.
Nylander was insured under...
May 3, 2018 —
A California federal court recently reversed Metlife's denial of long term disability benefits for a claimant with heart disease. Metlife attempted to rely on a ejection fraction rate reading as a basis to deny the claim. The Federal Judge ruled that Metlife abused their discretion and reversed the decision. In this video, we discuss the courts findings and offer some tips as to how to strengthen a cardiac related long term disability claim...
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 doing so. If the insurance company's doctor's opinion is different from your treating physician they...