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.
September 10, 2015 —
Unum is obviously scraping the bottom of the barrel and making attempts to reduce the number of claimants that are currently receiving long term disability benefits. We recently reviewed a Unum denial letter for a woman that has been deemed disabled by Unum since September 18, 1998. This woman was approved for social security disability benefits in 2000 and she has been receiving $488 a month from Unum. She is currently 53 years old. Her...
September 4, 2015 —
In Stockman v. GE Life, Disability and Medical Plan et al., the plaintiff severely injured his foot and totally lost the function of it for 12 months. He then applied for benefits under the GE Life policy claiming he suffered a "total and permanent" loss of the use of his foot. MetLife, Plan Administrator for GE, denied his claim on the grounds that the loss was not total and permanent. Both the Ohio district court and appellate courts disagreed...
August 28, 2015 —
A Pennsylvania federal court ruled in favor of a claimant who continued to suffer severe debilitating neck, shoulder and upper arm pain following a cervical fusion surgical procedure. The pain sent her into depression and she became dependent on pain killers requiring her to spend time in a drug rehabilitation program. The Life Insurance Company of North America (LINA) denied her application for long term disability benefits finding that her...
August 27, 2015 —
In this video nationwide disability insurance lawyers Gregory Dell and Cesar Gavidia discuss the latest trends they are seeing in Metlife's handling of both ERISA and private disability insurance claims.
August 21, 2015 —
Watch Gregory Dell and Stephen Jessup discuss Cigna's latest strategy for handling disability benefit claims. This video has some tips which may help you to secure disability benefits. Any of our lawyers are available for a free initial phone consultation to discuss your claim.
July 28, 2015 —
The deal combines the second - and fourth - biggest insurers in the U.S., measured by members, and would have estimated revenue of about $115 billion and serve more than 53 million people with medical coverage.
Anthems announcement to buy Cigna comes on the heels of two other health care industry mergers: Humana and Aetna Inc. agreed to buy Humana Inc. for $35 billion earlier this month, a day after Centene Corp. struck a $6.3 billion deal...
July 9, 2015 —
Watch our latest video discussing the recent increase in disability IME exams which we have noticed. In this video disability insurance lawyers Gregory Dell and Stephen Jessup discuss multiple ways that you can be prepared for a disability IME Exam.
July 3, 2015 —
In this video nationwide disability insurance attorney Stephen Jessup discusses a recent Sun Life long term disability claim in which the court finds that Sun Life failed to conduct a proper evaluation. The claimant that filed for long term disability benefits had a mental nervous disorder.
June 26, 2015 —
Gregory Dell and Cesar Gavidia just released this video discussing the recent claim handling activities of Unum insurance company. This video is not only helpful to learn about Unum insurance claims, but it is also helpful for claimants that have a disability benefit claim with any other disability insurance company. Let us know your thoughts about the video and any comments you may have about your experience with Unum.
June 2, 2015 —
Between 836,000 and 2.5 million people suffer from what is now known as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). The actual number is likely higher since many physicians misunderstand the disease and, as a result, some people suffer from the syndrome for years without being properly diagnosed.
Since only about half of medical school textbooks include information about ME/CFS, and only about one-third of medical schools...
May 22, 2015 —
The U.S. Court of Appeals for the Fourth Circuit recently agreed with a federal district court in South Carolina that the Federal Express Corporation (FedEx) was blatantly wrong when it denied long-term total disability benefits to its employee who was injured on the job. The claimant, Richard Bilheimer, had been employed by FedEx for eight years when he was involved in his second on the job car wreck. He was left with major injuries and...
April 21, 2015 —
You MUST file TWO appeals with Lincoln prior to filing suit!
Most long term disability insurance companies only require one mandatory appeal prior to initiating a lawsuit in federal court. Some insurers allow a voluntary appeal after the first appeal is denied, but do not require a second appeal prior to filing suit. However, Lincoln National Life Insurance Company requires TWO MANDATORY appeals before a suit may be filed in federal court...
April 14, 2015 —
A Georgia Federal Court recently concluded that Aetna abused its discretion in denying long term disability benefits to an Aetna employee who suffered from chronic pain due to Lupus, Fibromyalgia, Asthma, Hypocalcemia and Mild Degenerative Joint Changes. Aetna unreasonably denied benefits by relying on flawed peer review reports of the plaintiff’s medical records. The court found the reports “ignore and mischaracterize the evidence” and...
April 7, 2015 —
If you are insured under or receiving disability benefits from an employer provided Group Disability Insurance Policy governed by ERISA your benefit is or will be subject to reduction for sources of "Other Income" benefits you receive while on claim. Of these sources of Other Income Benefits, Social Security Disability (SSDI) benefits are the most common. These provisions are legal and enforceable, but what happens when Reliance Standard, for...
April 2, 2015 —
Click here for the case: Gaines vs Aetna . PDF
March 13, 2015 —
A Massachusetts Federal Court recently held that MetLife wrongfully denied long term disability benefits and abused its discretion by failing to address contrary evidence and placing undue weight on certain evidence. The court remanded the case back to MetLife with specific instructions to re-evaluate the claim. This case was not handled by Attorneys Dell & Schaefer but it is a good victory for disability claimants suffering with...
March 11, 2015 —
In a case not handled by Attorneys Dell & Schaefer, a Prudential Claimant has lost her right to sue after being denied disability benefits. In a recent decision by a Circuit Court Judge in the United States District Court for the Western District of North Carolina, a disabled woman's lawsuit against Prudential was dismissed because she unfortunately waited too long to file a lawsuit.
The claimant was previously employed by Thermo Fisher...
March 6, 2015 —
Employee Terminated Despite Suffering From Disability Which Impacted His Work Performance
Kevin worked for Ametek, Inc. from 2008 until July 2012, holding various positions over the course of that time. Beginning in 2009 he began suffering a number of serious health problems which forced him to take medical leave until early 2010, at which time he returned to work. Kevin worked, despite his serious health problems stemming from a spontaneous...
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 whether there was a sufficient causal nexus to deny a claim based upon a criminal-act exclusion. The...
January 29, 2015 —
In a recent long term disability case out of the Puerto Rico United States Federal District Court, a long term disability claimant's ERISA lawsuit was dismissed when the court ruled that MetLife's three year period to file a lawsuit following a claim denial is enforceable. In the case of Santana-Diaz v. Metropolitan Life Insurance Company, which was not handled by our law firm, the claimant argued that the disability denial letter did not warn...
January 14, 2015 —
Metlife sued the Federal Government claiming they are not a financial risk in the event of an economic crisis and do not need to be overseen by Federal Regulators. What is MetLife trying to hide such that they are fighting US regulators? AIG and Prudential were deemed in the same category as MetLife, yet these companies are agreeing to the higher level of scrutiny. Long Term Disability Insurance policy holders of Metlife should welcome the...
December 9, 2014 —
It is extremely common for insurance companies to deny disability benefits when the basis for the claim is the inability to work due to Fibromyalgia. The reason this happens so often is due to the subjective nature of the illness and lack of the existence of objective proof of the illness. Insurance companies notoriously ignore physicians' opinions that support their patient's inability to work, since these opinions are based on subjective...
November 11, 2014 —
What is an Occupation?
Pursuant to the vast majority of ERISA governed disability insurance policies, an Occupation is defined based on one of two standards - Own Occupation or Any Occupation. Quite often an insurance carrier will overlook the actual duties of an occupation and simply determine the ability to work based on the physical demand level associated with a particular occupation. If you are receiving disability insurance benefits or...
November 7, 2014 —
Every person that experiences pain also has a secondary dysfunction of their mental state. How could a person be in good spirits when he or she is suffering from a painful medical condition and unable to work? In this video, disability insurance lawyers Gregory Dell and Stephen Jessup discuss how disability insurance companies are manipulating the mental nervous limited pay period provision in order to deny long term disability benefit claims...
November 7, 2014 —
When suing an insurance company to recover disability benefits in an ERISA case, the three most likely outcomes by the court are; (1) awarding past benefits, (2) sending the claim back to the insurance company for further review (remand), or (3) finding in favor of the insurance company. The first and second outcomes are a win for the Plaintiff after which the court has discretion to award attorney's fees and costs. It is very common for a judge...
October 28, 2014 —
In an opinion issued on August 8, 2014 from the United States District - District of Massachusetts, a Federal Judge ruled that Unum's "decision to terminated Doe's benefits was not the product of reasonable decisionmaking and substantial evidence. It was arbitrary and capricious." Unfortunately for the claimant/plaintiff John Doe, the Court failed to award benefits to him and instead remanded the case back to Unum, the plan administrator, for a...
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 Plan administrators to conduct some level of analysis of the claimant's particular vocational...
July 25, 2014 —
What is a Statute of Limitations?
The Statute of Limitations is the amount of time allowed under the law in which a plaintiff can bring a lawsuit. ERISA does not specify a statute of limitations for filing a lawsuit within the language of the statute. As such, insurance companies often write a statute of limitations provision into the policy, the most common being a three year statute of limitations. The statute of limitation provision...
July 22, 2014 —
It is very common for group disability policies to contain provisions limiting LTD benefits to 12 or 24 months for conditions involving the cervical or lumbar spine as well as soft tissue injuries. It is important to be familiar with your policy language and its limitations prior to filing a claim for benefits, especially if your policy contains a limitation for certain medical conditions. It is often times possible to get around these...
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 for Means Industries, Inc. until 1990 when he inhaled fumes from a chemical spill, severely injuring...