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.
December 26, 2013 —
The question often arises as to whether an insurance company is permitted to follow claimants with surveillance for days or weeks at a time in order to attempt to discredit their disability claims. The answer to the questions is "yes." Most disability policies allow an insurance company to invade the privacy of a policy holder by hiring private investigators to follow them around if he or she is on claim or has submitted a claim for disability...
December 24, 2013 —
Generally, when employees have a question concerning their employer provided group long-term disability insurance coverage, the first place they turn is to their HR department. HR Departments are not in the business of underwriting, or interpreting insurance policies, and often do not have the adequate knowledge to competently answer specific questions concerning the terms and conditions of the disability insurance plan. They can, and should...
November 26, 2013 —
A former Assistant Sales Manager for HSBC was forced to leave work on May 14, 2008. This claimant suffered from constant low back pain due to spinal stenosis, disc bulges and protrusions, spondylosis at the L3-L4 and L4-L5 interspaces with T2 signal loss in the discs and disc space narrowing. The claimant described his constant pain like "the point of a bayonet into his back" that was "made worse by prolonged sitting, standing, or even a basic...
November 21, 2013 —
During the pendency of an ERISA disability administrative appeal with Cigna disability insurance company our disability lawyers requested the resume of the in-house medical doctor at Cigna. The resume was requested in order to verify the qualifications and experience of the physician that was hired by Cigna. After more than 30 days of waiting for a response, Cigna provided an extremely generic resume for Dr. John M. Mendez which failed to...
November 19, 2013 —
We typically see cases where claimants provide the disability insurance company with medical records that reflect substantial subjective complaints, such as pain, fatigue, headaches, but lack objective evidence - positive findings on MRIs, X-rays or lab work. The disability insurance companies commonly deny claims on the basis of there being no objective evidence.
However, a recent case out of Connecticut was denied on the opposite grounds...
November 15, 2013 —
It is not often that we send a letter to the President / CEO of a disability insurance company, but the conduct of Life Insurance Company of North America / CIGNA by denying disability insurance benefits to our client required us to do so. We hope Cigna will respond, but despite a $77 million dollar regulatory Settlement in May 2013, Cigna continues to engage in their same unreasonable claim denials. Below is a November 15, 2013 letter written...
November 14, 2013 —
MetLife writes one of the most restrictive 24 month limitations in its ERISA governed group disability policies for medical conditions that they deem fall under the definition of "Neuromusculoskeletal and Soft Tissue Disorder." The language commonly used defines the term to mean:
Neuromusculoskeletal and soft tissue disorder including, but not limited to, any disease or disorder of the spine or extremities and their surrounding soft tissue;...
November 12, 2013 —
A recent disability insurance court decision against United of Omaha Life Insurance Company, and affiliate of Mutual Of Omaha Insurance Company is a great victory for claimants suffering with either fibromyalgia or rheumatoid arthritis. The Alabama Federal Judge states in her 39 page written opinion that it was abuse of discretion for United of Omaha to deny disability benefits during the any occupation stage of benefits. The court further...
November 5, 2013 —
In the case of Cannon v. Aetna Life Insurance Company, a Massachusetts Court found that Aetna abused its discretion in denying LTD benefits to a pharmacist with Lyme Disease. The Plaintiff argued that Aetna failed to provide specific documents during the administrative appeal process, such as the entire claim file, which calls into question the integrity of Aetna's decision to deny his benefits.
Why is Aetna required to provide the complete...
October 31, 2013 —
Prior to her disability, Angel Dix was employed with Blue Cross / Blue Shield of Louisiana and insured under the company's long-term disability insurance plan. After enduring years of chronic back pain resulting from degenerative disc disease, and having undergone multiple spinal cord surgeries with no resolution of her chronic back pain, Mrs. Dix was forced to stop working and file a claim for disability benefits under her long-term disability...
October 22, 2013 —
On September 16, 2013, a Pennsylvania Federal Judge ruled that Sun Life Assurance Company was correct in denying long term disability insurance benefits to an Anesthesiologist claiming disability due to headaches and abnormal finding on Brain MRI. No portion of this disability claim was handled by Attorney Dell & Schaefer. The doctor in this case claimed that he was disabled as of December 11, 2007 when he resigned from his employment. The...
October 17, 2013 —
Attorney claims disability due to back, leg and foot pain, receives disability benefits for three years until Unum terminates based on surveillance video, IMEs and an FCE. On appeal Unum reinstates benefits until notified by scorned boyfriend that she was committing fraud. Unum again terminates benefits claiming fraud and requests repayment for over $1 million in overpaid benefits.
In the Fifth Circuit case of Truitt v. Unum decided in...
October 15, 2013 —
On September 11, 2013, a Massachusetts Federal Judge ruled that a long term disability insurance claimant whose monthly benefit had been underpaid by MetLife since 2005 was not able to collect the money owed as he waited too long to bring a lawsuit. No portion of this disability claim was handled by Attorneys Dell & Schaefer.
The plaintiff in this case argued that each month that MetLife underpaid his monthly disability benefit constituted a...
October 14, 2013 —
On October 15, 2013, the United States Supreme Court will hear oral argument in a long term disability insurance case against Hartford Insurance Company (Heimeshoff v. Hartford Life & Accident Insurance Co.). The issue before the court involves a long term disability insurance lawsuit which was dismissed as a result of the claimant filing a lawsuit after the statute of limitations had run. The claimant was a former Walmart employee. The statute...
October 7, 2013 —
Claimants become frustrated and feel helpless when their disability benefits are cut off by their insurance company with the explanation that they no longer meet the definition of disability when their own treating physicians documented that they were totally disabled and unable to work in even a sedentary occupation. It has become common practice for insurance companies to deny claims based on opinions from physicians paid by insurance...
August 29, 2013 —
The claimant in this case, Ms. K, went on short term disability leave after developing anxiety and fatigue upon returning from maternity leave. She received treatment from her psychiatrist and eventually returned to work. When she returned to work, she was informed that she was required to increase her work week from 25 hours to 40 hours. Immediately thereafter, she suffered an increase of panic and resumed her STD leave. She began treating with...
August 27, 2013 —
Background and History of the Claim
The Plaintiff in this case, Ms. L, applied for Waiver of Premium benefits with her Plan's administrator, Liberty Life Assurance Company of Boston, also known as Liberty Mutual. She claimed disability due to her medical conditions of insulin-dependent diabetes mellitus type II, chronic pain, degenerative joint disease, degenerative disc disease, myofascial pain syndrome, morbid obesity, obstructive sleep...
August 23, 2013 —
This ERISA lawsuit filed in Missouri Federal Court against Hartford is a textbook-like example of how Hartford will go to great lengths to ignore clear-cut medical evidence, including standing behind knowingly faulty and questionable reports from their paid physician file reviewers, as a means to justify denying claims of those who are truly disabled and entitled to benefits under the terms of their Long Term Disability Plan. Although it took...
August 20, 2013 —
One important aspect of ERISA cases that makes them different from other types of lawsuits and litigation, is that once the administrative appeal process closes and an ERISA lawsuit is filed, the "administrative record" can no longer be added to, or supplemented. This is because in an ERISA matter, the judge is only allowed to consider the evidence that was available to the claims administrator at the time the decision was made to deny...
August 15, 2013 —
The ERISA long term disability lawsuit filed against Hartford did not raise any issues out of the ordinary. The Plaintiff sought reversal of the decision to terminate long term disability benefits, unpaid benefits retroactive to the date of the denial, interest on unpaid benefits, attorney's fees and costs, a declaration that Plaintiff was totally disabled under the Plan's definition, and future payment of long term disability benefits under the...
August 15, 2013 —
August 15, 2013 -- Dell & Schaefer Managing Partner Gregory Dell has been named one of the Best Lawyers in America for 2014. Dell was named in the insurance law category and is being honored by the publication as a Best Lawyer for the second consecutive year.
Best Lawyers has published their list for over three decades and is one of the leading sources of objective legal referrals. Its first international list was published in 2006 and...
August 13, 2013 —
An Alabama Court recently made an interesting and important ruling in an ERISA lawsuit filed against MetLife that prohibited the Court from considering any medical evidence the Plaintiff submitted to MetLife for review after MetLife had already denied the Plaintiff's one mandatory administrative appeal allowed under the disability insurance policy (the Plan).
What is an "Administrative Record" in an ERISA Disability Case?
We have discussed...
August 8, 2013 —
It is common when dealing with claims for short and long term disability benefits to have the disability insurance company request "objective evidence" to support your claim that you are disabled due to a certain impairment. If your impairment, for example, involves a neck or back condition, then a MRI or a CT scan revealing herniated discs or some similar pathology, would easily be considered "objective evidence". However, if your disability...
August 6, 2013 —
Prior to ceasing work due to her disability, Ms. S was employed as a service center organizer for Boston Building Service. Her duties included providing worker support during the grievance process with the union, and field support various union related issues. In December 2008, Ms. S was forced to stop working and file for disability insurance benefits due to chronic knee and back pain. Ms. S also suffered from hypertension, gastro esophageal...
August 2, 2013 —
The Medical Daily journal recently reported a "breakthrough" regarding research into the cause of Fibromyalgia. Fibromyalgia, as a diagnosis, has instigated much controversy in the medical community, with many believing that the disease was only in the patient's head.
Researchers from a biopharmaceutical company, Intidyn, along with Albany Medical College, found that the ultimate cause of Fibromyalgia pain may be due to an excess of "sensory...
July 31, 2013 —
Many claimants are shocked and upset when they receive a denial or termination of their long-term disability benefits based on some doctor's opinions, who happens to live in another state, has never examined them nor ever had a conversation with them when their own treating physicians who have known and treated them for years supports their inability to work. Shouldn't their own treating physician's opinions hold more credibility over some...
July 25, 2013 —
Since insurance companies began underwriting and issuing long-term disability insurance policies, they have excluded and limited payments for certain medical conditions. In fact, it is very common to find provisions limiting the pay period - typically to 24 months - for disabilities arising from a mental illness, mostly in group long-term disability policies. As a result of the medical community finally accepting conditions such as fibromyalgia...
July 23, 2013 —
Lyme disease is a real disease that most disability insurance companies will claim is a psychiatric disease. CNN recently published an article that discusses some of the controversy regarding Lyme Disease and the failure of many doctors to properly diagnose it. Our disability lawyers have handled numerous Lyme Disease disability claims and we have worked with the leading Lyme disease doctors nationwide.
Lyme disease is not a psychiatric...
July 6, 2013 —
Even when a disability company pays a claimant it is rare that the claimant has any confidence that the disability company will continue to pay. On a daily basis our disability insurance attorneys speak with claimants that have either had their benefits denied or fear that they will be denied. We regularly write articles about the manner in which disability companies can handle a claim, but we wanted to share with you an anonymous comment that...
June 25, 2013 —
Lloyds of London disability insurance policies are often very restrictive and are different than most disability insurance policies available from just about every other company. When shopping for disability insurance one will discover that there are multiple insurance companies that can offer a variety of different disability insurance policies, and all can contain different definitions, language and coverage terms. Purchasing disability...