Did LINA wrongfully deny disability payments to claimant with multiple sclerosis? (Part II)

Dalit Waissman took sued Life Insurance Company of North America (LINA) when the company terminated her long-term disability payments in May 2006. In arguments presented before District Judge Jeremy Fogel of the U.S. District Court’s Northern District of California, San Jose Division on January 20, 2010, Waissman’s disability attorney did his best to show that the material in Waissman’s claim’s file demonstrated beyond doubt that Waissman was disabled according to the definitions laid out within her former employer’s long-term disability plan.

Long-term disability plan defines total disability

The long-term disability plan offered by SAP described total disability as the inability to perform all the essential duties of her occupation. If Waissman could earn over 80% of the money she had earned each month before her disability commenced, she would cease to be considered disabled under the plan. The plan did not define what “all the essential duties of her occupation” were.

LINA approves and later terminates long-term disability benefits payout.

In another article, we have discussed the details of Waissman’s case and why she was approved for disability benefits, and why LINA later terminated her benefits. We’ve also looked at the details of her medical history. See CIGNA (LINA) terminates disability payments to woman with multiple sclerosis.

Now, we will look at how the Court reviewed LINA’s wrongful denial of long-term disability benefits.

Court applies ERISA de novo standard to review long-term disability termination.

Both Waissman’s disability attorney and LINA agreed that the proper standard of review was de novo, meaning that the court would simply proceed to evaluate whether the plan administrator had made a correct or incorrect decision. The court would not go on to consider whether the administrator had acted arbitrary or capricious. It would be the court’s prerogative to determine whether Ms. Waissman meets the definition of disability.

Waissman’s disability insurance attorney would have to prove that she was disabled under the definition given by the plan. But if there was an exclusion that the insurance company wanted to use, it was LINA’s obligation to prove that this exception applied to her situation.

Court refuses to take judicial notices of external medical texts.

On occasion, the court has been willing to consider standardized, universally recognized medical texts to define the meaning of medical terms. But a medical texts that Waissman’s attorney asked the court to recognize did not measure up to the standard of reliability of a book such as the American Medical Association’s Diagnostic and Statistical Manual. As a result, the court was unwilling to give judicial notice to medical texts that were not included in the administrative record. Any external medical text would have been considered had it been included during Waissman’s appeal process. The quotes from McAlpine’s Multiple Sclerosis, fourth edition, which had been quoted by Dr. Gershfield in one of his letters to LINA were in the administrative record. The court would consider Dr. Greshfield’s opinion based upon this medical text.

Court looks at evidence supporting MS disability.

Did the administrative record support Waissman’s claim that she was disabled by her multiple sclerosis? The court looked at the notes from Waissman’s attending physicians, Drs. Lock and Gershfield. These neurologists’ notes were far more convincing then the conclusions presented by the physicians that LINA hired. Dr. Graulich had never spoken with either Waissman or her treating neurologists. He based his conclusions on medical records that existed prior to 2006. And his notes conceded that he did not consider the interplay between Waissman’s IC and MS.

Dr. Kundu’s statement that MS is a painless disease was contradicted effectively by Dr. Gershfield. His provision of quotes out of a standard textbook on MS bolstered his argument. LINA did not challenge the authenticity of the quotations or the fact that the textbook was generally accepted in the field as an authority on MS.

Dr. Kundu had suggested that the demands of his half-hour medical evaluation was similar to demands that Waissman would face in her sedentary occupation as a technical writer. The court found that this evaluation was shallow and without merit.

The court also considered the medical evaluation and neuropsychological reports from Dr. Bastien. These evaluations demonstrated that Waissman’s abilities across the board were so impaired that it would be impossible for her not only to work as a writer of technical publications, but unfitted her for almost any other occupation. LINA questioned Dr. Bastien’s credibility, claiming that she was a hired advocate. The court said that if this was true, why had LINA not secured other doctors with the same specialty to perform the same types of test?

Court looks at the terms of the long-term disability benefit plan.

With these matters out-of-the-way, the Court could begin looking at the terms of the plan itself. If there were any ambiguities in the policy terms, they would be construed in favor of Waissman. Otherwise, the court would look at the explicit language of the policy in context.

LINA argued that the phrase “all essential duties” meant “every” essential duty. The court found that it made no sense to even bother with determining whether “all” meant everyone or anyone of the essential duties of Waissman’s job. The administrative record supported either meaning because the administrative record demonstrated that Waissman couldn’t think clearly enough for long enough to perform her duties as a technical writer.

Both sides disputed over what the term occupation meant. Waissman’s disability attorney argued that the occupation meant her position as a senior technical writer at SAP. The defendant argued that it was the general occupation of technical writer.

Once again this argument seemed worthless before the court, because the record established that Waissman’s head pain and debilitating fatigue would have led to frequent absences from work, preventing her from maintaining a normal work load. These symptoms would also have prevented her from concentrating adequately on the work at hand.

LINA went on to argue that Waissman cannot be totally disabled because she could only be considered disabled if she was able to return to work, but was earning less than 80% of her prior earnings in her regular occupation. This argument didn’t convince the Court for the same reason that the Court had already concluded that Waissman would be unable to maintain a normal workload. The Court found that her disability attorney had demonstrated that she was not able to earn 80% of her income in her occupation because she was unable to work at all.

Court orders LINA to reinstate long-term disability benefits.

The evidence in the administrative record supported beyond a shadow of a doubt in the court’s eyes that Waissman’s termination of disability benefits was wrongful. The evidence supplied by her treating physicians, and the tests performed to evaluate her cognitive abilities, outweighed the evidence presented by LINA’s physicians.

The court ordered LINA to reinstate Waissman’s long-term disability benefits. LINA also had to award the disability benefits that were retroactive to May 25, 2006 when it terminated her coverage. The court also stated that it would entertain a motion for an award of reasonable attorney fees and costs.

The right disability attorney makes the difference.

This case demonstrates what happens when a skilled disability attorney has the opportunity to work with a disability claimant during the appeal process in order to build a strong administrative record. One of the deciding factors in this case was the recommendation of Waissman’s disability attorney that she see a physician who specialized in testing neuropsychological conditions. I always advise clients that without the development of a strong administrative record it will be difficult to win once a lawsuit is filed.

Did you find this helpful?
Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options
Submit a Strong Cigna Appeal Package

We work with you, your doctors, and other experts to submit a very strong Cigna appeal.

Learn more

Sue Cigna

We have filed thousands of disability denial lawsuits in federal Courts nationwide against Cigna.

Learn more

Protect Your Benefits
Get Your Cigna Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Cigna Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Cigna Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Answered Questions by Our Lawyers
Showing 8 of 70 Answered Questions

Q: Why can Cigna get away with not paying me anything for my disability?

Answered on November 6th 2022 by Attorney Jay Symonds
A: Barbara: It sounds like you have a complex situation. Unfortunately, it also sounds like you had legal represe... Read More >

Q: Do I have to be an active employee to apply for LTD?

Answered on October 27th 2022 by Attorney Steven Dell
A: Lori: Generally speaking, if out on claim and a new/different disability arises you can add that to your exist... Read More >

Q: Can Cigna refuse to give me a copy of my short term disability policy?

Answered on September 2nd 2022 by Attorney Cesar Gavidia
A: Dave, since the policyholder is your employer CIGNA can refuse to provide it to you. You should contact your e... Read More >

Q: Is my plan governed by ERISA?

Answered on October 9th 2020 by Attorney Alex Palamara
A: LeRoy, we will have to review the policy in order to give an opinion as to whether it would be governed by ERI... Read More >

Q: Can I add a physical disability claim to my mental health one without seeing a doctor (hard to get an appointment with COVID)?

Answered on April 14th 2020 by Attorney Cesar Gavidia
A: Heather, the only way to effectively include your physical disability claim is to see a physician qualified to... Read More >

Q: Do you handle CIGNA cases in Florida?

Answered on February 12th 2020 by Attorney Rachel Alters
A: Vito, yes. We absolutely do handle Cigna cases in Florida. Please email me at Rachel@diattorney.com and send... Read More >

Q: How can Cigna get away with not answering my calls?

Answered on July 22nd 2019 by Attorney Stephen Jessup
A: Carol, knowing Cigna it sounds like they are approving your claim on appeal for a closed period of time and th... Read More >

Q: Do you handle closed cases only, or open ones as well?

Answered on May 10th 2019 by Attorney Stephen Jessup
A: Renee, we handle all types of open claims with Cigna – applications, claims handling, appeals, lawsuits, buy... Read More >
Helpful Videos
Showing 12 of 861 Videos
Disability Benefit Tips
Showing 8 of 329 Benefit Tips

Is Cigna Seeking To Offset Disability Benefit by Social Security Survivor Benefit?

I recently spoke with a gentleman who called into our office who has been receiving long term disability benefits from Cigna for several years... Read More >

Is Cigna's Denial of Your Appeal Really a Denial?

Following the submission of your appeal has Cigna sent you a letter stating that after review of the information provided on appeal their deci... Read More >

What Should a Claimant Expect When Suing Cigna or any Other Disability Company for Long Term Disability Benefits?

ERISA disability lawsuits are complicated due to the pro-insurance company laws. Our disabili... Read More >

Are Cigna Short Term Disability Denials on the Rise?

When it comes to claims for short term disability benefits under ERISA governed group policies, more often than not the short term disability ... Read More >

Cigna's latest strategies for handling and denying disability benefit claims

Watch Gregory Dell and Stephen Jessup discuss Cigna's latest strategy for handling disability... Read More >

Is a Claimant's Complaints of Pain Enough to Qualify for Short or Long Term Disability Insurance Benefits?

The answer to this question applies to the vast majority of long term disability insurance claims that we handle on a daily basis. Pain is sub... Read More >

Is My Insurance Company Allowed to Take An Offset of My Monthly LTD Benefit for Social Security Benefits My Kids Receive As A Result of My Disability?

It is common practice for insurance companies to find ways to limit the amount of money they have to pay to claimants. If you are receiving lo... Read More >

Is My "No-Fault" Auto Insurance Settlement an Offset Under My Long Term Disability Insurance Policy?

If your policy is an employer provided group disability policy governed by ERISA, then any proceeds you receive from a settlement based on "No... Read More >
Dell Disability Cases
Showing 8 of 369 Dell Disability Cases

Cigna Sued For Failing To Make A Timely Decision on Appeal

If your disability insurance claim has ever been denied you will have received a formal denial letter from your insurance carrier in which you... Read More >

CIGNA Overturns a Waiver of Premium for Group Life Insurance Policy

In early 2019, the widow of a decease man contacted our firm as she was troubled by the actions of CIGNA, also known as Life Insurance Company... Read More >

Cigna Admits Error In Denying Disability Benefits

Our client, a former school teacher, suffering from multiple severe medical conditions including autonomic nervous system damage, small fiber ... Read More >

CIGNA Overturned Their Denial of LTD Benefits for Nevada Healthcare Coordinator

Our client, Ms. G, formerly worked as a Healthcare Coordinator for a large regional healthcare provider. For many years Ms. G suffered from ch... Read More >

CIGNA Denies Technology Manager under the Own Occupation Provision & Dell Disability Lawyers Wins Appeal

Our client, Mr. N, formerly worked as a Technology Manager / Vice President for a large bank. For many years Mr. N suffered from chronic debil... Read More >

CIGNA overturned previous denial of waiver of life insurance premiums

Our client was the husband and beneficiary of Ms. S, who formerly worked as a registered nurse for a regional Healthcare System. In January 20... Read More >

Dell Disability Lawyers successfully appeal denial of benefits to claimant with CRPS/RSD

Ms. S contacted our firm after receiving a letter from her disability carrier, Cigna, denying her claim for short term disability benefits und... Read More >

LINA overturned its previous LTD denial for Medical Technologist

Our client, Ms. H, formerly worked as a Medical Technologist for a National Clinical Laboratory. In July 2017 a number of medical issues, incl... Read More >
Disability Lawsuit Stories
Showing 8 of 764 Lawsuit Stories

Cigna Denial of LTD Benefits for Schlumberger Shop Manager Upheld

In Jerry Courville v. Life Insurance Co of North America (LINA), Plaintiff was employed as a shop manager for Schlum... Read More >

Missouri Court Rules Cigna Wrongfully Terminated Disability Benefits

In the case of Lapidus vs. Life Ins. Co. of N. Am. a Missouri federal court ruled against Cigna finding that Cigna wrongfully terminated long ... Read More >

Missouri Court Orders Cigna to Pay LTD Benefits to Medical Sales Executive

The Plaintiff in this case was vice-president of Medical Benefits at BJC Healthcare when a severe back condition required her to have a spinal... Read More >

Cigna's Termination of Disability Benefits was Arbitrary and Capricious

The case of Lani Kyle Moar v. Cigna Corporation, et al., demonstrates the lengths insurance companies will go to avoid paying long term disabi... Read More >

Court Criticizes Lina For Failing to Perform Independent Examination

Disability Insurance companies are criticized often for failing to perform independent medical evaluations and instead relying exclusively on ... Read More >

Lockheed Martin Systems Integration Analyst Wins Long-term Disability Lawsuit against CIGNA

Cal Van Steen had been employed as a Systems Integration Business Analyst at Lockheed Martin Corporation and participated in the company’s g... Read More >

Colorado District Court overturns denial of benefits by Life Insurance Company of North America

In Johnson v. Life Insurance Company of America, a Colorado District Court ruled in favor of the claimant finding LINA’s decision unsupporte... Read More >

Texas Judge Disagrees with Cigna and Applies Claimant Friendly Disability Standard of Review

In Brasseur v. Life Insurance Company of America (LINA), Plaintiff Wilfred Brasseur, a computer engineer, worked in the Houston office of Chic... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our lawyers for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability lawyers have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance lawyers that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.

In more than 98% of our cases, our lawyers have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.

We welcome you to contact any of our attorneys for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 700 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our lawyers help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.

Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.

A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, GoToMeeting sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.