Court Denied American General’s Motion for Partial Summary Judgment

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 faith and fair dealing. She also sought punitive damages.

American General filed a motion seeking a Partial Summary Judgment on these issues. The U.S. District Court for the District of Arizona carefully analyzed each individual issue and held that there were material issues of genuine fact on each one so that summary judgment was not appropriate.

Relevant Facts

In March 2012, Plaintiff, a psychiatrist with the VA, was awarded total disability benefits. She was informed that her case would be periodically reviewed and that she would need to provide updated medical records when requested to do so. In July 2014, a new case manager took over for American General who requested updated records.

The case manager found inconsistencies in the records, so hired Health Direct, Inc. (HDI), a third-party medical services provider, to provide an independent review of the medical records. HDI tried unsuccessfully to contact some of Plaintiff’s treating physicians and although it did not believe the records supported Plaintiff’s claim, it recommended a second review by an independent board-certified neurologist, Dr. Ramos.

Dr. Ramos concluded Plaintiff’s claim was no longer supported by her medical records. As a result, her total disability benefits were terminated. Plaintiff then sent updated medical records to American General. After another review, the plan administrator determined she could work with accommodations. Plaintiff disagreed and filed this ERISA lawsuit.

Breach of Contract and Bad Faith Claim

Although the disability plan, as written, had no provision for excluding those from coverage who are able to work with accommodations, American General determined that Plaintiff could return to work if:

  1. she be given flexible leave not to work if she contracted a migraine headache for up to two hours at a time for up to four times a month;
  2. be given a dark place to rest when experiencing a migraine;
  3. avoid severe stress-related work.

The Court held that, according to established precedent, to require a person covered under the plan to work with accommodations is “effectively rewriting the plan.” In addition, a reasonable jury might find the accommodations not reasonably realistic and thus the denial of benefits was not made in good faith. As such, summary judgment was not appropriate.

Punitive Damages Claim

The Court held that there was reasonable evidence in the record that could allow a jury to conclude that American General “willfully and knowingly failed to pay a valid claim.” Therefore, summary judgment on this issue was inappropriate.

This case was not handled by our firm, but we believe it can be instructive to those who feel their insurance plan provider acted in bad faith when denying disability benefits. If you have questions about this case, or any question about your disability claim, contact one of our disability attorneys at Dell & Schaefer for a free consultation.

DISABILITY INSURANCE COMPANY INFORMATION
Videos, Questions, Resolved Cases, Lawsuit Summaries & Company Reviews

disability insurance companies complaints

Leave a comment or ask us a question

FAQ

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 telephone, e-mail, fax, GoToMeeting.com 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 800-682-8331 or by email. Lawyer 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.

Reviews   *****

Darlene D.

I found Rachel to be a pleasure to work with. She was open and honest with me from the start regarding the expectations of settling my claim. Once the initial offer was made she kept constant communications with me to assure I was aware of the progress with the negotiations process.

Read 424 reviews

Speak With An Attorney Now

Request a free legal consultation: Call 800-682-8331 or Email Us