• Principal Life Wrongfully Denys LTD Benefits to Truck Driver After Change of Definition

Court Orders Principal Life to Reinstate Long Term Disability Benefits

Flaaen v. Principal Life Insurance Company, is a win for the claimant who suffered a severe back injury in August 2005 in his job as a truck driver. In January 2006, Principal granted his application for long term disability benefits since he could no longer perform the regular and substantial duties of his own occupation.

On December 14, 2014, Principal terminated Flaaen’s disability benefits on the grounds that he now had to meet the standard of being disabled only if he could not perform “the Substantial and Material Duties of any Gainful Occupation for which he or she is or may reasonably become qualified based on education, training, or experience.” Principal listed several occupations for which it determined Flaaen was qualified.

Flaaen objected, exhausted his administrative remedies and then filed this ERISA lawsuit. In his administrative appeals and in this court action, Flaaen argued that none of the jobs Principal said he could perform were ones he was qualified for. Additionally, even if he was qualified for them, he would be unable to earn an amount equal to or more than his primary monthly benefit payment.

The Court agreed with Flaaen and ordered the long term disability benefits to be reinstated. It also ordered Principal to pay benefits dating back to the termination date of December 14, 2014.

Standard of Review

The Court made it clear that the standard of review in this case made a difference in the outcome. Under the de novo standard, which the Court determined was the proper standard in this case, the Court was charged with reviewing the file to determine “whether Flaaen was disabled in the sense defined in the policy.”

If an arbitrary and capricious standard had applied, the Court would have been required to give deference to the plan administrator’s decision and uphold it if there was a “reasonable explanation, based on the evidence, for that decision.”

Ambiguous Policy Language of “Gainful Occupation” was Interpreted in the Claimant’s Favor

The major dispute in this case involved whether or not the claimant was able to perform the substantial duties of any gainful occupation for which he was trained, educated or in which he had experience. The policy defined “gainful occupation” as one where the claimant “could reasonably be expected to earn an amount equal to or greater than the Primary Monthly Benefit.”

Principal argued that as long as the occupation for which the claimant qualified had the potential of the claimant earning a median wage sometime in the future, it should meet the standard and the claimant should no longer be eligible for benefits.

Flaaen argued that such an interpretation was unreasonable and the clause should mean “what is reasonably likely now, as of the date of denial of his benefits.”

The Court agreed with Flaaen’s interpretation as being the most reasonable, noting that when a clause is subject to two different interpretations, it is ambiguous. Under ERISA, ambiguous clauses are interpreted in a way that favors the claimant.

Occupations Proposed by Principal Did Not Meet the Income Standard Required by the Policy Language

Principal conducted several vocational analyses and listed several different jobs it concluded claimant could perform. Flaaen disagreed and argued that none of them met the income qualifications required by the policy language and he was not even qualified to perform most of them.

The Court found in favor of Flaaen, concluding, “Flaaen has shown that he is currently unable to procure any gainful occupation in any field identified or proposed by Principal.” It also ordered Principal to pay benefits back to the date of termination of benefits.

Dell and Schaefer did not represent the Plaintiff in this case, however our lawyers are available to answer any questions you may have regarding your disability claim.

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Questions About Hiring Us

Do you help Principal claimants nationwide?

We represent Principal clients nationwide and we encourage you to contact us for a FREE immediate phone consultation with one of our experienced disability insurance attorneys.

Can you help with a Principal disability insurance policy?

Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Principal. We have helped thousands of disability insurance claimants nationwide with monthly disability benefits. With more than 40 years of disability insurance experience we have helped individuals in almost every occupation and we are familiar with the disability income policies offered by Principal.

How do you help Principal claimants?

Our lawyers help individuals that have either purchased a Principal long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer.

Our experienced lawyers can assist with Principal:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
  • ERISA and Non-ERISA Disability Benefit Lawsuits
  • Applying For Short or Long Term Disability Benefits
  • Daily Handling & Management of Your Disability Claim
  • Disability Insurance Lump-Sum Buyout or Settlement Negotiations

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.

Dell & Schaefer Client Reviews   *****

Dawn P.

I had to quit working after 8 years of dealing with chronic pain from 2 bulging and torn discs from an injury and failey back surgery. I was approved for Long term disability through my employer benefits, with Unum. They covered me with payments for one year, and suddenly sent a letter that their doctors disagreed with my surgeon and pain management doctors, and they felt I could go back to work full time. I hired a local attorney, trying to save some money, but I don’t think he had much experience dealing with big LTD companies such as Unum. He filed terrible appeals on my behalf with little to no effort on his part of building a good case for me. After a year of dealing with his condescending attitude and loosing my final appeal, I decided to call up Dell & Schaefer. I had contacted them a year prior when searching for an attorney. Cesar was willing to take my case and felt I had a good one. But I didn’t want to pay the percentage he was asking for if we won back then. The old saying, “you get what you pay for”, proved to be true in this case and I regretted not hiring him from the beginning!

Once I did hire him, and thank goodness he was still willing to take my case even though he was dealing with defending poor appeals by my previous lawyer, things got moving along for me. Because of his years of experience dealing with Unum, and his record of wins against them, within 6 months we had a settlement I could live with! The stress I suffered before Cesar and weight on my shoulders was gone! Cesar is a kind, caring, attorney who will fight for your rights! His assistant Michal always talked to me when I called in with questions or to check up on my case and never made me feel bad for calling. It was nothing like the previous relationship I had with my other attorney and his staff, who avoided me. Cesar explains the process well and keeps you updated on your options throughout the process. He was worth every penny!

I am grateful for their representation and would recommend anyone with an ERISA case to call him!

***** 5 stars based on 202 reviews

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