Former Employee of Proctor & Gamble Loses Federal ERISA Lawsuit

A Federal Judge has upheld Proctor & Gamble’s decision to deny a former employee’s claim for long term disability benefits. Formerly employed as a production tech at Proctor & Gamble’s Paper Product facility in Russellville, Arkansas, the claimant was forced to leave his occupation on April 6, 2008 due to degenerative disc disease, spinal stenosis and lumbar radiculopathy. Shortly after leaving work, the claimant filed an application for Short Term Disability (STD) benefits by Proctor & Gamble. His STD claim was approved and paid for the full 52 week period. Long Term Disability (LTD) benefits were then approved in April of 2009.

Effective August 1, 2009, Proctor & Gamble found the claimant to no longer be fully disabled, but determined that he was only “partially disabled.” This was a significant decision made by Proctor and Gamble as partial disability benefits on this policy will only be paid for a 52-week lifetime maximum. Although the claimant appealed the decision twice, Proctor and Gamble denied his appeals and found him still only to be partially disabled. Unfortunately for the claimant, since he was only approved as “partially disabled,” his claim was only to be paid through July 30, 2010. Because all of the required administrative appeals were denied, the former production tech was forced to file a Federal ERISA Lawsuit in Arkansas Federal Court.

Federal ERISA Lawsuit Filed

After the final denial issued by Proctor & Gamble, the claimant brought an ERISA lawsuit in the United States District Court for the Eastern District of Arkansas. Unfortunately for the former production tech, the Judge ruled in favor of The Proctor & Gamble Long Term Disability Allowance Policy and upheld its decision to deny the claimant’s claim for benefits.

The Court found that the Trustees of the Policy (those who make the determination of disability for the Policy) did not abuse their discretion in finding that the claimant was only partially disabled. The Judge pointed to the substantial evidence relied upon by the Trustees which indicated that the claimant could perform sedentary work. This evidence included that of his own treating physicians, one of whom stated that he was “doing great from surgery and is without complaints.” Another treating physician also concluded in his own reports that there was no substantial objective medical evidence to suggest an inability to work in a sedentary capacity. With this evidence in its favor, the Judge concluded that the Trustees of The Proctor & Gamble Long Term Disability Allowance Policy did not abuse their decision in denying LTD benefits to the claimant. The Court agreed that the former production tech was not totally disabled within the meanings of the Plan. Finally, the Court also awarded a judgment in favor of Proctor & Gamble as the claimant failed to pay Proctor & Gamble the overpayment owed due to his award of Social Security Disability Benefits.

Although this case was not handled by Dell and Schaefer, if you have been denied benefits under The Proctor & Gamble Long Term Disability Allowance Policy or under any long term disability plan, please do not hesitate to contact us for a free consultation.

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Our disability insurance lawyers help policy holders seeking short or long term disability insurance benefits from Arkansas. 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 Arkansas.

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Our lawyers help individuals that have either purchased a Arkansas 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 Arkansas:

  • ERISA and Non-ERISA Appeals of Disability Benefit Denials
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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.

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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.

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Dell & Schaefer Client Reviews   *****

Patricia T. (Florida)

If you think the insurance company is going to be FAIR, you are WRONG! Get an attorney, I recommend Dell & Schaefer. They entered my life approximately 4 years ago. I was in the mid years of my life, moving along routinely finishing up my 29th year of continuous employment as a professional Acute Care Registered Nurse, looking ahead to planning my future and possibilities ahead of me. I had planned to work at least another 15 years and maybe more if I could. I was hitting the peak of my value in the health system that employed me and I loved my job. Income was never an issue for me, as in my profession I could always find work and make as much income as I needed raising a family etc… But just incase, my father always taught me to have a safety net. So every year for 29 years, around benefit time I would fill out the forms and check the boxes for STD and LTD and pay the monthly dues for those policies in case I would ever need them, never expecting to use them. Well life had other plans for me.

My illness began slowly, I made adjustments to my work schedule and life schedule hoping that would allow me to stay employed. I didn’t want to give up the money, my benefits, the years experience I had, the value I had to contribute etc… That lasted for about a year and half then suddenly my body just couldn’t do it anymore. My illness exacerbated, necessitating me to leave work. I went out on my STD policy and initially Aetna the carrier of the policy was cooperative and approved my claim. After several months when I didn’t improve my STD policy was over and it was time to begin my LTD. At this point Aetna suddenly switched and began to deny all my claims for the same illness they had previously approved. I was shocked and bewildered, I could not believe how Aetna could be doing such a thing. What was happening, how could they just say NO! This wasn’t fair, I paid into this for 29 years… and was lost as to what to do.

I did some research on line, and found out this was a common thing all insurers were doing to people who had these kind of policies. What a rip off I thought. Here I thought I had a safety net. I was so angry and realised I was disillusioned about this system and having a safety net. I sat and cried fluctuating between anger, sadness, worry, the gamut of feelings. What should I do I thought, I need help and help fast. I couldn’t live without income. I did some more research and found Dell & Schaefer, I went through their website reading all the information and decided I need to call them to see if they could help me. My illness was not listed as a common illness for disability approval.

When I called them, they put me through immediately to someone and took some information. Later that day an attorney called me back and went through my situation explaining to me all my options and that they could help me. I wasn’t ready to make a decision on the spot, so I told them I would call them back. I was skeptical because at this point I didn’t trust anyone for numerous reasons and felt like all the systems I had faith in were failing me. Is this going to be another rip off, I thought?

After thinking about it for a day or two and consulting friends and family, I nervously called back Dell & Schaefer and I told them my concerns, we talked some more they never pressured me. I reluctantly agreed, not because of something they said, it was my own issue with trust now clouding my decision. Reflecting back that was the best decision I ever made. My attorney in the firm was Alex Palamara, I dealt with him exclusively and he always called me back, emailed me and let me know what was happening promptly. Nothing was ever too small for him to answer and he had compassion when I would complain about how unfair Aetna was being with their denial of my case. And YES, they did deny, and are still trying to find ways to deny me to this day 4 years later. Through the hard work and timely action taking by the attorney my appeal was reversed and my claim continues to be approved with the help of the attorney. I no longer have random calls from Aetna asking me repetitive questions that I already answered numerous times and the firm continues to coordinate the yearly reviews with Aetna and my physicians. I faced another denial at the two year mark when the policy changes the definition of gainful employment. Yea isn’t that beauty they sneak into the policy that you have really don’t understand. Alex anticipated that fought that and I have had a seamless benefit check now for 4 straight years.

I will not give up my representation, as educated as I am, in no way am I versed in disability law and the new ways insurance companies try to get out of paying the policy we have paid our hard earned money into for a safety net. I know things will not be easy and I will have to fight to continue my benefits, having Dell & Schaefer gives me security that someone will be there fighting for me and my benefits. I can’t thank them enough, I find them to be prompt, compassionate, knowledgeable and very fair with their fees. If you are thinking about hiring an attorney for representation you will be pleased with this firm. As a side note, my last years of employment I worked for a large hospital system, my job was coordinating with the hospital, physicians and Insurance companies to make sure the hospital would get paid. Specifically, I worked on denials of patients inpatient hospital bills. The insurance company would deny claims for the most unbelievable reasons. They know some people will just give up and not fight, that’s what they are counting on. I didn’t think they would do the same thing with STD and LTD policies, I was wrong and naive. Do yourself a favour, HIRE an attorney immediately from the beginning, otherwise the carrier will jerk you around till you give up, and you may inadvertently say or fill out a form wrong or miss a date and boom you are denied. You will never get your benefit you paid into. Hire Dell & Schaefer.

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