Disability Insurance Lawsuit Stories

In James Ampe v. The Prudential Insurance Company of America, et al., Plaintiff Ampe worked for several years for the Massachusetts Institute of Technology (MIT) as a senior development and test engineer. In August 2011, Ampe slipped and fell in his bathroom, hitting his head.He noticed some cognitive decline over the next few months and took intermittent FMLA leave. Meanwhile, his performance re...

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 disabili...

In Craig Robertson v. Principal Life Insurance Company, Plaintiff, a National Account Sales Manager with XPO Logistics in Phoenix, Arizona, became disabled in July 2016 after severely injuring his left foot. His request for short-term disability benefits was granted. In October 2016 he filed a claim for long-term disability (LTD) benefits, but in November 2017, that claim was denied.Plaintiff arg...

In a recent case out of Massachusetts, a federal district court addressed several often contested issues in the area of ERISA including how insurance companies are supposed to evaluate disability claims that are based on conditions like fibromyalgia which are based primarily on subjective complaints and who has the burden of proof when a policy limitation comes into play.Terminated after receiving nine yea...

It is important to point out that this case was not handled by Dell Disability Lawyers. However, we wanted to write about this case as there is much to learn from this ruling out of the United States Court of Appeals for the Eighth Circuit. First, this case is an example that demonstrates that just because you win summary judgement of your disability claim in District Court, it does not mean that the fight is ...

In Paula Le v. Unum Insurance Company of America, plaintiff was severely injured in an automobile accident and was unable to return to her job. She was covered by an employee welfare benefit plan (the plan) through her employer, Opelousas General Health System (OGHS). She was awarded long-term disability benefits beginning in September 2013.In January 2017, Unum informed her it was terminating her benefits...

In a recent case out of Massachusetts, a Court sided with a disabled claimant and found that Aetna’s decision to deny the claim for benefits was wrong. Aetna justified its denial as it believed the disabling medical condition to be a “pre-existing” condition and the policy governing this claim, like most Long Term Disability (“LTD”) policies, contained a provision that states that benefits will not b...

In a recent Florida case not handled by our law firm a claimant’s untimely submission of his ERISA appeal proves fatal to his claim. The case was decided by the United States District Court in the Middle District of Florida and reminds us of the importance of properly submitting an appeal in ERISA governed cases.Mr. Applegate had received benefits for 24 months for his inability to perform the material d...

Initial denialMr. Paquin became disabled in 2003 after contracting encephalitis from a mosquito infected with the West Nile virus. The infection resulted in brain damage and cognitive impairment rendering Mr. Paquin unable to continue working as a business development director for his employer, Transistor Devices. He qualified for short term and long term disability benefits under his employer sponsored di...

Prior to disability, David Do was employed as an Analyst-Desktop services for IVZ, Inc. He was responsible to resolving and handling “all support calls relating to desktop software/hardware installation and maintenance.”Mr. Do was insured under an employer sponsored long-term disability plan administered and funded by Metropolitan Life Insurance Company. In February 2013, Mr. Do injured his neck, back ...

In Lopez v. Standard Insurance Company, the U.S. Court of Appeals for the Eleventh Circuit upheld Standard’s termination of long-term disability benefits to Plaintiff who, according to Standard, was not disabled from performing “any occupation.”Plaintiff went to work as a sheetrock applicator for Palm Harbor Homes, Inc. in May 2003. In late September 2005, he had to leave work due to groin pain and c...

In Scott Griffin v. Hartford Life & Accident Insurance Company, Plaintiff was a medical transcriptionist who was initially awarded long term disability benefits in 2010 due to arm and wrist pain and a herniated cervical disc. He ultimately underwent surgery for the bad disc.Plaintiff’s initial benefits were awarded based on his inability to perform the regular duties of his own occupation. After 24 m...

In Wayne Torpy v. Unum Life Insurance Company of America, both Unum and Plaintiff Torpy appealed a ruling of the New Mexico District Court. Although several issues were presented, since the one resolved by the Court of Appeals vacated the lower court decision, the resolution of the other issues were left to the District Court to resolve on remand.Overview of Relevant FactsPlaintiff Torpy was a police o...

In reviewing long term disability denial letters we find that there are a handful of industry wide arguments made by insurance companies to minimize the nature of one’s occupation. The most common being the downplaying of the cognitive demands of a given occupation in favor of focusing solely on the physical demands of the occupation. This often occurs when (1) the nature of the disability is due to a medica...

The case of Lani Kyle Moar v. Cigna Corporation, et al., demonstrates the lengths insurance companies will go to avoid paying long term disability benefits. This Plaintiff’s perseverance resulted in the Court ordering Cigna to pay past due benefits, but also gave Cigna a new chance to deny benefits in a way that will not be arbitrary and capricious.It began in 2000 when Plaintiff, a flight attendant with...

In Fiorentini v. Paul Revere Life Insurance Company, Plaintiff Henry Fiorentini, CEO and owner of his own information-technology company Panatech, was granted total disability in 2009 due to problems he had when basal cell carcinoma attacked his right ear. The ear was amputated in 2008.In 2014, Paul Revere learned Plaintiff had returned to work full-time, assuming his position as CEO, so it terminated his ...

When it comes to ERISA governed claims, no circuit is more plaintiff friendly than the 9th Circuit. A recent ruling by a Washington district court reminds us of that although the behavior by the disability insurer, Aetna Life Insurance Co., in Gorena v. Aetna deserved a strong reprimand.Ms. Gorena worked as a staff analysist for Boeing for more than 10 years before leaving work due to her worsening multipl...

In Daniel T. Derichs v. AT&T Services, Inc., plaintiff, an employee of AT&T who suffered from post-traumatic stress disorder (PTSD), applied for short-term disability benefits. The plan administrator, Sedgwick Claims Management Services, Inc. (Sedgwick), denied Derichs’ claim. After exhausting his administrative appeals, Derichs filed this ERISA lawsuit.At issue was the correct definition of tota...

Disability Insurance companies are criticized often for failing to perform independent medical evaluations and instead relying exclusively on file reviews performed by in house doctors. The tendency to perform reviews in this fashion is more common with some carriers than others. Such is the case with Life Insurance Company of North America (LINA) also known as Cigna.In Guest-Marcotte v. Life Insurance Com...

In July 2016, Kimberly Garner, suffering from urinary incontinence, left her job with Amazon, and filed a claim for long-term disability benefits with Amazon’s long-term disability insurer, Aetna Life Insurance Company.The Amazon Long-term Disability Plan required that in order to receive monthly benefits, the employee insured must be unable to “perform the material duties of [their] own occupation sol...