Disability Insurance Lawsuit Stories

From 2002 until 2010, Julia Sun worked as a Registered Nurse caring for quadriplegic patients. Her occupation could not be considered, as far as strength demand was concerned, anything less than a “medium” physical demand level occupation. The substantial and material duties of her occupation included caring, bathing, feeding, dressing and transferring patients. She administered their medications and asses...

In Thomas A. Gonda, Jr., M.D. v Permanente Medical Group, Inc., et. al., plaintiff Thomas Gonda, a thoracic surgeon for The Permanente Medical Group, Inc., suffered double vision, headaches, memory loss, and difficulty focusing on and completing tasks following an accident in which he was hit by a car while riding a Segway. The accident also caused an exacerbation in Dr. Gonda’s long standing problems w...

In the case of Gallegos v. Prudential, a California Federal District in the Northern District of California entered an order instructing Prudential to reinstate the benefits to an insured suffering with Lupus. This ruling provides a plethora of useful information in arguing claims for disability stemming from Lupus, but also for any physical medical condition in which an insurance carrier argues a “lack of o...

In Rouleau v. Liberty Life Assurance Company of Boston, plaintiff Michelle Rouleau, a Registered Nurse (RN) for a Hospital, had a history of intractable lower back pain dating back many years. As an employee of the Hospital, she was covered by a Group Long-Term Disability Insurance policy issued by Liberty Life (Liberty).Benefit ProvisionsUnder the terms of the LTD Policy, the definition of disabi...

In Cathleen Kennedy v. The Lilly Extended Disability Plan, plaintiff Cathleen Kennedy, an executive Director of Human Resources, had a history fibromyalgia dating back many years. As an employee of Eli Lilly and Company, she was covered by The Lilly Extended Disability Plan (“the Plan”), which was administered initially by Anthem Life and Disability and later by Sedgwick Claims Management Services (�...

In Jarillo v. Reliance Standard Life Ins. Co., Judge Michael M. Anello of the United States District Court of the Southern District of California held that plaintiff Marife Jarillo met her burden of proof and was entitled to benefits under the ERISA. For about eight years, Jarillo worked in the marketing department of the Sycuan Band of The Kumeyaay Nation (a federally recognized Native American tribe located ...

In Jane Doe v. Standard Insurance Company, plaintiff Doe spent more than 25 years as an environmental attorney for a Maine law firm prior to become ill with depression and anxiety. She filed a claim for mental health disability benefits under the law firm’s disability policy. Her claim was approved, but based on a disability date of January 2012, when she claimed the date should be October 2011. Standard als...

Our office was recently contacted by an insured whose claim for long term disability benefits had been recently and abruptly denied by Prudential based on allegations of insurance fraud stemming from answers provided in an Activities of Daily Living Questionnaire (ADLQ) form and a subsequent field interview. For anyone on claim with Prudential, or with any disability insurance company for that matter, the ADLQ...

The case of Kidd v. The Prudential Insurance Company of America demonstrates the importance of disclosing all potential assets on a bankruptcy petition. This includes an administrative claim for long-term benefits and potential for a lawsuit if those benefits are denied. Because of the plaintiff’s claim she had no assets in Bankruptcy Court, she was judicially estopped from pursing her ERISA lawsuit in the T...

In Anderson-Posey v. Unum Life Insurance Company of America, plaintiff Traselynn Anderson-Posey, a CVS pharmacist, tripped, fell and injured her coccyx. The next day, June 21, 2013, she visited her primary care doctor, Dr. Hunter. Plaintiff complained of severe pain and an inability to sit down. Hunter prescribed narcotics and, when an x-ray showed a fracture, Hunter referred Plaintiff to Dr. White, a pain man...

The case of Arturo J. Otero v. Unum Life Insurance Company of America has an extensive procedural history going back to 2005 when Otero first applied for disability benefits due to his atrial fibrillation. He had a contentious bout with Unum at that time and returned to work on a part-time-basis in 2010. He continued to pay premiums to Unum for disability coverage.In February 2013, Otero filed a new claim ...

In the recent decision of Tobin v Hartford Life & Acc. Ins. Co. a Michigan Federal District Court overturned Hartford’s denial of long term disability benefits to a former Disney employee suffering from Fibromyalgia. The Court noted in its opinion that Hartford’s requirement of objective evidence of the diagnosis of Fibromyalgia was arbitrary under applicable case law in Michigan and that in denying he...

In Chamness v. Liberty Life Assurance Company of Boston, plaintiff James Chamness, a board-certified pediatrician who is also a pediatric sleep specialist, applied for long term disability benefits. He claimed he suffered from both physical and mental disorders. Specifically, he was diagnosed with asthma, irritable bowel syndrome, coronary artery disease, sleep apnea and gastroesophageal reflux disease.Pla...

Long-term disability attorneys Cesar Gavidia and Gregory Dell discuss a recent case against Prudential Insurance Company in which long term disability benefits were denied because the claimant claimed LTD benefits after he was terminated by his employer. This is a very specific fact pattern in this case, but it worked out well for the claimant. People seeking di...

Thousands of long term disability claimants receive both social security disability benefits and long term disability benefits. In this recent video we discuss a great legal decision in which Liberty Mutual's long term disability benefit denial was reversed for failure to properly consider the SSDI benefit approval.A disability carrier is not bound by the SS...

The Six Circuit Court of Appeals reverses a Hartford long term disability benefit denial.Long term disability insurance attorneys Stephen Jessup and Gregory Dell discuss this recent case in which the court basically states that there is no objective evidence of Fibromyalgia. It seems that the courts are really starting to understand fibromyalgia and its deva...

In Armani v. Northwest Mutual, plaintiff Avery Armani, a Controller for an insurance agency, injured his back while lifting a heavy back-up power supply at work. As an employee of the insurance agency, he was covered by a Group Long-Term Disability Insurance policy issued by Northwest Mutual (NWM).Benefit ProvisionsUnder the terms of the LTD Policy, the definition of disability changed after benef...

In Bosley v. Metropolitan Life Insurance Company (MetLife), plaintiff Robert Bosley, a registered nurse, has his 2009 claim for long term disability approved by MetLife. He received benefits from 2008 until 2010 at which time he returned to work in sedentary “desk job” position. In 2011, he again received long term disability benefits running from 2011 until 2012 when he returned to work as an advice nurse...

In Brasseur v. Life Insurance Company of America (LINA), Plaintiff Wilfred Brasseur, a computer engineer, worked in the Houston office of Chicago Bridge & Iron Company when he became disabled. LINA denied his application for long term disability benefits on the grounds that he “was not disabled as defined by the Plan’s terms.” Ultimately, Brasseur filed an ERISA lawsuit in Houston. He filed a motion ...

In Filthout v. AT&T Midwest Disability Benefit, et al., plaintiff Rebecca Filthout had worked several years for Michigan Bell Telephone Company as a service representative when she began having chest and back pain. She was initially diagnosed with kidney problems. Her first application for short term benefits under her employee disability insurance policy provided by AT&T Midwest Disability Benefit Pla...