Disability Insurance Lawsuit Stories

In Coulter v. Aetna Life Insurance Company, a Michigan federal court found that Aetna committed a number of errors in its review of claimant Sharon Coulter's medical file. In addition, it misinterpreted three separate Functional Capacity Evaluations (FCE). The Benefit Appeals Committee (BAC) for Alcoa, Coulter’s employer, relied on the information provided to it by Aetna to terminate Coulter's long term disa...

In Peterson v. Principal Financial Group, plaintiff injured her back in a car accident and subsequently underwent a spinal fusion. She was awarded 24 months of disability when she was unable to return to her own occupation as a Target employee. After 24 months, the definition of disability changed to requiring her to be disabled from any job "that provides 128% or more of the disability benefit." Principal ref...

In Bigham v. Life Assurance Company of Boston, a Seattle federal court held that Liberty erred in terminating the plaintiff's long term disability benefits when it was clear that she could not perform the required tasks of her own occupation as a Security Technical Program Manager for Amazon, LLC. In that role, she was required to "focus her thoughts and interact with others for long periods of time on a daily...

In Winkler v. Principal Life Insurance Company, Thomas Winkler, a financial planner, collected 24 months of disability benefits when he was unable to work in his own occupation due to his neuromyelitis optica, also known as Devic's Syndrome. At the time he became disabled, he was covered by a policy that was later amended to provide a wider, more encompassing, definition of disability. Winkler argued that, in ...

In Green v. Sun Life Assurance Co., the issue concerned whether or not the claimant was continuously disabled during the 180-day required elimination period in order to qualify for disability benefits. The plan administrator, Sun Life Assurance Co., was aware that the claimant had been awarded disability benefits by the Social Security Administration (SSA), but failed to review the SSA file or the determinatio...

In Zorn v. Principal Life Insurance Company, the plaintiff, a member of the National Association of Professional Insurance Agents, obtained insurance provided to the association by Principal Life Insurance Company (PLIC). The policy provided for five years of benefits for those disabled from their own occupation. After that time, the definition of disability changed and insureds were then considered disabled o...

Shuping v. The Union Central Life Insurance Company is a plaintiff friendly case in the early stages of disability litigation in a Texas federal court. After Randy Shuping filed his ERISA lawsuit, Union Central made a motion asking the court to make its disability decision solely on the administrative record. It argued that plaintiff was not entitled to discovery of any other information or documents. Shuping ...

In Spath v. Standard Insurance Company, the plaintiff was injured at work and was initially granted disability benefits. Upon a review of the claimant's file, Standard changed its mind. On September 17, 2014, Standard sent Spath a letter telling her it had made a mistake and was immediately terminating her benefits. The letter told her she had 180 days to file an appeal and, if she did not, it would close her ...

In Halley v. Aetna Life Ins. Co., the plaintiff, an executive vice-president of a manufacturing company, suffered from spinal osteoarthritis and underwent numerous surgeries including a spinal fusion. He was granted three years of disability benefits when he was unable to perform the job requirements of his own occupation.After 36 months of disability, the definition under the Aetna policy changed, allowin...

In Zuke v. American Airlines, Inc., plaintiff had received 13 years of long term disability benefits when MetLife, the plan administrator, terminated them. When Zuke's administrative appeal was denied, she filed an ERISA lawsuit. When the Ohio district court agreed with MetLife, she appealed. On appeal, the Sixth Circuit held that MetLife's termination of benefits was arbitrary and capricious since it was base...

In McMillan v. AT&T Umbrella Benefit Plan No. 1, the plaintiff, who had worked for AT&T for nearly six years as a Senior IT Client Consultant, filed a claim for short term disability benefits based on multiple medical conditions, including his coronary disease, hypertension, diabetes and sleep apnea. The plan administrator for AT&T is Sedgwick Claims Managements Services, Inc. (Sedgwick).Althou...

In Sim v. Reliance Standard Insurance Co., et al, the Sixth Circuit court in Ohio granted plaintiff's motion for discovery in his quest to show that Reliance did not give his claim for disability benefits a full and fair review due to its conflict of interest between being the plan administrator and the payor of benefits. In granting plaintiff's motion, the court relied on other Sixth Circuit cases and noted t...

In Mackey v. Liberty Life Assurance Company of Boston, an Arkansas federal court ruled that Liberty abused its discretion when it denied benefits to Mackey on the grounds that there were three vocational alternatives for her without actually considering her abilities to perform the job duties of the alternate occupations. The court did not accept Liberty's conclusion and remanded with instructions that, "A ben...

In Anderson v. Sappi Fine Paper of North America, plaintiff worked for Sappi for 30 years as a carton line operator during which time she suffered continuously from chronic pain due to her club feet. Her job required her to stand for several hours a day. After she fractured her foot while on vacation, she quit work and filed a claim for disability asserting that due to her long-term feet and knee problems, she...

The court discounted the video surveillance, finding "The video surveillance footage was of marginal, if any, relevance." The court continued, "The surveillance video of Ms. Young does not depict activity inconsistent with her reported limitations. The video does not demonstrate Ms. Young has the ability to work full-time in her regular occupation." The court ordered that the plaintiff was entitled to long ter...

In Allen v. Unum Life Insurance Company of America, after her long term disability benefits were denied, plaintiff, a pharmacy technician who suffered a serious back injury in a car accident, filed a federal lawsuit under ERISA. She included a claim for defamation based on two letters sent by the Plan administrator. One letter was to her treating physician asking for more information about her medical conditio...

In Tracia v. Liberty Life Assurance Co., of Boston, despite an extended discussion of the history of the plaintiff's disability, his various medical conditions, reports of treating physicians and analysis of independent reviewers, the court divided the case into two main issues:#1- Liberty erred by failing to advise the plaintiff of the type of objective evidence it required in order to consider his claim,...

Herbert v. PNC Financial Services Group, Inc. and Affiliates Long-Term Disability Plan involves a plaintiff who applied for long-term disability benefits based on her chronic vertigo (dizziness) and nausea. She was treated by five different physicians who all noted she had these chronic conditions, but not one medical professional placed upon her any restrictions relevant to her employment.Despite the plai...

In the case of Solnin v. Sun Life and Health Insurance Company, et al., the plaintiff, an assistant bank manager, injured her back at work and was initially granted short term disability benefits under her employee benefit plan. The case has an extensive procedural history of Sun Life terminating benefits, adminstrative appeals and at least one previous court case.In this action, in its attempt to discredi...

The plaintiff in Neno v. Aetna Life Insurance Company, employed as a Senior Forensic Professional by a computer corporation, received short term disability benefits under his employer's welfare benefit plan due to his debilitating neck and hip pain. After 24 months, those benefits were exhausted and his application for long term disability benefits was denied.According to Aetna's policy, in order to obtain...