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SunLife & Aetna Life Insurance Company sued for denial of disability benefits

Here are examples of two recent cases in which SunLife Insurance Company and Aetna Life Insurance Company had a structural conflict of interest and denied disability insurance benefits. In most long term disability insurance claims which are governed by ERISA there is an inherent structural conflict of interest. The conflict of interest exist because the disability insurance company not only pays the benefits, but has the ultimate authority to approve or deny benefits. How can a disability company act a fiduciary to the insured when at the same time a decision to pay benefits will reduce the net income of the company?

The US Supreme Court addressed the conflict of interest issue in the case of MetLife v. Glenn. The court basically said that when there is a structural conflict of interest it is only one factor that must be considered when a disability company denys benefits. The existence of a structural conflict of interest is not a reason to reverse a claim denial. An experienced disability insurance lawyer must be able to prove to that the insurance company acted unreasonably, regardless of the structural conflict of interest.

Sun Life refuses to pay disability insurance benefits to Arkansas woman

Cynthia Evans and her Arkansas disability lawyer recently filed a civil complaint against Sun Life Assurance Company of Canada (Sun Life) in the Circuit Court of Saline County, Arkansas regarding Sun Life’s refusal to pay disability insurance benefits to Ms. Evans as result of her being completely and totally disabled.

Based upon the information provided in the complaint, Ms. Evans and her disability attorney are asking the court for relief in such a manner that will compensate her for back payments she is owed along with attorney’s fees and court fees.

Ms. Evans’ disability lawyer will have to demonstrate to the court the nature of her disability, how it precludes her from working at any occupation, and whether Sun Life acted arbitrarily and capriciously when they denied Ms. Evans’ claim.

Furthermore, Ms. Evans will have to provide the court with all the necessary documentation from her treating physicians and other medical professionals treating Ms. Evans regarding her disability.

Sun Life, however, will try to demonstrate that their decision to deny Ms. Evans her disability insurance claim was fair and reasonable.

Pennsylvania man denied disability insurance benefits by Aetna

A South Carolina disability attorney acting on behalf of Theodore Beers, Jr. of Franklin, Pennsylvania has filed an ERISA lawsuit against Aetna Life Insurance Company in United States District Court for the District of South Carolina in the Greenville Division. The venue for this case is proper since Aetna does business in Greenville South Carolina.

Mr. Beers was employed by ABB Power T&D until 1993. During this time of employment, he was a participant in a group plan with Aetna for long-term disability benefits. When Mr. Beers was no longer able to work as result of becoming disabled, he filed a claim with Aetna so he could receive long-term disability benefits from the plan in which he was a participant.

Aetna subsequently denied Mr. Beers’ claim and Mr. Beers’ appealed Aetna’s denial.

Mr. Beers and his disability attorney allege Aetna denied Mr. Beers’ claim due to a structural conflict of interest and also ignoring evidence that is relevant to Mr. Beers’ claim. In short, Mr. Beers’ claims Aetna abused its discretion by denying Mr. Beers his long-term disability insurance benefits.

Mr. Beers asks the court to find in his favor by having Aetna pay him his long-term disability benefits along with any court costs and attorney’s fees.

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There are 4 comments

  • I have suffered another cardiac arest, was revived by my internal ICD / Pacemaker. The Dr. Who examined me after my hopitalization for acute renal failure said he found nothing remarkable. He gave me no test and spkoe to me for 30 seconds no more. Since his unremarkable comment I have suffered two cardiac arrests. Do you also handle malpractice suits? James P Doyle

    James P DoyleMar 10, 2014  #4

  • Sun Life claims they have a right to “toll” (stop time requirements) if information Sun Life Assurance wants information it has not received. Although a specialist has prescribed medications to treat my deteriating liver and I have received it he advised me on Wed. (three days ago) I cannot take the medication until my heart specialist runs more tests. I had a heart attack 01/18/2014. I was examined by heart specialist on Fiday 1/30/2014 and he said I should no longer drive a car or operate any kind of machinery. I only want what Sun Life Assurance of Canada agreed to pay me should I become disabled but I will be forced to sue because Sun Life Assrance played so fast and loose with doctors and myself. Isn’t America great.

    J. P. DoyleFeb 2, 2014  #3

  • J. P.

    SunLife would appear to be outside of the timeframe in which it has to render a decision on your claim. Please feel free to contact our office to discuss how we may be able to assist you.

    Stephen JessupJan 28, 2014  #2

  • SunLife just sent me a letter saying my term insurance is not portable because I am completely disabled but SunLife is also my LTD provider and has not made a decsion as to whether or not I am disabled. SunLife signed for my LTD application on 10/17/2013. It is 01/29/2014. All Dr. and hospital paperword has been in their possesion since 12/20/2014. Great company isn’t it?

    J. P. DoyleJan 28, 2014  #1

FAQ

Do you help Aetna claimants nationwide?

We represent Aetna 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 Aetna disability insurance policy?

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

How do you help Aetna claimants?

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

  • 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   *****

Randy K.

This was the second time my LTD provider (Prudential) terminated my coverage. Steve got my coverage back the first time the provider terminated it. I contacted Steve and Danielle immediately when I was notified of the second termination.

Even though the LTD provider was to use Dell & Schaefer as a conduit of communication to me, they superseded this agreement and communicated this fact directly to me. Steve and Danielle began gathering the supposed facts behind the termination and saw they were bogus. My case file was sent to an independent physician in a different state who simply read documents to determine that my symptoms were falsified and upheld the termination. Steve contacted the provider and drew exception to that entire process.

Since I am not an attorney I can’t begin to imagine the legal wrangling that took place to contradict that opinion. An actual “hands on” IME was scheduled by the LTD provider to see if it would concur with the other physicians findings. The findings of the “hands on” physical examination disagreed in nearly every way with the report delivered by the physician that simply read a report and didn’t lay a hand on me.

As a result of the dedication of Steve and Danielle my LTD was reinstated this month, along with all the back benefits dating back to the date of termination in June of 2015. Steve and Danielle went, in my opinion, above and beyond the call of duty to see that I got back what was rightfully mine. They have my eternal admiration and respect!

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