Disability Benefit Claims Law Blog

10th Circuit Court of Appeals validates MetLife's accidental death and dismemberment denial

Gregory Dell — Wed, 10 Mar 2010 16:00:00 -0500

Verla Hancock participated in a group benefit plan sponsored by her employer, Intermountain Healthcare. The plan's claim fiduciary was Metropolitan Life Insurance Co. (MetLife). Under the plan, Verla obtained basic life insurance, supplemental life insurance and accidental death and dismemberment coverage (AD & D).

The plan stipulated that in order to benefit from the AD & D coverage, the policy holder had to be 1) Injured in an accident; 2) The accident had to be the sole cause of injury; 3) The accident had to be the sole cause of death; 4) The death had to occur within 365 days of the accident. The District Court found that policy beneficiary Terri Hancock had failed to demonstrate that she had a claim against MetLife for accidental death and dismemberment in her mother's death.

Would Terri Hancock's appeal be successful? Let's look at the facts surrounding Verla Hancock's death.

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Unum's claim handling exposes them to a multi-million dollar bad faith disability lawsuit

Gregory Dell — Tue, 09 Mar 2010 08:30:00 -0500

Ronnie Hogan sued Provident Life & Accident Insurance Company (Provident) and Unum Group Corp. (Unum) asserting claims under Florida law that the insurance companies had failed to attempt in good faith to settle his claim. Hogan also accused the insurance companies of making misrepresentations that would have made a settlement less favorable for him. He accused them of exercising general business practices that involved mishandling claims, breaching their fiduciary duty, common law fraud, negligence and even conspiracy to commit statutory violations. Provident and Unum asked the judge to dismiss Hogan's case based on a failure to state his claim or at least to pass judgment based on the pleadings presented by the two sides.

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Standard Insurance denies disability claim to a wheelchair bound woman

Gregory Dell — Thu, 04 Mar 2010 09:00:00 -0500

Lynda Sacks worked as a mortgage loan underwriter for Countrywide Home Loans, Inc. Her employer offered both short-term and long-term disability plans issued by Standard Insurance Company (Standard) effective January 1, 2005. Standard was responsible for funding both disability plans and making the claims determinations.

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Accidental death & disability dismemberment; AIG reversed by Colorado Court

Gregory Dell — Sat, 27 Feb 2010 14:00:00 -0500

After Hans-Gerd Rasenack was struck by a hit-and-run driver he applied for benefits under the accidental death and dismemberment insurance he paid for through employee deductions. The policy was issued through AIG Life insurance Company (AIG) and administered by AIG Claim Services. The policy provided an accidental paralysis benefit which covered hemiplegia.

At issue before the U.S. Court of Appeals for the Tenth Circuit was the decision of the U.S. District Court for the District of Colorado. The matter before the court arose under the Employee Retirement Income Security Act (ERISA) which lays out the procedures the court must follow in evaluating a case.

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$4.3 million in disability benefits for general surgeon following UNUM jury verdict

Gregory Dell — Sat, 27 Feb 2010 08:30:00 -0500

Our client, a general surgeon with chronic back pain, will finally receive the long-term disability benefits that he has been denied since October 2004. The United States District Court for the Central District of Illinois entered a final judgment of $402,268.00 against UNUM (formerly known as Paul Revere Life Insurance Company). In addition to the $402,000 our client's disability policy will pay him more than $3.9 million over his lifetime.

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Liberty Mutual reverses decision to terminate disability benefits

Gregory Dell — Mon, 22 Feb 2010 08:30:00 -0500

Attorneys Dell & Schaefer win a long-term disability appeal on behalf of a psychologist whose disability benefits were denied by Liberty Mutual. Our client’s benefits were re-instated and she will now receive several hundred thousands of dollars throughout her lifetime.

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Attorneys Dell & Schaefer Files Class Action Law Suit Against Prudential

Gregory Dell — Fri, 19 Feb 2010 15:00:35 -0500

On February 18, 2010, Attorneys Dell & Schaefer and lead trial attorney Gregory Dell filed a nationwide class action lawsuit against Prudential Insurance Company of America (“PRUDENTIAL, NYSE:PRU”), in the Eastern District of New York Federal Court. This lawsuit was filed to protect the potentially thousands of long-term disability claimants that filed a second/voluntary appeal after November 14, 2005 in which their second/voluntary appeal was denied by the same Prudential employee that denied the claimant’s first appeal. Dell & Schaefer is seeking to stop Prudential from conducting unlawful voluntary appeal reviews which violate ERISA. Additionally, the class action seeks an order requiring Prudential to re-evaluate thousands of voluntary appeals which were denied by Prudential after November 14, 2005.

The class is currently represented by four individuals that have each had their voluntary appeals denied by the same person that denied their first appeal. The Employee Retirement Income Security Act “ERISA” requires that the decision maker on a second appeal must be an independent person who was not involved with any previous denial of a disability claim. Unbeknownst to the Plaintiffs, Prudential had instituted an undisclosed cost-saving method of appeals review that blatantly violates federal ERISA law.

“This process is manifestly unfair, and we contend, not legal,” said attorney Gregory Dell. “The whole point of the ERISA-governed appeals process is to substantially reduce lawsuit expenses and create an environment where claim denials will be objectively evaluated. Prudential’s actions are a breach of their fiduciary duty to all disability claimants,” he said.

Through the nationwide representation of multiple claimants with Prudential long-term disability claim denials, our law firm obtained internal email communications which confirms Prudential’s unilateral decision to cut administrative cost by not providing a “full and fair review” of all voluntary appeals,” said Dell.

The reassessment of denied claims could result in millions of dollars of past due benefits. Prudential is one of the country’s largest group long-term disability insurers, with coverage in force for more than two million individuals.

Click here to if you believe you may have a potential claim against Prudential Insurance Company of America

Disability Attorneys Dell & Schaefer, established in 1979, have represented thousands of clients with their claims against disability insurance companies. The firm’s disability income division, managed by Gregory Michael Dell, is comprised of eight attorneys who represent claimants nationwide, throughout all stages (i.e. applications, denials, appeals, litigation, & lump-sum policy buyouts) of a claim for individual or group (ERISA) long-term disability benefits. For a free consultation, please call 800-828-7583 or use our contact page.

US Court of Appeals Upholds Denial of Disability Benefits By Metlife

Gregory Dell — Thu, 18 Feb 2010 11:53:46 -0500

Another case appeared in the U.S. Court of Appeals that highlights the importance of exhausting all the administrative options available before taking a case to court. Additionally, this case demonstrates the importance of a treating physician responding to all requests from a disability insurance company.

What happened here? And what can you learn from this case that could help you win your claim for disability insurance benefits?

First, we will look at the history of the case. Then we will look at the law as the court interpreted it.

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Harvard University Ordered By Massachusetts Federal Court To Pay Long-Term Disability Benefits To A Former Employee

Gregory Dell — Fri, 12 Feb 2010 15:17:26 -0500

When Rosemary McGahey was denied long-term disability benefits after 24 months, she appealed Harvard University’s decision. She had been approved by Social Security for disability coverage. But Harvard claimed that their standards were different than Social Security’s. At Harvard’s request, she had seen numerous physicians and psychologists, physical therapists and occupational therapists. Did the evidence from these visits validate Harvard’s decision?

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Federal Court Reverses Standard Insurance Company's Denial Of Long-Term Disability Benefits To An Attorney

Gregory Dell — Thu, 04 Feb 2010 11:00:22 -0500

The case we are going to discuss here highlights one of the ways an insurance company attempts to justify discontinuance of benefits after they have begun paying them.

George Nevitt, a practicing attorney fell down a flight of stairs on June 19, 2001. His injuries were so severe, that The Standard Insurance Company (Standard), the company that provided his company’s employee welfare benefit plan, initially approved Nevitt’s claim for disability benefits. In April 2007, Standard terminated Nevitt's coverage claiming that he no longer qualified because of the mental disorder limitation of the plan.

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Tribal Court Retains Jurisdiction For Tribal Member's Disability Insurance Lawsuit Against Assurant And Union Security

Gregory Dell — Wed, 03 Feb 2010 12:14:59 -0500

When Richard Geroux brought a long-term disability insurance underpayment complaint before the Tribal Court of the Keweenaw Bay Indian Community, L’Anse Reservation, Mich., the insurance companies involved, Assurant, Inc (Assurant) and Union Security Insurance Company (Union Security) immediately sought to remove his case to the United States District Court for the Western District of Michigan, Northern Division. The insurance companies claimed that Geroux’s case fell under ERISA jurisdiction and should be considered in Federal Court.

What is at stake here? Whether the tribal court had jurisdiction. Geroux moved on August 8, 2008 to have his case sent back to tribal court, arguing that his complaint should be decided in tribal court. The Assurant and Union Security filed a counterclaim on August 21, 2008 seeking to move action to Federal Court. They also opposed Geroux’s motion to review the case at tribal council on August 25. In response, Geroux moved to dismiss Union Security’s counterclaim.

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Appellat Court Reverses Unum's Denial Of Disability Benefits To A Registered Nurse ("RN") And Trial Court Victory

Gregory Dell — Mon, 01 Feb 2010 10:39:09 -0500

Many long-term disability cases revolve around the issue of what constitutes the ability or inability to work in any gainful employment for which you “are reasonably fitted by education, training or experience.” The following case is another example.

In July of 2001, Linda Gardner stopped working as an operating room nurse. She had been diagnosed with avascular necrosis (AVN) in both of her knees, explaining the severe pain she had been suffering from. One of the symptoms of AV is its progressive nature. Temporary or permanent loss of blood supply to affected bones destroys the bone tissue and causes collapse. The resulting pain in an affected joint can limit movement severely.

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Disability Claimant Takes Reliance Standard To Court Twice Within 5 Years

Gregory Dell — Fri, 29 Jan 2010 16:05:31 -0500

A ruling in U.S. District Court for the Southern District of New York found Reliance Standard Life Insurance Company (“Reliance”) acted in an arbitrary and capricious manner when it denied Elizabeth Diamond long-term disability benefits. Here is her story.

Ms. Diamond worked for Paine Webber as a desktop publisher. Coverage from Reliance through a Group Long Term Disability (LTD) Insurance Policy paid for by her employer was included in her benefits package. Ms. Diamond fell ill and ceased working on September 9, 2000. She first applied for long-term disability benefits in early March of 2001.

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Unum's Attempts To Dismiss A Physician's Bad Faith Disability Lawsuit Are Denied By Pennsylvania Federal Court

Gregory Dell — Wed, 27 Jan 2010 11:10:59 -0500

An opinion issued by the United States District Court for the Middle District of Pennsylvania in November 2009 highlights the challenges an attorney faces when a complaint for denial of disability insurance benefits involves parties from different jurisdictions. An attorney must be very knowledgeable regarding insurance contract law in their state, because the laws of the state in which the contract is signed are the laws that will apply unless preempted by ERISA.

The case we are going to consider involves Edward J. Zaloga, a doctor of osteopathy. He filed his complaint originally in the Court of Common Pleas for Lackawanna County, Penn. in December 24, 2008. Because the claim exceeded the value of $75,000 and neither Provident Life & Accident Insurance Company (Provident Life) nor Unum Group (Unum) had corporate offices in Pennsylvania, jurisdiction over the case resided with the U.S. District Court.

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Court Finds MetLife's Denial Of Short-Term Disability Benefits Arbitrary And Capricious

Gregory Dell — Mon, 25 Jan 2010 16:00:23 -0500

After 18 years of work as a management assistant at Raytheon Company, Dorothy Whitehouse suffered a psychotic episode in the workplace triggered by an experience with her boss and co-workers. The severity of the attack prompted her to immediately schedule an emergency appointment with her therapist, a licensed social worker on August 23, 2007.

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Attorneys Dell & Schaefer Files Lawsuit And Obtains Lump-Sum Buyout Of Disability Policy For Podiatrist With Median Nerve Injury

Gregory Dell — Wed, 20 Jan 2010 15:37:48 -0500

Dr. C, a podiatrist / podiatric surgeon, was successfully practicing in Texas prior to the injury which caused his disability. During a routine blood draw, the phlebotomist taking Dr. C’s blood sample mistakenly injected the needle too deep into Dr. C’s right arm. Dr. C immediately felt shooting and burning pain radiating down his right arm and into his hand. In the weeks that followed, Dr. C experienced severe burning and tingling in his right arm. Dr. C consulted with a colleague in the hospital, a hand specialist, who explained that it was likely that the phlebotomist had injured his median nerve during the blood draw. The hand specialist advised Dr. C that if his symptoms did not resolve within a few weeks to come back and see him.

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Attorneys Dell & Schaefer File Lawsuit And Obtain Lump-Sum Buyout For Chiropractor After Disability Carrier Denies Disability Benefits

Gregory Dell — Wed, 20 Jan 2010 15:34:51 -0500

Dr. Z, a chiropractor, suffered an injury to both of his wrists while performing work in his backyard. As a result, Dr. Z was forced to discontinue his profession as a chiropractor and file disability claims under his three long-term disability insurance policies. Wanting to insure his financial future in the event that he became disabled, Dr. Z maintained three individual disability policies with three different insurance companies. Initially, the disability carriers approved Dr. Z’s claims and began paying him monthly disability benefits.

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Court Finds CIGNA Failed To Follow Proper Claim Denial Procedure, Nurse's Right To Pursue Disability Law Suit Under ERISA Supported

Gregory Dell — Thu, 07 Jan 2010 11:26:54 -0500

Linda Chavis filed a complaint against Cigna Group Insurance and Life Insurance Company of North America (LINA) on June 24, 2009, alleging that the insurance company had breached two disability insurance contracts by refusing to pay her claims for short-term disability (STD) insurance and for long-term disability (LTD) insurance. While Cigna filed a motion to dismiss the complaint, Chavis stated in her complaint that she and her employer had paid all the required premiums for both policies, but she had been wrongfully denied benefits for both policies.

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Prudential's Failure To Produce Documents Weighs In Long Term Disability Claimant's Favor

Gregory Dell — Wed, 06 Jan 2010 09:58:39 -0500

In a ruling filed on November 17, 2009, the United States Court of Appeals for the Eighth Circuit found that Prudential Insurance Company of America (Prudential) had failed to provide Barbara Brown adequate information with which to appeal their decision to deny her long term disability (LTD) benefits. As a result, the court did not apply a common court-approved practice which demands that all administrative options must be exhausted before filing suit.

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Third Circuit Court of Appeals Upholds Hartford's Denial Of Long-Term Disability Claim Based on Pre-Existing Condition Defense

Gregory Dell — Tue, 05 Jan 2010 10:51:42 -0500

The Third Circuit Court of Appeals recently rendered a very difficult decision in favor of Hartford Insurance Company dealing with the interpretation of pre-existing condition clauses in long-term disability income policies. The three judge panel ruled 2-1 in favor of upholding Hartford’s denial of disability benefits. The law in each state is different for pre-existing conditions, therefore a disability claimant should consult with a disability insurance attorney prior to filing a claim for benefits.

In the case we are going to consider here, Jay Doroshow v. Hartford Life and Accident Insurance Company, two judges found Hartford had been neither capricious nor arbitrary when the insurance company denied Doroshow’s claim for long-term unemployment. The third judge disagreed, arguing in his dissent that Doroshow had not received treatment for the condition that precipitated his claim with Hartford. We will have to look at the backdrop against which this case developed.

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