Disability Attorney Law Firm Dell & Schaefer

Tempur employee suffering from chronic fatigue syndrome sues Union Central Life for denial of disability benefits

Gregory Dell — Fri, 03 Feb 2012 10:36:51 +0000

A federal lawsuit was recently filed in the U.S. District Court in Pennsylvania against the Union Central Life Insurance Company (Union) by a Pennsylvania disability attorney. The Plaintiff, Janet G., worked as a Direct Sales Supervisor for Tempur World, Inc. (Tempur). Due to her employment at Tempur, Janet was provided long-term disability insurance with Union Central.

In this case, the Plaintiff filed a disability lawsuit to recover payment of long-term disability insurance benefits.

Case Facts Against Union Central Life Insurance Company

The Plaintiff worked as a Direct Sales Supervisor until September 17, 2004 when she became disabled due to Chronic Fatigue Syndrome and was no longer able to perform her essential duties of her Own Occupation as a Direct Sales Supervisor. Plaintiff filed for and received short-term disability benefits from Union. Union then determined in March 2005 that Plaintiff was also eligible for long-term disability benefits. Union paid the Plaintiff long-term disability benefits for the first 24 months as stated by the terms of the Policy.

According to the terms of the Policy, the long-term disability benefits could only continue if the Plaintiff was prevented from performing the essential duties of any occupation for which she was qualified for via education, training, or experience.

As the Plaintiff was still disabled after the 24-month period, Union continued to pay long-term disability benefits.

Union Terminates Plaintiff’s Long-Term Disability Benefits

Via letter dated March 5, 2010, Union terminates Plaintiff’s long-term disability benefits based on the reasoning of internist Dr. V., a graduate of Guntur Medical College in India. Dr. V. claimed that the Plaintiff was disabled due to fatigue and depression, not Chronic Fatigue Syndrome, thereby violating the terms of the Policy and supporting grounds for a termination of benefits.

By letter on August 2, 2010, Plaintiff appealed Union’s decision to deny benefits.

By letter on November 1, 2010, Union denied Plaintiff’s appeal, citing the opinion of another internist, Dr. C. to support its decision to deny benefits.

Plaintiff has exhausted all administrative remedies, which has led to the filing of this lawsuit against Union.

Lawsuit Filed By Disability Attorney Against Union

The lawsuit states that Union failed to provide the following to the plaintiff:

The long-term disability benefits that were owed to her under the terms of the Policy, a Policy to which the Plaintiff had paid all premiums, thereby insuring her under the terms of the Policy;
A fair assessment of her claim, as the two expert opinions Union used to deny the Plaintiff’s claim were from internists and not from rheumatologists, who were the proper experts to provide competent opinions in the field regarding Chronic Fatigue Syndrome, thereby not providing solid grounds to terminate Plaintiff’s benefits;
Not properly weighing the opinion of the Social Security Administration’s decision that Plaintiff is disabled due to Chronic Fatigue Syndrome in evaluating whether Plaintiff’s benefits should be terminated or not;
Properly evaluating Plaintiff’s condition, conducting Functional Capacity Evaluation and other tests that cannot test fatigue, not providing solid grounds to terminate Plaintiff’s benefits.

Plaintiff Seeks Following Relief From Union Lawsuit

Due to Union actions, Plaintiff wants the Court to provide the following relief:

All disability payments due as of March 5, 2010 through the time she remains disabled;
A declaratory judgment that Plaintiff is disabled according to the terms of the LTD policy, which means that Plaintiff is entitled to all benefits ongoing as long as she fits the LTD terms of the policy;
All prejudgment interest from March 5, 2010 through the date of the Judgment;
All attorney’s fees, court costs, and reasonable costs;
All other relief that is deemed just and proper by the Court.

About the author: Gregory Michael Dell is an attorney and managing partner of the disability income division of Attorneys Dell & Schaefer. Mr. Dell and his team of lawyers have assisted thousands of long-term disability claimants with their claims against every major disability insurance company. For a free consultation, please call 800-828-7583 or use our contact page.

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Wells Fargo disability claimants in Alabama and Florida file lawsuits against Liberty Life Assurance Company of Boston for unpaid long term disability benefits

Gregory Dell — Tue, 31 Jan 2012 10:29:07 +0000

Wells Fargo disability claimants in Alabama and Florida file lawsuits against Liberty Life Assurance Company of Boston for unpaid long term disability benefits

Recently, two Wells Fargo employees were forced to file Federal Lawsuist against Liberty Life after being denied disability benefits. Utilizing the services of an Alabama Disability Attorney and a Florida Disability Lawyer, the two lawsuits are currently pending. Let’s take a closer look at both cases:

Alabama claimant, Rita S., and her attorney filed a lawsuit against Liberty Life Assurance Company of Boston in the United States District Court for the Northern District of Alabama Southern Division on August 22, 2011 in an attempt to receive payment on Rita’s rightfully deserved disability benefits. Employed as a Wells Fargo teller, Rita ceased working on April 9, 2007 as a result of multiple medical problems. Her medical issues included “fibromyalgia, restless legs syndrome, arthritis, advanced degenerative disc disease, neck pain and medication side effects.” She remains unable to perform her teller job or any other position.

Attorney files suit against Liberty Life on behalf of Wells Fargo Teller

At first, Rita was awarded her Liberty Life disability benefits, but later the insurer terminated those disability benefits. After exhausting all her Liberty Life disability benefits administrative appeals, Rita hired a disability attorney and awaits the district court’s decision concerning her eligibility or ineligibility for disability benefits. In their complaint, Rita and her disability lawyer surmise that the insurer was wrong in terminating Rita’s disability benefits and that this action “constituted a breach of [Liberty's] obligation under” the benefits plan, violates ERISA and is “arbitrary and/or capricious.” Consequently, Rita and her disability attorney are suing the insurer for “compensatory damages and/or equitable relief in an amount to be determined by the Court,” in addition to pre-judgment and post-judgment interest, attorney’s fees and court costs.

Lawyer files suit against Liberty Life on behalf of Wells Fargo Lead Teller

On September 16, 2011 Florida Claimant Kathleen S. and her disability attorney filed suit against Liberty Life Assurance Company of Boston for her disability benefits compensation. A Wells Fargo employee, Kathleen was working as a lead teller when she was forced to stop working due to her disabled condition. Fully qualifying to receive her Liberty Life disability benefits, Kathleen applied for disability benefits in May 2010 when she succumbed to her disabling condition of SLE (Systematic Lupus Erythematosus, chronic pain, gastritis, chronic and severe fatigue, depression, and fibromyalgia with “significant limitations.”

May 7, 2010 was the date when Kathleen became disabled and has not returned to work since that time. On January 11, 2011, Liberty Life informed Kathleen that she did not deserve to collect long term disability. According to the insurer, she does not qualify as “disabled.” Appealing this decision, Kathleen provided physician testimonials that verified her disabled condition to no avail. In the face of three physician recommendations that Kathleen should not return to work as well as Kathleen’s award of Social Security Disability benefits, the insurer continues to state that Kathleen is capable of gainful employment. Thus, Kathleen, through her attorney filed suit against Liberty Life in the United States District Court of Southern Florida Fort Lauderdale Division and asks the court for relief.

In the subject complaint, Kathleen and her attorney allege that Liberty Life’s denial of long term benefits to Kathleen is “wrongful,” “arbitrary and capricious” and was a breach of contract as well as a breach of the insurer’s fiduciary responsibilities to Kathleen. They claim that the insurer is “guilty of bad faith, has been stubbornly litigious, and has caused [Kathleen] unnecessary trouble, expense, and emotional distress.” The pair claim Liberty Life’s actions toward Kathleen were “intentional, willful, and in bad faith, and raise the presumption of conscious indifference to” Kathleen’s best interests. Kathleen’s unpaid long term disability benefits, plus interest as well as attorney’s fees and litigation costs.”

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Texas claimant takes Reliastar to task for denied disability benefits

Gregory Dell — Mon, 30 Jan 2012 10:26:05 +0000

Suffering from multiple medical conditions and unable to function in a daily job, a health care professional and her Texas disability lawyer filed a lawsuit against Reliastar Life Insurance Company to force the insurer to pay disability benefits as contracted in an employee welfare benefit plan.

Cynthia O., a “RN Bariatric Clinical Coordinator,” stopped working on January 29, 2009 due to “fibromyositis, fibromyalgia, chronic fatigue syndrome, depression, agoraphobia and panic disorder.” In addition, the medications that Cynthia was prescribed to cope with the symptoms of her maladies cause cognitive functioning problems and sedation effects.

Claimant and her disability lawyer file lawsuit per ERISA

Fully qualifying as a totally disabled per the terms of her employee benefits disability plan, Cynthia should be receiving her entitled disability benefits from Reliastar, but has been denied her benefits. According to the complaint that Cynthia’s lawyer filed on August 25, 2011 in the United States District Court for the Southern District of Texas Houston Division, the insurer violated Cynthia’s disability plan provisions and ERISA (the Employee Retirement Income Security Act of 1974) by denying Cynthia her rightly deserved disability benefits.

Basis of disability benefits case

In the complaint Cynthia’s disability lawyer notes that Reliastar has wrongfully denied Cynthia her disability benefits because:

Cynthia is totally disabled and cannot perform her job duties;
The insurer failed to “afford proper weight to the evidence in the administrative record showing that [Cynthia] is totally disabled;
Reliastar did not apply the definition of disability as laid out in the plan that Cynthia was a beneficiary of;
Reliastar’s denial of Cynthia’s disability claim is “unreasonable, arbitrary, and capricious”; and
Reliastar’s has “violated its contractual obligation to furnish disability benefits to” Cynthia.

Background of Reliastar claimant’s pursuit of disability benefits

Cynthia is 57 years old and was previously employed by St. Joseph Health System. Due to degenerative and traumatic injuries, Cynthia ceased working at St. Joseph as a RN Bariatric Clinical Coordinator on January 29, 2009, filed a claim for short term disability benefits with Reliastar and was denied disability benefits. Cynthia was further denied long term disability benefits from the insurance provider and after using all her administrative remedies, providing ample medical records that verify her disabled condition as well as evidence of her Social Security Administration favorable disability decision, Cynthia was forced to engage a disability attorney to take her case to a Texas District Court.

Claimant’s demands of Reliastar

In their complaint Cynthia and her lawyer accuse the insurer of wrongfully denying Cynthia her disability benefits in spite of medical evidence proving her disabled condition and ask the District Court to:

Grant Cynthia declaratory relief by finding declaring that she is entitled to injunctive relief in the form of short term and long term disability benefits from Reliastar;
Order the insurer to reimburse Cynthia for attorney’s fees while pursuing her lawsuit; and
Award Cynthia “such other relief as may be just and appropriate.”

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Duke University Doctor sues UNUM Life Insurance Company for long term disability benefits

Gregory Dell — Thu, 26 Jan 2012 11:10:16 +0000

Dr. Karen M. and her North Carolina disability attorney filed a lawsuit against UNUM in the United Stated District Court for the Eastern District of North Carolina to acquire her long term disability benefits. The beneficiary of disability benefits under a plan provided through her employer Private Diagnostic Clinic PLLC at Duke University Medical Center, Dr. Karen ceased working as a general practitioner on February 23, 2007.

Dr. Karen suffers from “severe cognitive dysfunction that included executive function, memory loss, peripheral neuropathy, gait disturbance (impaired tandem gait), and abnormal reflexes” as the result of several medical conditions that includes “Vitamin B 12 deficiency, Vitamin D deficiency and sleep apnea.”

UNUM arbitrarily decides that claimant is no longer disabled

Diagnosed with “neurocognitive syndrome,” Dr. Karen can no longer indent and diagnose diseases and prescribe treatments, making her totally disabled from performing her own occupation as a physician or any other occupation. Dr. Karen submitted a claim for long term disability to UNUM on May 26, 2007 and began receiving her disability benefits as expected. On July 7, 2009, Dr. Karen was informed that her disability benefits were being terminated as UNUM had determined that she no longer was disabled. Dr. Karen appealed this decision and was denied that appeal on December 10, 2009.

On October 12, 2010, UNUM stated that Dr. Karen no longer was entitled to her UNUM Life Insurance Premium Waiver as well. She again appealed and was denied that appeal on June 24, 2011. Having no options available to make use of her UNUM policy, Dr. Karen hired a disability lawyer and filed a lawsuit under ERISA (the Employee Retirement Insurance Security Act of 1974) and U.S.C. § 1132. Under these provisions, Dr. Karen’s attorney claims that UNUM wrongfully denied Dr. Karen her long term disability benefits in violation of her plan terms and conditions in that Dr. Karen is unable to work and the insurer did not properly evaluate Dr. Karen’s claim and ignored the credible evidence provided that verified her disabled condition. According to Dr. Karen’s disability attorney, UNUM “falsely attempted to claim that [Karen's] condition is a behavioral health condition subject to the ‘mental illness limitations,’ section of her policy, using this as a basis to evade Dr. Karen’s severe cognitive dysfunction and memory loss” problems. Thus, UNUM has violated its contract with Dr. Karen.

Claimant was also denied her life insurance premium waiver by UNUM

In their second claim, Dr. Karen and her attorney accuse UNUM of denying Dr. Karen’s Life Insurance Premium Waiver benefit by ignoring evidence of Dr. Karen’s total disabled condition and again ascribing Dr. Karen’s symptoms to a mental illness, which is an inaccurate assessment of her condition. They accuse the insurer of not conducting a full and fair review of Dr. Karen’s claim as dictated by law, and allege that UNUM violated its “contractual obligation to waive Dr. Karen’s life insurance premium payments as stipulated in her plan.”

Consequently, Dr. Karen and her attorney ask the District Court to:

Grant Dr. Karen declaratory judgment and find her disabled and entitled to long term disability benefits from UNUM;
Grant Dr. Karen declaratory and injunctive relief and find her entitled to her insurance plan’s waiver of premium benefit;
Order UNUM to reimburse Dr. Karen for reasonable attorney’s fees; and
Order the insurer to pay any other relief deemed appropriated to compensate for the damage she has sustained as a result of UNUM’s termination of her disability benefits.

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California Consultant sues Northwestern Life Insurance Company for unpaid disability benefits

Gregory Dell — Wed, 25 Jan 2012 11:32:45 +0000

Northwestern Insurance beneficiary Todd W. and his California disability attorney‘s complaint against the insurer accuses Northwestern of breach of the Duty of Good Faith and Fair Dealing and Breach of Contract in response to its denial of Todd W.’s disability benefits.

Citing an advertisement of Northwestern Insurance Mutual Life Insurance Company as the reason why Todd W. first purchased a Northwestern benefits policy, Todd W.’s disability attorney accuses the insurer of “hooking” potential disability benefit customers by promising peace of mind, only to breach that trust by failing to deliver disability benefits when beneficiary’s most need them. Having received only a small portion of the disability benefits that he was entitled to from his disabled condition, Todd W. and his attorney state in their complaint that the insurer:

Unreasonably failed to conduct an impartial vocational review of Todd W.’s disability claim;
Unreasonably failed to identify any medical personnel who reviewed Todd W.’s disability claim;
Unreasonable failed to provide copies of internal medical records reviews to Todd W. concerning his disability claim;
Unreasonably failed to rely upon board certified treating physicians who had examined Todd W. and instead relied upon consultants who only reviewed Todd W.’s medical records; and
Practiced these unreasonable actions due to financial bias.

Complainant’s disabling condition

A large event consultant, Todd W. applied for disability benefits on his Northwestern policy on November 21, 2007. After awarding Todd W. disability benefits and paying those benefits through August 2008, Northwestern terminated Todd W.’s disability award, claiming Todd W. was no longer disabled. However at the time of this termination Todd W. continued to suffer from complications of facial paralysis, a viral infection that “has left him virtually deaf in one ear, and tinnitus.” Having fully cooperated with the insurer and providing medical records to support his disabling condition Todd W. exhausted all his administrative appeals and has been forced to hire a disability attorney and file suit against Northwestern to get his rightfully deserved disability benefits.

Northwestern Mutual Life Insurance Company terminates claimant’s disability benefits

Having unreasonably terminated Todd W.’s disability benefits, Northwestern is accused of breaching its duty of good faith and fair dealing with Todd W. and causing him unnecessary suffering as a result of the financial stress the insurer has caused Todd W. In the subject complaint, Todd W.’s attorney states that Northwestern’s treatment of Todd W. as “despicable conduct carried on by [Northwestern] with a willful and conscious disregard of the rights of [Todd W.].” In addition, the attorney for Todd W. claims that as a result of the insurer’s breach of its contract with Todd W., Todd W. has been damaged and he and his client request that the Court force Northwestern to repair the damage it has caused to Todd W. by:

Paying Todd W. damages for unpaid disability benefits, with interest;
Paying general damages for “mental and emotional distress”;
Paying for Todd W.’s attorneys’ fees to settle this issue;
Paying punitive damages to Todd W.;
Paying court costs; and
Compensating Todd W. with any other damages as the Court sees fit.

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At least five lawsuits were recently filed in Florida District Courts against Prudential for non-payment of disability benefits to deserving claimants

Gregory Dell — Tue, 24 Jan 2012 12:29:56 +0000

With at least five suits filed against them in July for denying disability benefits, Prudential Insurance Company of America has a lot of unhappy claimants in Florida.

Darlene H. v. Prudential Insurance Company

On July 25, 2011, Darlene H. and her Florida disability attorney filed suit against Prudential when the insurer failed to pay her disability benefits as expected. In the complaint, filed in the United States District Court of Florida, Tampa Division, Darlene and her disability attorney accuse the insurer of having a conflict of interest in deciding whether or not to pay out disability benefits, acting arbitrarily and capriciously, failing to apply the provisions of their plans consistently, failing to conduct a “full and fair review” of her claim as stipulated in the Employee Insurance Retirement Security Act of 1974 (ERISA), failing to follow their own internal guidelines for determining awards of claimant disability benefits, and failing to comply with laws governing the administering of such disability policies. Darlene and her attorney want the Court to order the insurer to provide a “full and fair” review of Darlene’s claim as well as cover her attorney fees and court costs.

Lisa T. v. Prudential Insurance Company

On July 19, 2011, Lisa T., an employee at Zimmerman & Partners Advertising, Inc. as a Human Resources Director, and her disability attorney filed suit against Prudential in the United States District Court for the Southern District of Florida, Fort Lauderdale Division. Lisa became disabled in June 2009 from SLE (Systematic Lupus Erythematosus), chronic and Severe Fatigue, Worsening Memory Loss, Swelling of hands and Feet, Decreased Concentration Status, Chronic Joint Pain, Persistent Erythromelagia, Guillan-Barre Syndrome, Rhematoid Arthritis, Reynaud’s phenomenon and poor sleep. Prudential initially paid Torres long-term disability from December 2009 until May 2010. At that time, Prudential determined that Torres no longer met the definition of disabled and no longer qualified for long-term disability benefits. Still suffering from the debilitating symptoms of SLE, Torres appealed the decision only to be denied again.

Consequently, as a result of the withholding of her entitled disability benefits, Torres and her attorney filed a complaint against Prudential alleging that its decision was arbitrary and capricious and breached the contract the insurer had with Torres. Torres and her disability attorney ask the District Court for an order to force Prudential to fulfill its obligations under Torres’ disability policy and reinstate her benefits plus attorney’s fees.

Charles C. v. Prudential Insurance Company

In the July 19, 2011 complaint filed against Prudential Insurance Company by Charles C. and his attorney, the plaintiff, a US Food Service, Inc. Sales/Territory Manager filed for disability benefits when he became disabled in August 2009. Suffering from “gastroenterological symptoms, cervical radiculopathy and Myelopathy and lumbar radiculopathy,” Charles was paid long-term disability benefits from February 2010 until August 2010. Claiming Charles no longer met its definition of disabled, Prudential terminated Charles’ benefits. With ammunition from the insurer’s own doctors, who verified that Charles’ medical records indicated that Charles was limited in his ability to perform his job, Prudential ignored all evidence of Charels’ disabling condition and denied all appeals, which led to the filing of Charles’ lawsuit.

In the complaint the two allege that Prudential was arbitrary and capricious, ignored Charles’ documentation of his condition, breached its contract with Charles, and “is guilty of bad faith, has been stubbornly litigious, and has caused (Chares) unnecessary trouble, expense, and emotional distress.” Consequently, they ask the Florida District Court to render judgment for Charles and against Prudential and force the insurer to pay Charles’ disability benefits per the terms and conditions of his policy as well as reimburse him for attorney’s fees and court expenses.

Arnold R. v. Prudential Financial

A senior vice president and his Florida disability lawyer filed suit against Prudential on August 1, 2011 in the Miami Division of the United State District Court of the Southern District of Florida for unpaid disability benefits. Arnold , an HIV sufferer since 1992, was the beneficiary of a long term disability insurance policy with Prudential that went into effect in 1982, which was originally administered by his employer Bank of New York. At the time of his diagnosis, Arnold was the Senior Vice President of Global Custody and Securities Lending for the Bank of New York. According to Arnold’s lawyer, as stated in their complaint, Arnold “suffers from debilitating gastrointestinal problems, particularly chronic diarrhea, fatigue, problems with memory and concentration, and peripheral neuropathy in his lets as well as recurring skin conditions and rashes and recurring pulmonary conditions such as pneumonia and bronchitis,” due to his illness and medications he takes to control his HIV infection. Consequently, Arnold went on short term disability from Prudential in August of 1992. On May 1, 2005, Arnold’s disability benefits administration was taken over by Prudential. And, on January 10, 2006, Prudential terminated Arnold’s benefits.

According to Prudential, since Arnold was originally on the Executive Disability Plan, he does not fall under the definition of “disabled” per that plan. Asked for a copy of this document and not receiving that copy, Arnold appealed the insurer’s decision to terminate his disability benefits. That appeal and his second appeal were denied, still without the provision of the again requested plan details. Finally in January 2007, Arnold was able to procure a copy of the Executive Disability Plan Summary from Bank of New York. However, the plan was not the 1982 version, but the 1995 version. Not able to document that there even was an Executive Disability Plan when Arnold began receiving his disability benefits in 1992, Arnold is disabled under his plan.

With little progress in pointing out this discrepancy to the disability plans, Arnold hired a attorney to help him retrieve his rightful disability benefits. In the complaint, Arnold and his disability attorney, claim that Prudential and the Bank of New York has breached its contract with Arnold, that it has failed to provide documents in violation of the Employee Retirement Security Act (ERISA) and have asked the Court to order the defendants to pay all Arnold’s unpaid disability benefits plus interest, pay civil penalties for their failure to provide requested documents to Arnold and his attorney, pay Arnold the correct amount of disability benefits had he been subject to the Executive Disability Plan, pay Arnold’s attorney’s fees and Court costs.

Nancy P. v. Prudential

On July 14, 2011, Nancy P. and her disability attorney filed a lawsuit against Prudential to recover her wrongfully denied disability benefits. In the complaint, filed in the United States District Court for the Northern District of Florida, Pensacola Division, Nancy and her attorney allege that the insurer has breached its duty as fiduciary administrator of Nancy’s disability plan and has a conflict of interest in taking on the role of administrator to the plan.

Nancy was paid disability benefits from December 16, 2009 until March 17, 2010. Then Prudential refused to pay any disability benefits to Nancy after March 18, 2010, claiming Nancy no longer qualified as disabled. After appealing this decision, Nancy turned to an attorney to take her case to District Court. She and her disability attorney ask the Court to award Nancy her disability benefits, continuing and unpaid since March 18, 2010, interest, attorney’s fees and a declaration that Nancy meets the disability qualifications under the plan and is entitled to such benefits as provided by the plan.

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Electrical assembly worker for Northrop Grumman files a complaint against UNUM for denial of long term disability benefits

Gregory Dell — Fri, 20 Jan 2012 10:19:39 +0000

Fifty-nine-year old, former Northrop Grumman Corporation employee Rita L. and her Utah disability lawyer filed suit against UNUM Life Insurance Company and her employer in Federal Court in Utah. Claiming that the UNUM Plan Administrator erroneously denied Rita her disability benefits, the complaint asks the District Court to right this wrong.

An employee of Northrop Grumman Corporation for 24 years as an electrical assembler, Rita “developed a series of chronic severe health problems which gradually worsened over time.” At the time of her application for her disability benefits from UNUM, Rita suffered from “degenerative disc disease of the lumbar spine, knee pain, hip pain, migraine headaches, sleep apnea, as well as anxiety and depression.” And, even though Northrop Grumman made some accommodations to help Rita continue working, there came a point in time when she could no longer perform her duties as an electrical assembler.

Utah claimant quits work due to disabling condition

Consequently, Rita quit her job on December 22, 2009 and applied for and was awarded short term disability benefits from her employee UNUM plan. Once her short term disability benefits ran out, Rita applied for her long term disability benefits, but was denied on August 3, 2010. After exhausting all administrative appeals with the insurer and being denied again and again, Rita has found it necessary to hire a disability attorney and file this lawsuit.

Details of claimant’s complaint against UNUM

In the complaint, Rita’s attorney points out that Rita provided the insurer with all the necessary and required medical documentation that verifies her disabling condition. Rita and her disability attorney allege that UNUM failed to provide a full and fair review of her claim and in so doing violated ERISA as well as breached its fiduciary duty to award disability benefits pursuant to the terms and provisions of Rita’s disability insurance plan. They claim the denial of Rita’s entitled disability benefits has resulted in damages to Rita in the amount of some $30,000.00 or more and ask the Court to order UNUM to reverse its denial of Rita’s claim, award her long term disability benefits retroactively to June 20, 2010, plus interest, award Rita reasonable attorney’s fees and costs and award her any other relief the Court “deems just, proper and equitable in the circumstances.”

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CIGNA under fire in Minnesota Federal Court for termination of claimant’s disability benefits

Gregory Dell — Wed, 18 Jan 2012 11:10:49 +0000

Beverly S. and her Minnesota disability attorney filed a lawsuit against CIGNA in the United States District Court for the District of Minnesota in an effort to procure her entitled disability benefits.

A former employee of Medica Heal Plans (Medica) since May 26, 2006, Beverly S. became disabled in June of 2008 when she “developed increasing difficulty functioning” in the performance of her job due to “various medical problems. These medical problems included “rheumatoid arthritis, ovarian cancer, the after-effects of chemotherapy for ovarian cancer, fibromyalgia, chronic fatigue syndrome, lymphedema, peripheral neuropathy, obstructive sleep apnea, irritable bowel syndrome, and depression.”

Claimant was initially awarded disability benefits

Beverly S. applied for her ERISA-governed CIGNA disability benefits and was awarded long term disability benefits in June 2008. Subsequently, Beverly S. applied for and was awarded Social Security Disability Insurance benefits (SSDI), and adhered to CIGNA’s requirement that her disability benefit payments be reduced by the amount of SSDI she received. Beverly S.’s SSDI payments began on September 1, 2008. Then on December 30, 2008, per the terms and conditions of her CIGNA insurance policy, Beverly S. received a waiver on premium payments for her CIGNA life insurance plan.

In April 2009, Beverly S. contacted the insurer and asked for “assistance in making a return to some work.” Hoping to be able to return to part-time employment, Beverly S. signed a Rehabilitation Plan Agreement with CIGNA. After complying with the rehabilitation plan, Beverly S. and her vocational counselor informed the insurer that Beverly S. was looking for a work-at-home opportunity. As such, Beverly S. began working part time for J. Lodge on October 2009 from home by propping up in a chair or in her bed to participate in her new job.

Claimant’s disability claim “red-flagged” as fraud by CIGNA

Unbeknownst to Beverly S., as a result of her part time work, Beverly S.’s claim was red-flagged for a fraud investigation. The basis of this investigation was that: “(1) Beverly S. was working from home; (2) Beverly S. had too many doctors; [and] (3) Beverly S. was perceived as ‘defensive and aggressive’ when asked about her work limitations.” Surveillance was ordered on Beverly S. by the insurer which captured Beverly S. traveling to a medical appointment and shopping for groceries.

After her claim was reviewed by a CIGNA nurse, who reviewed only a portion of Beverly S.’s medical information, Beverly S. was informed in a letter on March 30, 2010 that it had been determined that she was able to work in any occupation, and her disability benefits would be terminated. Beverly S. appealed the decision, underwent a functional capacities evaluation (at her own expense) and was evaluated for her function ability to return to full-time employment. It was determined that she was precluded from performing any full-time work, including sedentary work. Beverly S.’s records were then forwarded to a CIGNA internist for review, with the internist opining that Beverly S.’s evaluation was wrong and Beverly S. was not disabled.

Claimant’s Life Insurance Benefit Plan Administrator considers Beverly S. disabled

About the time of all this investigation, Beverly S.’s Life Insurance benefit plan was transferred to the care of UnitedHealthcare Specialty Benefits, who continues to waive Beverly S.’s premium payments as according to this company Beverly S. remains disabled. Beverly S. submitted a second appeal to CIGNA in an effort to retrieve her disability benefits from the insurer, along with proof of the validity of her functional capacities evaluation with a refuting opinion of the pervious internist’s opinion to no avail.

CIGNA claimant engages a disability attorney

Consequently Beverly S. had no other option but to hire a disability attorney to file the subject lawsuit against CIGNA. Asserting that Beverly S. has “satisfied the applicable definition for disability under the LTD [(long term disability)] plan,” is being “wrongfully denied benefits under the LTD plan,” and is a victim of CIGNA’s “breach of the LTD plan and ERISA for terminating disability benefits,” Beverly S.’s attorney asks the District Court for:

Beverly S.’s past due LTD benefits plus interest;
Continuation of Beverly S.’s LTD monthly benefits payments per the terms of the plan;
Payment of costs, disbursements and other expenses of the litigation; and
“Such other further relief as this court deems just and proper.”

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Question writer for Jeopardy/Sony Pictures files suit against Prudential

Gregory Dell — Mon, 16 Jan 2012 10:24:13 +0000

A California disability attorney and his client filed suit against The Prudential Insurance Company of America (Prudential) in the United States District Court Central District of California on October 28, 2011 for unpaid long term disability payments due per the terms of an employee disability insurance plan.

Lorraine A., a former Sony Pictures Entertainment Inc. question writer for the television game production Jeopardy succumbed to Multiple Sclerosis and stopped working for the company in July of 2006. At the time of her departure from work, Lorraine’s health was deteriorating as a result of her illness and she was unable to perform “the material duties of her occupation.” In fact, her cognitive abilities were so affected that “she was unaware of her right or ability to make a claim for benefits under the Sony LTD Plan” at the time of her departure from its employ.

Prudential claimant files for disability benefits after succumbing to multiple sclerosis

In May 2010, Lorraine “became aware of her right” to make a disability claim on her Sony disability insurance policy and did so, but was denied her claim on July 22, 2010. Her appeal to the insurer was denied by Prudential on March 18, 2011. On October 19, 2011 Lorraine submitted a second voluntary request for reconsideration of her denied claim. Despite overwhelming evidence that she qualifies for long term disability benefits through her employee insurance policy, Lorraine’s request for reconsideration was denied. Consequently, Lorraine has now exhausted all pre-litigation solutions and has hired a disability attorney to present her claim to the District Court of Central California for the rendering of a decision in the matter.

Prudential allegedly is in violation of ERISA and breached its contract with claimant

According to Lorraine’s attorney, Prudential breached its contract with Lorraine and violated the Employee Retirement Insurance Security Act of 1974 ERISA) by:

Failing to pay long term disability benefits to Lorraine;
Failing to adequately and properly evaluate the merits of Lorraine’s claim; and
Other acts or omissions.

Claiming an unspecified amount of damages sustained in addition to the loss of her disability benefits, Lorraine and her disability attorney look to the California District Court to determine how much to award her in the litigation. Their requests include:

Payment of Lorraine’s disability benefits per her Prudential plan;
Declaration that Lorraine is entitled to immediate reinstatement of her long term disability plan and all ancillary benefits provided in the plan;
Remanding of Lorraine’s denial of benefits back to the administrator to re-evaluate her claim and take into consideration all medical documentation verifying her disabled condition;
Entitlement to attorneys’ fees and court costs;
Pre-interest on unpaid disability benefits; and
Other relief the Court “deems just and proper.”

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New Jersey claimant files suit against New York Life, Unum and Paul Revere for miscalculated disability benefits

Gregory Dell — Fri, 13 Jan 2012 10:13:00 +0000

William M. never suspected that should he need to make use of his disability insurance policy (which he had faithfully paid premiums on for years) that the promised disability benefits would be denied him when he needed them most.

A sales representative for Long Forms, Inc., President and part owner of Advanced Transportation Systems, Inc. and The Institute of Logistical Management as well as an hourly employee of Temple University as a Criminal Justice instructor, William was diagnosed with Hodgkin’s’ Lymphoma in 1997. Between January 1997 and February 1998, William underwent surgeries, biopsies, chemotherapy, and radiation to combat the progression of the disease.

Side effects from the chemotherapy and radiation, forced William to cease working for Long Forms, Inc. and Temple University, and William filed a claim with New York Life Insurance and received disability benefits for two months, after which he received residual disability benefits for another six months, total disability benefits for the next sixteen months, and finally 50 percent benefits for another nine months before the insurer closed the claim. William was not made aware that he was eligible for and entitled to ongoing residual disability benefits after December 31, 1998, when his claim had been closed.

Claimant’s History with NY Life, UNUM, and Paul Revere Life

William’s salary suffered great losses and decreases following the initial episode of his disability and even though William had a history of Type II diabetes, Gout, torn rotator cuff, hypertension, high cholesterol, sleep apnea and obesity, he was not aware that from 1998 until 2003 he was entitled to residual disability benefits. In February 2004, William began suffering from a variety of symptoms, including dizziness, difficulty swallowing, difficulty speaking, and chills, and was unable to acquire a proper diagnosis even after several emergency room visits and numerous diagnostic tests. In June 2004, William was diagnosed with myasthenia gravis, an autoimmune neuromuscular disorder with symptoms of “fluctuating muscle weakness and fatigue.” Taking a barrage of medications, William was unable to “perform the material and substantial duties of his regular occupation,” and his condition worsened. Noting that William’s symptoms got worse during times of stress, William’s doctor also noted that William was “getting significant side effects from the prednisone [he was taking] including weight gain an profuse edema which is pitting in nature.”

In February 2006, William filed a disability claim with UNUM through his Paul Revere Life Insurance policy, a subsidiary of NY Life, for his disabling condition of “debilitating effects of myasterhenia gravis and cerebrovascular disease.” William’s attending physicians indicated that William shouldn’t be working as extensively as he was. With a maximum benefit of $5,800.00 per month disability payment, William was misled into believing that this disability benefit amount was only available to him until age 65, when in fact, the amount was available to him for life. Due to a miscalculation of William’s disability benefits, UNUM did not provide William with the correct amount of his entitled disability benefits. And, not only did the insurer miscalculate the amount of William’s disability payments, but it also used a date of 2004 to calculate disability benefits when William’s disabling date should have been 1997.

While William continues to receive disability benefits from UNUM, the amounts are incorrect and the insurer has failed to investigate the miscalculation of his disability benefits payments. Alleging that the disability insurers, NY Life, UNUM, and Paul Revere Life falsely denied William some of his disability benefits proceeds, was deceptive, fraudulent and have a company-wide policy to withhold claimants’ residual disability benefits, William and his New Jersey disability attorney filed a complaint against the insurers in the United States District Court of New Jersey to resolve the issue. In addition, the pair allege that the insurers “have acted and continue to act with ill will and evil intent to frivolously refuse payment of valid Total and/or Residual Disability benefits,” which “constitutes bad faith” under N.J. Stat § 17:29B-4 (2005).

Details of Claim against the Three New Jersey Insurers

William and his lawyer also claim that the insurers intentionally misrepresented the terms and conditions of disability policies by accepting premiums without intention of honoring those terms and conditions and pay entitled disability insurance benefits as in William’s case and the neglect of complying with their obligations of a fiduciary duty towards William and other disabled policyholders.

Consequently William and his disability attorney have asked the District Court to find in William’s favor against the three insurers NY Life, UNUM, and Paul Revere Life, “jointly and severally, for compensatory and punitive damages in an amount in excess of $150,000.00, plus attorney’s fees, expenses, costs, interest and other damages allowable by law.”