Lash v. Reliance Standard – Case Dismissed For Failure To State Claim Against Matrix
The Complaint alleged that Reliance made the final decision to deny Lash’s claim. The claimant failed to state a claim against Matrix is granted.
Disability Law Blog
Kouzmanoff v. Unum – Court Upholds Unum’s Decision To Deny Diabetes Claim
The present case involves an ERISA claim for short-term disability and long-term disability insurance benefits where the claimant argues that the administrator improperly denied his claims for benefits. Marc Kouzmanoff (“Kouzmanoff”) was a sales representative for Thompson Reuters Holdings, Inc. (“Thompson Reuters”). In 2001, he developed diabetes; …
Koning v. United Of Omaha – Insurer Failed To Adequately Evaluate Medical Evidence
In this case, the court found that United of Omaha Life Insurance Company failed to evaluate the medical evidence presented adequately. The insurer ignored favorable evidence submitted by her treating physician(s), selectively reviewed the evidence it did consider from the treating physicians, failed to conduct its own physical examination, and …
Khalil v. Liberty Life – Surveillance Supports Long-Term Disability Claim Denial
The Court held, “The level of activity or the lack thereof that Mr. Khalil reported to Liberty in support of his claim of continued disability was undermined by the video evidence that Liberty collected during the three years of review.” The claimant’s claim was further undermined by the fact that his own treating physicians ultimately opined that …
Kerridge v. United Of Omaha – Medical Evidence Does Not Support Disability
On May 8, 2015, United informed Kerridge’s counsel by letter that it had denied Kerridge’s appeal. United indicated that its decision was based on the records from Dr. Wilson and the Cleveland Clinic, the other records in Kerridge’s file, and Dr. Zafar’s report from the IME. Kerridge filed a civil action in Federal Court seeking review of United’s …
Baker v. Sun Life – Court Rules In Favor Of Insurance Company
In this case, Kenneth Baker (“Baker”) was an employee who worked for Dunkin Donuts. Through his employment there, he held a policy for long-term disability benefits. Unfortunately, Baker lost all of his administrative appeals with the insurance companies. He also lost at the lower Federal Court. The opinion below relates to Baker’s appeal of the …
Tyler v. American General – Psychiatrist Files Action For Bad Faith And Punitive Damages
Here, Kelly Ann Tyler (“Tyler”) filed a claim for a breach of disability insurance contract against United States Life Insurance Company and American General Life Insurance Company (together, “American General”). Further, she filed claims for a breach of the covenant of good faith and fair dealing by American General, seeking punitive damages. …
Kochanek v. Aetna – Court Upholds Claim Denial Due To Lack Of Medical Evidence
Katherine Kochanek (“Kochanek”) worked as an employee of Home Depot U.S.A., Inc. (“Home Depot”). Through her employment, she was covered by the Home Depot Welfare Benefits Plan which included short term disability benefits. Aetna Life Insurance Co. (“Aetna”) served as the administrator of the Plan. Under the Plan, a “disability” is considered to be …
Kaiser v. Mutual of Omaha – Pre-Existing Condition Exclusion Does Not Apply
The fact that Dee was eventually diagnosed with cancer and that her shoulder pain “in retrospect” was caused by her cancer is not material to a determination of whether her medical care providers at the time of the medical treatment suspected cancer.
Jones v. Aetna – Court Finds Breach Of Fiduciary Duty Claim Isn’t Duplicative
Lisa Jones submitted a claim for long-term disability benefits under an LTD Plan provided to her by Boeing. Aetna was the plan administrator; Aetna denied the LTD claim. Ms. Jones sued under the Employee Retirement Income Security Act (ERISA) for denial of benefits and breach of fiduciary duty. The district court (lower court) dismissed the …
Coats v. Reliance Standard – Court Finds That Benefit Calculation Is Incorrect
Jennifer Coats (“Coats”) was employed by Cottage Health Care as a staff nurse. Through her employment, she was able to participate in an employee welfare benefit plan which included coverage for long-term disability benefits. These benefits were funded by Reliance Standard Life Insurance Company (“Reliance Standard”). More specifically, Reliance …
Doe v. Standard – Insurer’s Decision Was Based On The Wrong Occupation
The court agreed with Doe that Standard's reliance on the DOT description of a generic "lawyer," rather than a job description that fully and accurately encompassed the material duties of Doe's specialized area of legal practice, rendered Standard's decision arbitrary and capricious.
Ingravallo v. Hartford – Second Circuit Overturns Claimant-Friendly Decision
The Second Circuit recently ruled in favor of Hartford in a long-term disability claim involving multiple sclerosis, finding that Hartford's denial of long-term disability coverage was not arbitrary and capricious.
Killen v. Reliance Standard – Court Finds There Was No Abuse Of Discretion
The Court affirmed the district court’s decision granting summary judgment to Reliance Standard on the ground that it did not abuse its discretion in denying the claimant’s long-term disability benefits. In other words, the Court ruled in favor of the insurance company.
Campbell v. Hartford – Claim Denial Supported By Surveillance And Claimant’s Treating Physician
The court ruled that Hartford reasonably relied on medical opinions and surveillance evidence in deeming her ineligible for continued benefits, which means Hartford’s decision to terminate LTD benefits was rationally justified and thus is not arbitrary and capricious.
Hans v. Unum – Court Upholds Denial Of Claim For Chronic Fatigue Syndrome
The judge stated that, "the record, the policy, and the Parties’ arguments do not support the assertion that Plaintiff was disabled as of July 2012 (termination of LTD benefits) and August 2012 (termination of LWOP benefits). The Court, therefore, has no alternative other than to affirm Unum’s decision to deny Plaintiff’s benefits.”
Griffin v. Hartford – Plaintiff Failed To Furnish Proof Of Loss
In this case, the court agreed with the district court that Hartford’s decision was reasonable and did not amount to an abuse of discretion. The record readily shows that Griffin received a fair and thorough consideration of his claim and that the available evidence reasonably supported Hartford’s conclusion.
Granville v. Aetna – Aetna’s Denial Was Arbitrary And Capricious
Here, Aetna has engaged in multiple procedural irregularities, including conducting a self-serving paper review of the medical files based on the incorrect disability standard, relying on the opinion of a non-treating, non-examining physician without reason, and denying benefits based on inadequate information and lax investigatory procedures, as …
Graham v. LINA – Court Rules LINA Must Review Claim Under Medium-Occupation Standard
Defendant informed Plaintiff that her claim for LTD benefits was denied because the medical information provided did not support restrictions and limitations and did not demonstrate a functional loss. The plaintiff argued that she was not required to submit objective medical evidence to prove her disability.
Godmar v. Sedgwick – Decision To Deny Claim Was Arbitrary And Capricious
Disability benefits were paid for approximately one month and then were terminated. The termination letter acknowledged that “a medical condition may exist” but stated that “there must be objective medical information to support disability benefits” under the Plan. However, the court concluded that the decision to deny Godmar’s claim for short-term …
Gilewski v. Provident – Substantial Evidence Supports Decision To Terminate Claim
After reviewing the administrative record and giving no deference to Provident’s decision to terminate benefits, the court found substantial evidence supporting Provident’s decision to terminate Gilewski’s long-term disability benefits.
Gailey v. LINA – Court Affirms Long-Term Disability Denial
The Court held that Life Insurance considered all relevant information, including Abbey’s treatment notes, treatment notes from Plaintiff’s treaters at Philhaven, and the notes from the board-certified psychiatrist based on his peer review of Plaintiff’s medical records. The Court concluded that in light of the foregoing thorough review and …
Filthaut v. AT&T – Court Rules STD Denial Meets Arbitrary And Capricious Standard
The Court addressed several issues within the Plan’s determination that the Court found did meet the required arbitrary and capricious standard. (1) Whether the Plan ignored favorable evidence from the Plaintiff’s treating physicians. (2) Whether the Plan conducted a selective review of the evidence from Plaintiff’s treating physicians. (3) Whether …
Maiden v. Aetna – Experts’ Bread Has Been Buttered By Aetna Before
The problems in Aetna's review of Maiden's evidence—inexplicably disregarding the opinions of treating physicians and ignoring evidence supporting disability while cherry-picking evidence to support a denial—lend an unmistakable hue of capriciousness to Aetna's review.