The case involves a dispute over long-term disability (LTD) benefits between Geiger, the claimant, and Zurich American Life Insurance Company of New York (“Zurich”), the administrator of an ERISA-regulated benefits plan. Background Geiger worked at CBS News in New York as a writer/editor. In March 2018, at the age of 58, Geiger could not go …
Case Summary Blog
Sutton v. MetLife – LTD Policy Requires Objective Evidence, Not Conclusive Proof
The plaintiff, Sutton, filed a lawsuit against MetLife, the defendant, for the wrongful denial of long-term disability benefits under his employer’s plan governed by ERISA (Employee Retirement Income Security Act). Background Under the disability plan’s policy documents, if an employee’s disability is attributable to a neuromuscular or musculoskeletal condition, benefits are normally paid for only …
Sutton v. MetLife – LTD Policy Requires Objective Evidence, Not Conclusive ProofRead More
The Standard Wrongly Applies Pre-Existing Condition Exclusion To Claim
Recently, we appealed a claim denial issued by The Standard. The claim had been denied because the insurance carrier had determined that the claimant’s condition was caused or contributed to by a pre-existing condition. This is not an unusual basis for a long term disability claim denial. However, upon further review, we determined this pre-existing …
The Standard Wrongly Applies Pre-Existing Condition Exclusion To ClaimRead More
Cannon v. Aetna – Aetna Not Bound By SSA Disability Determination
Case Name: Gregory Cannon v. Aetna Life Insurance Company Court: United States District Court for the District of Massachusetts Type of Claim: Long-Term Disability Insurance Company: Aetna Life Insurance Company (hereinafter “Aetna”) Claimant’s Employer: PharMerica Corp Claimant’s Occupation / Job Position: Pharmacist Disabilities: Gastroparesis, syncope, and working diagnoses of paroxysmal atrial fibrillation, Lyme disease, Parkinson’s disease and …
Cannon v. Aetna – Aetna Not Bound By SSA Disability DeterminationRead More
Dardick v. Unum – Unum Succeeds In Denying LTD Claim For Cardiac Impairments
In Dardick v. Unum Life Insurance Company of America and First Unum Life Insurance Company, Unum succeeded in denying the claimant long-term disability insurance benefits. Dardick filed a lawsuit after Unum Life Insurance Company of America denied his claim for benefits under a group disability benefits plan provided by his previous employer, Westcon Group, Inc. The U.S. District …
Dardick v. Unum – Unum Succeeds In Denying LTD Claim For Cardiac ImpairmentsRead More
Gaines v. Aetna – Court Rules Aetna Refused To Credit Reliable Evidence
Plaintiff appealed the initial denial of benefits under the Plan, stating that her request for disability was not based solely on her thyroid surgery but rather on symptoms associated with lupus and chronic pain. On September 12, 2011, ALIC again upheld the denial of benefits to the Plaintiff. As allowed under ERISA, the Plaintiff sued to challenge that decision. Both parties moved for judgment on the administrative record.
Gaines v. Aetna – Court Rules Aetna Refused To Credit Reliable EvidenceRead More
Brown v. LINA – Can A Peer Review Doctor Outweigh My Doctor’s Opinion?
In this case, the Court found that the Plaintiff’s complaints of pain were credible there was no reason to question the Plaintiff’s credibility. As such, the Defendants’ motion for decision was denied and Plaintiff’s motions was granted.
Brown v. LINA – Can A Peer Review Doctor Outweigh My Doctor’s Opinion?Read More
Abrams v. Unum – It’s The Disabling Symptoms That Matter, Not The Exact Medical Label
Today we review Abrams v. Unum Life Insurance Company of America that was decided by the United States District Court for the Western District of Washington. William Abrams was a trial and appellate lawyer for the Schwabe law firm. His disabilities were described as debilitating symptoms from an illness. Although the exact medical condition was …
Abrams v. Unum – It’s The Disabling Symptoms That Matter, Not The Exact Medical LabelRead More
Paquin v. Prudential – Insurer Wrongfully Disregarded Treating Physicians’ Opinions
In this case, the claimant won a reinstatement of his long-term disability insurance benefits in the United States District Court for the District of Colorado. The Plaintiff’s Medical History and Claim History: Mr. Paquin worked for Transistor Devices, Inc. as a Business Development Director. In 2003, Mr. Paquin contracted encephalitis from a mosquito infected by …
Paquin v. Prudential – Insurer Wrongfully Disregarded Treating Physicians’ OpinionsRead More
Robinson v. Aetna – Claim Sent Back To Insurer To Assess Disability Under Plan’s “Any Occupation” Definition
Plaintiff Laverne Robinson brought a lawsuit against Aetna Life Insurance Company (“Aetna”) and Mondelez Global LLC Employee-Paid Group Benefits Plan (“the Plan”) for unpaid long-term disability (“LTD”) benefits under the Employee Retirement Income Security Act of 1974 (“ERISA”). Robinson was a former utility machine operator for Mondelez. As an employee, she could receive disability benefits under the Plan. Aetna served …