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Case Summary Blog

Mercado v. Aetna – Court Rules Aetna’s LTD Claim Denial Was Reasonable

Under the arbitrary and capricious standard, the review is limited to whether reasonable grounds existed to support Aetna’s denial of benefits based on the administrative record before it. The Court held that Aetna reasonably concluded that Plaintiff was no longer entitled to long-term disability benefits and that their decision process was neither arbitrary nor capricious. Aetna’s denial of continued long-term disability benefits was affirmed.

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McKenna v. Aetna – Court Gives Little Weight To The Opinion Of Non-Examining Physician

Aetna approved the Appellant’s claim for LTD benefits from September 25, 2012, through February 23, 2013, but denied her claim for benefits for any period thereafter. Thus, the Sixth Circuit limited its review to determining, de novo, whether the Appellant was entitled to benefits beyond February 23, 2013.

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McIntyre v. Reliance – Court Rules Plaintiff Is Disabled Under Any Occupation Standard

Melissa McIntyre (“McIntyre”) worked as a Mayo Clinic Health System nurse. She was covered under a long-term disability plan which was administered by Reliance Standard Life Insurance Company (“Reliance”). Around 2011, McIntyre’s health caused her to cease working. McIntyre suffered from Charcot-Marie-Tooth Syndrome, a neurological issue that can result in atrophy of the hands, legs, …

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Mawa v. Hartford – Disability Claim For Peripartum Cardiomyopathy Denied

In the present case, Brenna Mawa (“Mawa”) worked as a nurse, Branch Director, and Clinical Director; she was employed by LHC Group, Inc. (“LHC”). The company was insured by a Group Long Term Disability Plan for Employees issued by the Hartford Life & Accident Insurance Company. This plan defined a disability as whether a person can perform …

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Smith v. United of Omaha – Pre-Existing Condition Or Unspecified Medical Problem?

Marcia L. Smith (“Smith”) worked as a property manager for Arlington Properties, Inc., and starting on March 1, 2016, she was covered under a long-term disability plan administered by United of Omaha Life Insurance Company and Mutual of Omaha Insurance Company (collectively, “United”). The plan provided the following as part of its exclusions: Three months …

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Maher v. Prudential – Court Rules LTD Denial Was Not Arbitrary And Capricious

Here, Melissa Maher (“Maher”) was Manager of Research and Development at Bonne Bell, L.L.C. (“Bonne Bell”). Her job duties were considered to be light with sedentary demand. Further requirements were the ability to use ten pounds of force and other exertions of lesser amounts more frequently. Because of her employment with Bonne Bell, Maher was …

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Leonor v. Provident – “The Important Duties” Does Not Equal “All The Important Duties”

Case Name: Leonor v. Provident Life and Accident Company and Paul Revere Life Insurance Company Court: United States Court of Appeals for the Sixth Circuit, on appeal from the United States District Court for the Eastern District of Michigan Type of Claim: Long Term Disability Insurance Companies: Provident Life and Accident Company (hereinafter “Provident Life”) and Paul Revere Life Insurance Company …

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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; later, in 2016, he applied for disability benefits arguing that his job duties included a …

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