In Kimberly J. Guest-Marcotte v. Life Insurance Company of North America, Plaintiff, an insurance risk manager, was diagnosed with Ehlers-Danlos Syndrome (EDS) Type III, a hereditary disease characterized by loose connective tissue which results in frequent joint dislocations and subluxations. In June 2013, due to chronic pain and fatigue, Plaintiff quit work and applied for short term disability benefits (STDs) under her employment welfare plan administered by Life Insurance Company of North America (LINA).

LINA denied her claim. After two unsuccessful administrative appeals, Plaintiff filed an ERISA lawsuit in a federal district court in Michigan. That court ruled in favor of LINA, so Plaintiff appealed to the U.S. Court of Appeals for the Sixth Circuit.
… Continue

In Anne Wittmann v. Unum Life Insurance Company of America (Unum), the U.S. District Court for the Eastern District of Louisiana did not make any ruling about whether or not Wittmann, an attorney suffering from fibromyalgia, was entitled to long term disability benefits. The only question presented was whether or not she had exhausted her administrative remedies before filing this ERISA lawsuit.
… Continue

In the case of Green v. Life Insurance Company of North America (LINA), Plaintiff Michael Green was a truck driver for McLane Company, Inc. (McLane). In December 14, 2014, he began having symptoms of foggy and cloudy vision. His ophthalmologist diagnosed him with posterior vitreous detachment (PVD) in his right eye and sent him back to work. The doctor also recommended that plaintiff see a retinal specialist if his eye symptoms got worse.

On February 25, 2015, Plaintiff saw a retina specialist who diagnosed Plaintiff with “macula-off retinal detachment of the right eye.” After three unsuccessful surgeries to repair the detachment, Plaintiff suffered a permanent vision loss and was unable to return to his job as a truck driver.
… Continue

In Joan Clark v. Unum Life Insurance Company of America and Unum Group Corporation (Unum), Clark worked approximately 33 years for Aerospace Testing Alliance (ATA) in Tullahoma, Tennessee, as an instrument technician. For about half of those years, she suffered from systemic lupus erythematosus (lupus). Except for a short time in 2012, she continued to work.

In 2016, due to the worsening of her condition, she quit work on the advice of her physician and applied for long-term disability (LTD) benefits. Despite Clark providing reams of medical evidence to support her disability, Unum denied her claim based on reports by its own reviewing physicians. Even though the plan granted authority to the administrator to require Clark to undergo an independent physical examination, it did not do so. … Continue

In Damon Zaeske v. Liberty Life Assurance Company of Boston, Zaeske stopped working on April 4, 2014, due to chronic back pain. His initial application for long-term disability benefits was approved with the caveat that his medical condition would be subject to periodic evaluation. He began receiving benefits on July 6, 2014.

In late October 2014, Liberty asked for updated medical records from Zaeskes three treating physicians, but received no response. Liberty informed Zaeske that he had until December 11 to submit updated records. As of December 12, he had not done so, so Liberty denied him further benefits.
… Continue

Those facing the inability to work due to a disability often till have a lot of work to do – in the form of fighting for their disability insurance benefits. Far too often the individual is the one being neglected and pushed around, even by their own insurance providers who is supposed to help them and take care of them after filing a disability insurance claim. That is where Disability Insurance Attorneys Dell & Schaefer can help fight for you! Disability insurance attorneys Gregory Dell and Stephen Jessup discuss the new ERISA regulations drafted by the Department of Labor that took effect on April 1, 2018. It is the hope of many that this regulation will work for the disabled claimants. It remains to be seen if the Department of Labor’s regulation changes will make a noticeable impact to the benefits of insureds and claimants.

… Continue

In a recent case out of Massachusetts, a Court sided with a disabled claimant and found that Aetna’s decision to deny the claim for benefits was wrong. Aetna justified its denial as it believed the disabling medical condition to be a “pre-existing” condition and the policy governing this claim, like most Long Term Disability (“LTD”) policies, contained a provision that states that benefits will not be paid for pre-existing conditions that cause someone to be disabled during their first year of coverage. Specifically, the policy stated that “a disease or injury is a pre-existing condition if, during the 3 months before the date you last became covered: it was diagnosed or treated, or services were received for the disease or injury, or you took drugs or medicines prescribed or recommended by a physician for that condition.”
… Continue

In Jennifer L. Miller v. Sedgwick Claims Management Services, Inc. (Sedgwick), Plaintiff, an account manager for American Honda Motor Company, suffered from many debilitating medical conditions, particularly fibromyalgia, which included insomnia, chronic pain, inflammatory arthropathy, and fatigue. Her last day of work was May 3, 2017.
… Continue

No matter how long you’ve been on disability insurance, your insurance company can evaluate and discontinue your disability insurance benefits at any time. So it’s paramount to be ready for them to take it away. Even if you’ve been collecting disability insurance for a decade or more, your insurance company can discontinue it by administering a neuro-psych evaluation.
… Continue

In this case, a policyholder was diagnosed with an aggressive form of skin cancer and had to undergo treatments. Due to the date of his policy renewal and the date of his treatments, the policyholder did not expect there to be any issue regarding his eventual claim when he had to file for disability. The severity of his cancer and the invasiveness of his treatments made it so he was unable to work and had to make a claim on his disability insurance policy with Aetna.
… Continue