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.
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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.
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The ERISA regulations were drafted by the Department of Labor after feedback from lawyers, defense attorneys, insurance companies, and a variety of advocate organizations. There is one regulation in particular that is especially beneficial for claimants that insurance attorneys Gregory Dell and Stephen Jessup are excited about because they’ve been on the losing side of it in the past decade.
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In Christopher Foglia v. Reliance Standard Life Insurance Company, Plaintiff, a former Vice President of Realogy Group, LLC (Realogy), was awarded long-term disability benefits (LTDs) when he became unable to perform all the duties of his own occupation. He had been diagnosed with numerous medical problems, including HIV, Hepatitis C, and many symptoms that accompany such diagnoses. In addition to his physical symptoms, Plaintiff also had decreased cognitive functioning that made it impossible to perform his job.
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In Giovanna Reichard v. United of Omaha Life Insurance Company, the Plaintiff received both short term and long term disability benefits from her employer primarily due to her Crohn’s disease and related gastrointestinal issues and rheumatoid arthritis. During the first 24 months of her disability, she only had to prove that she could not perform the duties of her own occupation as a registered nurse for Coordinated Health.

When the definition of disability changed to requiring her to be unable to perform the duties of any occupation, United ordered a review of her medical records by its own registered nurse, nurse Grancer. Grancer found Plaintiff’s Crohn’s disease stable.
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In the case of Juanita Nichols v. Reliance Standard Life Insurance Company, the plaintiff, aged 62, developed circulatory disorders including Raynaud’s disease. These conditions prevented her from working at her life-long job as a Hazard Analysis and Critical Control Points Coordinator at Peco Foods chicken processing plant. Raynaud’s is a condition where exposure to cold results in serious medical problems, possibly even gangrene.
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The case of Lani Kyle Moar v. Cigna Corporation, et al., demonstrates the lengths insurance companies will go to avoid paying long term disability benefits. This Plaintiff’s perseverance resulted in the Court ordering Cigna to pay past due benefits, but also gave Cigna a new chance to deny benefits in a way that will not be arbitrary and capricious.

It began in 2000 when Plaintiff, a flight attendant with United Airlines, was first awarded long term disability benefits when she developed lupus and congestive heart failure. Initially, she received benefits for 24 months when Cigna found she was disabled from working in her own occupation. Benefits continued even after the definition changed and Cigna agreed she was disabled from working in any occupation for which she was qualified.
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In this video, disability insurance lawyers Gregory Dell and Alex Palamara discuss Mr. Palamara’s recent win of an administrative appeal against Mutual of Omaha. The claimant suffered from a multitude of medical issues, including COPD, emphysema, lupus, spinal stenosis, and fibromyalgia. Mutual of Omaha denied his claim for short term disability benefits after a nurse reviewed his medical records.
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In this video, Attorneys Gregory Dell and Cesar Gavidia discuss a current case Mr. Gavidia is litigating in Federal court concerning Aetna’s initial granting, then denying, long term disability benefits to a software engineer who suffered a stroke in 2011. He later returned to work, but after about three years, he started having issues with cognitive, visual, auditory, spatial, and perceptual functioning that interfered with his ability to do his job, so he filed a claim for long-term disability benefits with Aetna Insurance Company.

To support his claim, the engineer submitted his medical records from his neuropsychologist and reports of cognitive testing. Aetna’s own medical professionals agreed with the reports, so Aetna approved his claim. About 18 months later, benefits were terminated. As a basis for its denial of any further disability benefits, Aetna relied somewhat on the claimant’s social media postings that indicated to Aetna that the man was not disabled. Aetna also denied his administrative appeal.

That is when Mr. Gavidia became involved in the case and filed an ERISA lawsuit in Federal court. The main litigation issues are: 1) The policy appears to only require claimants to be disabled from their own occupation, but denial letters say he must be disabled from any occupation; 2) Aetna chose an incorrect specialist to examine and review the records. It should have chosen a neuropsychologist; 3) Aetna’s neurologist only spent about 30 minutes with the claimant, conducted only a screening test, and did not review raw data from the claimant’s treating physician’s neuropsychological testing.

This video is of disability attorneys Gregory Dell and Stephen Jessup discussing a case Mr. Jessup won on appeal against Hartford on behalf of his client who suffered from pain, swollen joints, and cognitive dysfunction due to Rheumatoid Arthritis (RA). The man reported that his pain was under control, but his cognitive problems interfered with his ability to do his job.
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