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.
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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.
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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.

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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.”
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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.
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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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