Articles Posted in Fibromyalgia Disability Claim

New Hampshire Court holds that Unum properly terminated LTD benefits based on self-reported pain limitation clause in policy even though Plaintiff provided objective proof of disability through a positive trigger point test.
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United Health Group employee suffering with Fibromyalgia is denied short term disability benefits and loses her battle with Sedgwick Claims in a Virginia court.

In the case of Day v. United Health Group, Inc. Short Term Disability Plan, the plaintiff sought disability benefits against the defendant, a self-funded plan that was administered by Sedgwick, due to complaints of abdominal pain and body pain resulting from fibromyalgia. This case is a prime example of why it is imperative to ensure that a claimant’s medical records provide actual “objective” medical evidence of their inability to perform the material and substantial duties of their occupation. It may seem logical that the opinion of one’s treating physician should take precedent over a third party reviewer hired by Sedgwick.

However, according to many disability policies, it is not sufficient for a claimant’s physician to conclude that they are unable to perform the material and substantial duties of his or her occupation, or even document symptompatolgy that explains such an inability. Without “objective” medical evidence of such a condition, some courts are concluding that the denial of benefits based on the lack of such evidence is reasonable.
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A New Jersey disability attorney filed a federal lawsuit against the Unum Life Insurance Company Of America (Unum) and MOL (America) Inc. Plan (MOL). The Plaintiff, Aleksandr K., worked as a computer programmer for MOL, which contracted with Unum to provide long-term disability insurance benefits to its employees. Plaintiff, because of his employment at MOL, was eligible and covered under this group policy.
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On August 17, 2001, John H. and his Texas disability attorney filed a lawsuit against UNUM Life Insurance Company of America in Federal Court in an effort to secure John H.’s disability benefits, both short term and long term, under the Employee Retirement Insurance Security Act of 1974 (ERISA).

While employed by ION Geophysical, John H. was covered under a UNUM group disability benefits policy that was effective for John H. as of January 1, 2005. And, since John H. was employed by ION Geophysical at the time of his disability, UNUM is obliged to provide him with disability benefits, but has failed to do so.
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A California disability attorney recently filed a federal lawsuit on behalf of a Cardiologist who has been unable to fully perform the duties of his occupation since a bicycle accident left him with serious injuries. The Plaintiff filed this disability lawsuit to recover long-term disability benefits that were wrongfully denied by Unum.
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A New Jersey disability attorney, on behalf of a disability claimant, recently filed a lawsuit at the District Court for the District Of New Jersey against the Provident Life and Accident Insurance Company (Provident) and Unum Group (Unum) under the Employee Retirement Income Security Act (ERISA) for allegedly adopting unreasonable claims procedure in denying the plaintiff’s claim for disability benefits.
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An Illinois disability attorney recently filed a lawsuit against the Life Insurance Company of North America (LINA) at the District Court for the Northern District of Illinois. In Deborah Shepherd Vs. Life Insurance Company Of North America, A Cigna Company, the plaintiff Deborah Shepherd alleged that LINA acted with specific bias and contrary to the fiduciary duties owed to the Plaintiff by denying her claim for long term disability LTD benefits and is seeking remedies through the Court. Let’s have a closer look at the case.
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Recently, three different lawsuits were filed under the Employee Retirement Income Security Act (ERISA) for denial of disability insurance benefits against the Prudential Insurance Company of America (Prudential) at the District Court of the United States. In all three cases filed through the respective plaintiffs’ disability attorney, Prudential was alleged to have wrongfully denied the respective plaintiffs their claim for long term disability (LTD) benefits.
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Mr. Scott A. Boles, a former restaurant manager employed by Telesis, Inc., filed a complaint in the Nebraska court against Unum for denial of disability insurance benefits under two separate claims. Boles, employed to manage various Lazlos restaurants, was covered by the Group Long Term Disability Insurance Policy issued by Unum to Telesis, Inc in 2006. Boles had also purchased Disability Income Insurance Policy in 1994, and has paid all the premiums as necessitated by the contract.
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