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In this video, Attorneys Gregory Dell and Victor Peña discuss trends with Disability Insurance companies. Insurers across the country seem to be getting stricter with their evaluation of claims. They are conducting more field interviews, more independent medical exams (IMEs), and using video surveillance. The goal seems to be to deny as many claims as possible. The more people a company has on claim, the less profit there is to the insurance company.

Unum, the oldest insurance company in America, is using long and extensive denial letters in an attempt to make it seem difficult to challenge. Other companies, particularly Cigna, seem to have a policy of denying initial claims. They take advantage of every level to deny a claim in order to discourage and delay the award of disability benefits. At Dell & Schaefer, we work diligently to present enough medical information so that we may be able to avoid the deny and delay tactic.
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In Sarah G. Gorena v. Aenta Life Insurance Company, Plaintiff was employed for 10 years as a staff analyst for Boeing when she sought disability benefits solely due to her diagnosis of multiple sclerosis (MS), although she had a number of other health issues. After being awarded several periods of short-term disability, in July 2015, she made a claim for long-term disability benefits (LTD). Her claim was denied, as was her administrative appeal. After exhausting her administrative remedies, she filed this ERISA lawsuit.
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In Mark v. Aetna Life Insurance Company and FedEx Office and Print Services, Inc., Plaintiff Julia Mark, an employee of FedEx Office, injured her neck, back, ankle, and left knee when she fell on a sidewalk. Her left knee continued to cause her pain. She filed a claim for short term disability benefits (STD) with Aetna, the disability Plan Administrator to whom FedEx had delegated authority to interpret the plan.
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In this recent case out of California, the Plaintiff previously worked in IT for the Capital Group Companies. However, he was forced to stop working on February 2, 2011, due to chronic fatigue and fibromyalgia. Through his employer, the former IT employee had long term disability coverage under a Policy with Reliance Standard. After applying for benefits, his claim was approved in August 2011 and ultimately paid through March of 2015. Unfortunately benefits after March of 2015 were denied as Reliance Standard believed he no longer satisfied the definition of disability. After numerous appeals were filed and numerous reviews conducted, a lawsuit was filed.
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In Kristen Reetz v. Hartford Life and Accident Insurance Company, the Western District Court for Seattle, Washington, granted Reetz’s motion for judgment, reinstating her long-term disability benefits that had been terminated by Hartford. As the Court commented, “Ms. Reetz’s medical history, as well as the facts behind Hartford’s termination of LTD benefits, are long and complex.”
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In James Wilson v. Reliance Standard Life Insurance Company, a Michigan District Court ruled in favor of Reliance and found its termination of long term disability benefits to plaintiff Wilson was not arbitrary and capricious.

Plaintiff, an Air Force veteran, was employed by RCF Information System, a defense contractor, as a Programmer/Systems Analyst, a sedentary position. After a little more than three years of employment, he was diagnosed in November 2014 with lymphoma of his spine, a malignant cancer. His claim for short term disability was approved and, as he continued to receive treatment for the lymphoma, his claim for long term disability was also approved.
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In Marie West v. Aetna Life Insurance Company, Plaintiff West, a contract administrator at Ciber Inc., fell down some stairs on October 22, 2007. She fractured her spine and suffered a traumatic brain injury (TBI). Although she continued working for a time, by June 2008, she had to undergo a spinal fusion. After attempting unsuccessfully to return to work, she required a second spinal fusion. She was still unable to work due to continuous debilitating pain. Finally, in July 2009, her claim for long term disability was approved based on a finding that she was unable to work in her own occupation.
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In this video, Disability Insurance Attorneys Alex Palamara and Gregory Dell discuss the issues with a recent case in which Dell & Schaefer Attorney Alex Palamara was successful in an ERISA appeal for his client against Lincoln Financial. Mr. Palamara was able to prove the negligence of Lincoln Financial for failing to properly investigate a long term disability claim.
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In this video, disability insurance attorneys Rachel Alters and Gregory Dell discuss a California Federal Court decision in which a SunLife disability insurance denial was reversed. The SunLife policy holder suffering from Fibromyalgia was on claim for 5 years when SunLife abruptly decided the claimant could return to work.
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In Melissa Vacarro v. Liberty Life Assurance Company of Boston, Melissa Vacarro was employed by NetApp Inc., when she began suffering from fatigue, pain and deteriorating cognitive abilities, particularly in the areas of memory and comprehension. She applied for disability benefits with Liberty, the disability insurer for her employer.

As an “HR Program Manger 5,” Plaintiff claimed to be a Class I employee. Liberty also covered Class II employees, which had a different and more stringent definition of long-term disability after the first 24 months of disability that the one for Class I employees.
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