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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.

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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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In this video, disability attorneys Gregory Dell and Victor Peña discuss a case Mr. Peña won against MetLife for a claimant who came to us after his first appeal to MetLife was denied and his then attorney refused to continue. The man worked in a job that was classified as “light duty,” even though it required him to stand for long periods of time, lift heavy items, and work with tools. He suffered from back conditions, carpal tunnel syndrome, knee injuries and had other symptoms that interfered with his ability to work in his own occupation.
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In this video, disability lawyers Gregory Dell and Alex Palamara discuss Mr. Palamara’s recent win on appeal of long-term disability benefits from Cigna on behalf of a registered nurse who suffered from disabling back conditions including spinal stenosis and degenerative disk disease. Shortly after Cigna’s decision to award benefits, it made a buy-out settlement offer.
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In this video, attorneys Gregory Dell and Stephen Jessup talk about the difficulties doctors often face when applying for disability benefits. Many doctors are hesitant to admit they have a disabling condition. They fear it may affect their ability to sell their medical practice. They are also concerned about what may happen if patients discover their doctor has medical problems.
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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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