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Florida and Nationwide Insurance Law Blog

Social Media Causes Long-Term Disability Claimant to Lose her Benefits

In a recent case out of the Fifth Circuit Court of Appeals, Davis v. Aetna Life Ins. Co., No. 16-10895, (5th Cir. 2017), the Court found that surveillance footage and social media were a contributing factor to the denial of the claimant's long-term disability benefits.

Sun Life Financial Acquires Assurant Employee Benefits for $975 Million

In March 2016, Sun Life Financial completed its acquisition of U.S. Employee Benefits business of Assurant for $975 million. This purchase nearly doubled Sun Life's Group Life and Disability business, and the combination of the companies created the sixth-largest group benefits business in the United States. On its own, Sun Life had business in force of about $2.6 billion, but with the acquisition of Assurant, the business in force is increased to about $4 billion. Sun Life further reported that following the acquisition, and as of June 30, 2016, it had total assets under management of $865 billion.

DI Law Group Successfully resolves Long Term Care Claim against Genworth

DI Law Group was hired to assist a 91 year old woman in obtaining the home health care benefits to which she was entitled under her long term care policy with Genworth Insurance Company. After months and months of providing Genworth with information, medical records, and physician forms clearly detailing her inability to safely dress, transfer, and bathe without either hands-on or standby assistance, she and her son became extremely frustrated and reached out to our firm. Our client, a widow who I will refer to as Mrs. X, procured a long term care and home health care policy over 25 years ago and timely paid her premiums every year because she felt it was important not to have to burden her children physically and financially should the day come that she could no longer take care of herself. About 2 years ago, Mrs. X began to experience some memory issues, balance problems, and overall weakness. However, she took great pride in being extremely independent and was extremely reluctant to admit that she needed assistance. As a result, her son (who is in his 60s) became very worried and felt it necessary to spend more time with her to make sure that she did not fall and could get to her doctor appointments. Unfortunately, her health continued to decline and after her 3rd or 4th fall he convinced him mom to apply for home health care benefits under her Genworth Long Term Care plan.

Federal District Court Finds that Hartford Failed to Provide a Claimant with a Full and Fair Review of her ERISA Governed Disability Insurance Claim.

In a recent case out of the Southern District of Indiana, Miller v. The Hartford Life And Accident Insurance Co., & Springleaf Finance, Inc. Disability Plan, No. 116CV00166TWPDML, 2017 WL 2214938 (S.D. Ind. May 19, 2017), the federal court found that Hartford failed to afford the Plaintiff a full and fair review of her ERISA governed disability insurance claim and remanded the matter back to Hartford to reevaluate the claim.

DI Law Group Sponsors the 2017 Celebrating everyBODY Walk supporting the Alliance for Eating Disorder Awareness.

DI Law Group was proud to sponsor the 2017 Celebrating everyBODY Walk, held by the Alliance for Eating Disorders Awareness. The purpose of the Walk is to foster awareness and understanding of and promote early intervention of eating disorders. As always, DI Law Group was honored to be a part of this inspiring and uplifting event. The Alliance for Eating Disorder Awareness provides free presentations, support groups for individuals and their families who are struggling with eating disorders, and publishes an annual national and local guide to treatment facilities. DI Law Group looks forward to sponsoring the Walk in the years to come and to continuing to support the vital work of the Alliance for Eating Disorders Awareness.

Reliance Standard Life Insurance Company Denial Tactics Dismissed By Court in ERISA Disability Case

Most individuals who have filed any type of insurance related claim have experienced the delay and denial tactics used by their insurance company to avoid payment. Disability carriers often take extreme and arguably egregious measures to "prove" that a claimant is not disabled under the terms of their disability policy. In a recent case, the US District Court for the Northern District of California found Reliance Standard Life Insurance Company's (RSL) denial of benefits wrong and ordered the company to reinstate the Plaintiff's benefits.

Seventh Circuit Upholds District Court's Decision that a Claimant with Fibromyalgia was Disabled under her ERISA Governed Disability Plan and Commented on the Disabling Nature of Fibromyalgia.

In a recent case, Kennedy v. The Lilly Extended Disability Plan, No. 16-2314, __F.3d__, 2017 WL 2178091 (7th Cir. May 18, 2017), the Seventh Circuit Court, overturned a disability insurance benefit denial of a claimant with fibromyalgia. The claimant in the Kennedy case was the executive director of Lilly's human resources department, earning a monthly salary of $25,011. Kennedy was diagnosed with fibromyalgia and was suffering from its severe symptoms. Ultimately, she was unable to continue to work and filed a claim for disability benefits under Lilly's self-funded ERISA governed disability plan. Originally, Kennedy's claim was approved and she received benefits for over three years. However, the plan required Kennedy to undergo a physical evaluation over 100 miles from her home by a physician it hired. The "examination" lasted a mere five-minutes. The plan also hired a rheumatologist to conduct a records review of Kennedy's medical information, who falsely alleged that the American
College of Rheumatology does not consider fibromyalgia to be disabling on an extended basis. Based on the opinions of these two physicians, the plan terminated Kennedy's benefits.

The Fifth Circuit Court of Appeals Calls into Question Whether Deference Should be Given to the Factual Benefit Determinations of ERISA Plan Administrators.

In a recent decision, Ariana M v. Humana Health Plan of Texas, Inc., 2017 WL 1423765 (5th Cir. April 21, 2017), the Fifth Circuit Court of Appeals called into question the validity of its holding in Pierre v. Connecticut General Life Insurance Co./Life Insurance Co. of North America, 932 F.2d 1552 (5th Cir. 1991), in which the Fifth Circuit held that courts had to give deference to an ERISA benefit plan administrator's factual determinations, even if the plan did not contain a discretionary clause. Accordingly, under Pierre, a reviewing court cannot overturn an ERISA plan administrator's denial of benefits unless it found that the denial of benefits was arbitrary and capricious, an extremely high bar to reach for claimants.

Bert Bell/Pete Rozelle NFL Player Retirement Plan and the NFL Player Supplemental Disability Plan Ordered by Federal District Court to Pay NFL Player Full Disability Benefits

The Bert Bell/Pete Rozelle NFL Player Retirement Plan and NFL Disability Plans are notoriously difficult for a NFL player to collect benefits under from the NFL. Further discouraging is that rarely are the cases filed by NFL players denied disability benefits under these Plans won in court. However, recently, a federal district court found that the Bert Bell/Pete Rozelle NFL Player Retirement Plan and the NFL Player Supplemental Disability Plan were wrong to deny disability benefits to retired player Jesse Solomon and ordered the NFL Plans to pay him the full disability benefits at issue.

AVOIDING LONG TERM CARE POLICY DELAY TACTICS

Long Term Care/Home Health Care Insurance providers seem to make a habit of doing everything possible to delay making a decision on a long term or home health care claim for benefits in what would appear to be a clear effort to avoid paying benefits owed under these very important, and often lifesaving policies. Like many of our clients, Mrs. X procured an insurance policy that would pay for a health care aid in her home if and when she needed assistance with at least two of the Activities of Daily Living. At age 91, she had balance issues and was weak; and thus it became dangerous for her to bathe without hands on assistance, get dressed without hands on assistance, and get in and out of chairs, her bed, or a car without either hands on or standby assistance. Despite what would appear to be her clear right to benefits under her policy, her long term care insurance company, John Hancock, continued to request information from Mrs. X and her physicians, claiming they did not have sufficient information upon which to make a decision. Because Mrs. X could not function without assistance from an aide and had little family in the area that could help her, she was forced to pay the home healthcare aid from her own limited finances, thereby making it extremely difficult for her to meet her monthly financial obligations.

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