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August 2017 Archives

Fourth Circuit Court of Appeals Finds Bert Bell/Pete Rozelle NFL Player Retirement Plan was Wrong and Unreasonable When it Denied a 9 Year NFL Veteran with Traumatic Brain Injury Total and Permanent Disability Benefits

In May of 2017, we discussed the case of Jesse Solomon v. Bert Bell/Pete Rozelle NFL Player Retirement Plan, where the district court held that the NFL Plan was wrong and unreasonable when it denied Total and Permanent Disability ("TPD") benefits to Jesse Solomon, a nine year veteran of the NFL with traumatic brain injury. Since that time, the NFL Plan appealed the decision to the Fourth Circuit Court of Appeals, which upheld the district court's decision that the NFL Plan acted arbitrarily and capriciously.

Federal Circuit Court of Appeals Holds that a Return of Life Insurance Premiums Paid After the Death of an Insured is Insufficient When an Insured Continued to Pay Premiums with the Understanding there was Continued Life Insurance Coverage

In the recent case of McCravy v. Metropolitan Life Insurance Company, 690 F.3d 176 (4th Cir. 2012), the Fourth Circuit Court of Appeals determined that a return of life insurance premiums to Mrs. McCravy after her daughter's death was insufficient where Mrs. McCravy continued to pay premiums through the date of her daughter's death with the understanding that there was continued life insurance coverage for her daughter. The Court ruled that under these circumstances, Mrs. McCravy was entitled to pursue her claims for the full life insurance benefit promised to her under the life insurance policies that she paid continued premiums for until her daughter's death.

Liberty Life's Wrongful Denial of Disability Benefits for Bipolar Disorder and Carpal Tunnel Syndrome

In the case, Suson v. The PNC Financial Services Group, INC., No. 15-CV-10817, 2017 WL 3234809, at *1 (N.D. Ill. July 31, 2017), Liberty Life Assurance Company of Boston, acting as the Plan administrator for PNC's ERISA disability plan, denied long term disability benefits to Ms. Suson who was diagnosed with bipolar disorder in 1996 and had received regular psychiatric treatment since 1990. She had also been treated for bipolar disorder and diagnosed with fibromyalgia and several other degenerative joint diseases for which she received regular treatment. Ms. Suson filed her claim for long term disability benefits on July 24, 2014. She initially based her claim for benefits on bipolar disorder but on September 3, 204 advised Liberty Life that she was also disabled due to fibromyalgia and physical limitations. Liberty denied Suson's claim for LTD benefits on October 8, 2014 stating that the records did not "reasonably support" that she had any "impairments attributable to the presence of mental illness that would preclude" her from working. Ms. Suson appealed the adverse determination and Liberty upheld its denial.

Cigna Continues to Engage in Unreasonable Delay and Denial Tactics of Disability Insurance Claims, Including Alleging that Disabling Conditions are Pre-Existing, After Cigna was Forced to Overturn Denials Under Similar Circumstances

In 2003, Susan Kristoff was diagnosed with breast cancer. After undergoing treatment, it was determined that she was in full remission and cancer free. As a precautionary measure, she was placed on Tamoxifen to prevent the recurrence of cancer in the future. Later, Susan was hired as an outside salesperson for a large corporation and obtained a disability insurance policy with Cigna through her employment. Susan continued to undergo regular evaluations and each time, her physicians assured her she remained cancer free.

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