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December 2017 Archives

A Federal Court Overturns AETNA's Termination of Total Disability Benefits to a Claimant, finding that AETNA'S decision was Arbitrary and Capricious.

In a recent case, Patterson v. Aetna Life Insurance Company, No. CV 15-8156, 2017 WL 4786562 (D.N.J. Oct. 23, 2017), the United States District Court for the District of New Jersey, determined that Aetna's termination of Christopher Patterson's Long Term Disability Benefits was arbitrary and capricious. Mr. Patterson was employed by First Consulting Group, Inc. ("FCG"), which provided Long Term Disability Benefit coverage to its employees under the Long Term Disability group policy (the "LTD Policy"). The LTD Policy provided that disability occurs when an employee is unable to perform the material duties of their "own occupation" solely because of the disease or injury; and when the employee's work earnings are 80% less of their adjusted pre-disability earnings.

Attorney's Fees Granted for Sedgwick Arbitrary and Capricious Denial

In the case of Corey v. Sedgwick Claims Mgmt. Servs., et al., No. 1:15 CV 1736, 2017 WL 4844008 (N.D. Ohio Oct. 26, 2017), the Sixth Circuit remanded the case to the administrator for a "full and fair review." In this case, the Plaintiff was an employee for Eaton Corporation. As an employee, he was entitled to participate in the Corporations Disability Plan for U.S. Employees. The plan states that a participant is eligible for short term disability benefits if an illness, whether occupational or non-occupational, prevents them from performing the essential duties required for the job. In addition, the plan states that the participant would need to provide verification from a health care practitioner proving, that due to the disability, they will not be able to perform such duties. The plan requires, for both Short Term and Long Term Disability Plans, that the participants provide objective findings of disability. That is findings that their health practitioners observe through objective means, not the participants own description of the symptoms.

DI Law Group Successfully Resolves Cardiac Claim against Disability Insurance Co.

When our client, an attorney, originally hired us to help his with his ERISA long-term disability insurance claim, his claim for disability benefits had already been denied. He had been diagnosed with a cardiac condition and advised by his cardiologist to reduce stress and change his lifestyle in order to prevent further heart damage and possible heart failure. In keeping with his doctor's orders, he took on a less strenuous legal role in the law firm where he worked and significantly reduced his hours. After the filing of an appeal and then a lawsuit, the denial was ultimately reversed and our client continued to work in the reduced capacity prescribed by his physician and the insurance company paid his benefits for many years.

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