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If you have a disability insurance policy, it is important to understand what that policy covers in case you ever lose your ability to work due to an illness or physical injury. Policies differ with regard to the type of conditions covered, the length of time of...
Each year, millions of Americans pay insurance companies for coverage, trusting that if the unexpected happens, the terms of the policy will be honored and their claims will be paid. One type of policy is Accidental Death and Dismemberment insurance. What Is...
Your insurance claim has been denied, now what? Dealing with insurance claims that have been denied can lead to frustration, confusion, and discouragement. The reality is, the appeal process can be complex and leave you feeling overwhelmed. We are here to help. First,...
Insurance companies that sell short- or long-term disability insurance policies are in business to make a profit. It follows that they are not necessarily there to be benevolent supporters of their policyholders when they struggle with disabling health conditions. To...
Most disability insurance policies allow the insurer to arrange for a reasonable, relevant independent medical examination (IME) of the claimant. While on its face this sounds fair and even potentially helpful for a disability claimant, the insurance company may use...
Life insurance seems straightforward. You buy a policy or get one through your employment that will pay money to your beneficiary after your death. You name your beneficiary or beneficiaries as part of the enrollment process and normally can change your beneficiary...
Using a variety of surveillance and investigation techniques, disability insurance companies often try to gather information about claimants’ daily activities. Then, they use the information to say the claimants are not disabled – and not eligible for disability...
Different laws apply to each of two types of disability insurance policies. The first kind of policy is governed by the federal law ERISA, short for the Employee Retirement Income Security Act of 1974, which applies to almost all policies offered through employment....
Court in ERISA appeal finds classic LTD disability insurer cherry-picking Disability insurers have an arsenal of tactics to deny or terminate disability benefit claims. One common tactic is “cherry-picking” in which the insurer or its claims administrator picks...
A federal appeals court on April 5, 2021, agreed with the trial court that the insurer had denied the short- and long-term disability insurance claimant’s applications wrongly and without the required substantial evidence to do so. Last year, we talked in this space...
On March 22, 2021, the U.S. District Court in the Western District of Washington ordered Prudential to pay long-term disability (LTD) benefits to the claimant, a software engineer who said he was unable to work based on mental impairments that developed after abusive...
Most disability insurance policies contain clauses that provide for the denial of disability claims for the first policy year if the disabling impairment was a pre-existing condition during a period of time immediately before the policy took effect – called the...
Life insurance is often purchased to protect the surviving beneficiary or beneficiaries financially, especially if the insured was a breadwinner. Because of this, it is important that insurance companies timely pay life insurance benefits. The last thing a grieving...
While the medical community has communicated that many people who get COVID-19 either have no symptoms or a mild case, they have also advised that many experience severe symptoms, even if they do not require hospitalization. Additionally, an increasing number of...
For most of the past year, hospital based nurses, doctors, and medical staff as well as first responders have been repeatedly exposed to the traumatizing effects of COVID-19. Watching patients suffer from an illness about which we have little understanding and having...
On October 15th, the U.S. Court of Appeals for the 11th Circuit ruled in favor of our client, Darren Mickell, in the case, Mickell v. Bell/Pete Rozelle NFL Players Retirement Plan, holding that the NFL abused its discretion when it denied disability benefits to...
After paying the premiums for long-term care insurance coverage for years, it can be emotionally upsetting and financially devastating when the insurance company denies a claim for benefits. Unfortunately, this scenario is not uncommon. Long-Term Care insurers utilize...
We are all at risk of needing a long-term care support system should we become chronically sick, sustain a long-lasting or permanent injury, develop problems with cognition or face frailty related to the aging process. When one of these challenges prevents someone...
The U.S. Court of Appeals for the Sixth Circuit recently held in favor of a long-term disability (LTD) claimant whose insurance company denied his claim based largely on severe, chronic back pain. Disability insurance companies often improperly discount credible...
We are currently having a collective experience that provokes some degree of natural anxiety in almost everyone. However, when the level of anxiety becomes overwhelming, it can prevent a person from being able to work in their occupation. Individuals with a private,...
Disability insurance policies often ban coverage for disability that stems from pre-existing conditions. In other words, if someone had a medical problem within a specified time frame prior to their effective date of coverage and they became disabled within the first...
The challenges of COVID-19 are not limited to contracting the virus and becoming ill. Many people are experiencing extreme stress and even trauma as a result of the pandemic – including first responders, medical personnel, those at greater risk due to advanced age or...
A federal court in Texas recently found in favor of a long-term disability (LTD) claimant whose insurer had terminated his benefits. The March 10 opinion illustrates federal rules for interpreting disability insurance policies. In Chavez v. Standard Insurance Co., the...
Our client, Mrs. Y was covered under her employer-provided Short-Term and Long-Term Disability Insurance Policy, issued by Metropolitan Life Insurance Company (“MetLife”). Ultimately, Ms. Y became disabled from her occupation and any occupations due to cervical and...
People acquire disability insurance as a safety net to provide financial support should they become disabled from working. Short- and long-term disability insurance policies fall into two buckets. On one hand, group policies such as those available through employers...
Alicia Paulino-Grisham, one of the founding partners of Disability Insurance Law Group, is providing a live video presentation called Disability: Navigating the Maze, for the Lupus Foundation of America on April 14, 2020 at 6:00 pm to 7:30 pm. Ms. Paulino-Grisham...
On January 21, an Alabama federal court decided that the proper standard of judicial review in an appeal of a long-term disability insurance benefit termination was “de novo” review. In an appeal of a federal disability insurance denial or termination, the court must...
Kansas City Life Insurance Co. denied the short- and long-term disability applications of a nurse anesthetist who was allegedly taking Fentanyl on the job. The insurer said that the reason the claimant lost his job was a failed drug test after coworkers reported he...
At our law firm, we represent professional athletes in their claims for disability insurance. Pro athletes are of course at higher risk than most people of serious work injury because of the dangerous nature of high-level athletic performance on a regular basis....
We recently posted information in this space about how disability insurers use surveillance to investigate the lifestyles of their disability claimants to try to uncover evidence that the claimants’ activities are inconsistent with the medical conditions...
A recent court opinion sheds light on the ramifications of disability insurance policy language that describes what powers the insurer's administrator has to decide claims. We recently posted a blog about the standards of review courts apply when considering an appeal...
When you are ill or injured to the point where you had to file a claim for disability benefits under your disability insurance policy, it can be disheartening to learn that during the initial review process or even while on claim that your insurance company put you...
A federal appeals court decided that because a disability insurance plan administrator missed a strict ERISA deadline for issuing a benefits decision on review, the correct standard for the court reviewing the denial of benefits to use is "de novo" rather than...
A large insurance company that sells short- or long-term disability coverage can intimidate an individual fighting for their rightful benefits after having become disabled. When that insurer decides its own claims internally, rather than outsourcing that...
At , we represent professional athletes in their claims for long-term disability insurance often based on debilitating mental or physical injuries. Obviously, professional sports are not gentle on bodies or brains and disabling injuries can...
On Sept. 3, the U.S. Court of Appeals for the 1st Circuit held that Aetna had wrongly denied long-term disability insurance coverage to a claimant with malignant melanoma. The opinion turns on a legal issue that comes up often in LTD cases — whether the claimant...
When Florida residents have a medical disability that keeps them from working, they often depend on their disability insurance to help them financially survive. Unfortunately, insurance companies sometimes refuse to pay, leaving people between a rock and a hard place....
Injuries that occur on the job may be compensated through a workers' compensation claim. However, injuries that result in a prolonged absence or even permanent disability may qualify the employee for benefits under their employer's short-term disability and/or...
If you do, you could suffer from agoraphobia. The hallmark of this anxiety disorder is a need to get away from situations and places that make you feel panicked, helpless, embarrassed or trapped. You may feel like you need to get back into your comfort zone.You may...
Florida residents and others looking to purchase life insurance should understand that policies are binding contracts. Therefore, they may contain exclusions or exceptions that buyers need to look for prior to making a purchase. The exclusions or loopholes included in...
When a person is unable to work due to a medical condition, he or she may need certain types of financial support. If you find yourself in this position, you may understand first-hand how complicated it can be to navigate the process of recovery, from getting the...
The National Football League is well known for denying the valid disability claims of its players. After submitting a claim for disability benefits to the NFL, which is self-insured and administrates all NFL claims, the player is often sent to numerous "neutral"...
NPR recently published the web article, 'Mental Health Parity' Is Still An Elusive Goal In U.S. Insurance Coverage, written by Graison Dangor....
Ms. R. was an executive of a large corporation for over 12 years. She was on track to take over the eastern division of her company. Ms. R. began noticing that during the day, she felt fatigued; however, it was not a normal feeling of being tired. It felt more like a...
Multiple sclerosis is considered an "immune-mediated" disease, where an individual's immune system attacks the central nervous system. The cause of multiple sclerosis is unknown. However, scientists believe that a combination of genetic and environmental factors...
When Florida residents file claims with their private or group disability insurance, they may be surprised to find themselves confronted with delays or denials of the claim. This can be devastating as people often rely on these insurance policies to provide...
is the proud sponsor of the Lupus Foundation of America Walk to End Lupus Now. sponsored and attended the Walk that took place on April 27, 2019 in Orlando, Florida. Our Team has also sponsored and will attend...
Ms. Doe hired to assist her in the claims process after being confused by CIGNA's handling of her claim due to Traumatic Brain Injury. Ms. Doe suffers from Mental/Nervous Disorders including anxiety and depression as well as physical...
Florida residents who collect Social Security Disability benefits might be alarmed to hear the details of a new proposal from the Trump administration. In an effort to catch people allegedly faking their disabilities, the proposed policy promotes the use of...
As you age, preparing for the future becomes a priority. Florida residents may be living longer, but they are also suffering from physical and mental ailments that require a substantial amount of care.The odds of needing long-term care at some point in the future...
Many people in Florida and elsewhere in the country have faced serious hardship after their applications for disability benefits were denied by their insurance companies. One firm, Life Insurance Co. of North America, was found to be liable in its treatment of a woman...
A professional may face difficulties when attempting to bring a claim to a disability insurer. Doctors, lawyers, business owners, and other skilled professionals work hard and spend significant sums of money to make sure they have disability insurance policies that...
Surveillance is a frequent tool used by disability insurance companies to try to deny or terminate claims. We often hear from claimants: "I have nothing to worry about, because I am actually disabled. Let them follow me;" "I would know if I were under surveillance;"...
As more people are becoming accepting of transgender surgery, insurance companies are changing policies. In this vein, a major disability carrier recently did so after initially denying a claim. This is good news for the transgender community in Florida as many are...
Before you submit an appeal of your group short-term ("STD") or long-term ("LTD") disability claim, it is essential that you understand your obligations and rights under the applicable law. What you do not know, could hurt you!Most group STD and LTD claims that you...
There is a great disparity in how people think about insurance. Many Florida residents think of it as a necessary evil and purchase the minimum required for specific purposes, while others seek to protect themselves against risk by acquiring upgraded and broader...
Most Florida residents rely on the insurance company they work with to get their policies right. After all, they may not feel as though they have a choice in purchasing insurance in the first place, so they discuss coverage options and begin paying premiums.However,...
In May 2015, Wells Fargo & Company (Wells) hired Rosa Ramirez as a Financial Crimes Specialist. Shortly thereafter, in August 2016, Ms. Ramirez stopped working at Wells after suffering a mental breakdown following an altercation with her manager. Thereafter, due...
Having insurance coverage can provide peace of mind. The hope, of course, is to never have reason to file a claim, but the expectation is that if a loss occurs, the insurance company will respond in a timely manner, address the issue professionally and pay an...
If you are a private insurance policyholder in Florida, you have a right to file a valid claim should you need insurance benefits for a specific purpose related to your policy - e.g., a car accident, flood or theft. But if you have a claim that's denied, you have a...
Our client (Ms. X), a director of credit and collections in New York, hired to assist with her Long-Term disability claim with Cigna. She was diagnosed with Fibromyalgia, Lupus, Encephalopathy, Migraine headaches, Chronic Fatigue, Sleep...
In Florida, your claim for long-term care benefits is governed by your long-term care insurance policy. If you're no longer able to care for your needs on your own and need to go into a long-term care facility, it's important to obtain a complete copy of your...
Throughout the time claimants are eligible for disability benefits and benefits are being paid, claimants are intermittently advised that their claim is being reviewed and that updated information is required. This often indicates that the insurance company is...
Individuals who receive short term disability and long term disability coverage as a benefit of their employment are often shocked when their insurance carrier unreasonably delays the review and approval of a claim or unjustifiably denies or terminates their...
Those who have filed insurance related claims have experienced the outcome-driven assessments in which insurance companies typically partake to determine an individual's disability. A recent federal court case, Gorena v. Aetna Life Insurance Company ("Gorena"), is a...
Insurance companies in Florida and throughout the country are required to act in good faith in investigating and paying out policy claims. However, bad faith is defined differently depending on where the claim is made. In some cases, a bad faith action by an insurance...
Many Florida residents experience traumatic events. Some of them are able to deal with the situation and move on with life within a reasonable amount of time. However, others cannot move on from the trauma quite to so easily. They tend to bear the scars from the event...
When faced with a disability claim, the definition and interpretation of "totally disabled" under your assigned plan is central to the outcome of your claim. As portrayed in Derichs v. AT&T Services, Inc., a recent US District Court for the District of Kansas...
In many instances, insurances companies in Florida and other states make an effort to meet the needs of families and individuals with unique care requirements. But one mother has experienced unexpected difficulties with her insurance provider about a request for a...
A long-term disability policy is designed to help a Florida resident pay for costs related to treating medical issues. According to one woman, Liberty Life Assurance Co. failed to live up to the terms of a policy that she participated in. The suit was filed in U.S....
When a family in Florida loses a loved one, the pain and grief can be immense. Unfortunately, the practical costs can also be significant. This includes dealing with final expenses, hospital bills and funeral costs. When a life insurance policy refuses to pay out,...
Individuals in Florida and throughout the country are eligible to buy health insurance through the Affordable Care Act (ACA). About 80 percent of those who buy policies through the ACA receive subsidies to make their policies more affordable. As part of changes to the...
You may think that purchasing a life insurance policy is the safest way to provide for your loved ones after your death. It is a simple transaction with you paying your premiums and your loved one receiving a payout after your death.Unfortunately, if it were that...
People in Florida typically seek out medical care at emergency rooms for acute and worrisome conditions and injuries. To discourage the use of emergency care, the insurance company Anthem launched a policy of reviewing emergency charges and denying coverage if the...
When a Florida resident gets seriously injured or sick and needs to file a claim on their disability insurance, they could be faced with an unexpected denial of benefits. Many group and other employer insurance plans are covered under ERISA, the federal Employment...
Some people in Florida who have long-term care insurance could have their claims denied if the insurer rules that it is related to a preexisting condition. This happened to a woman in Louisiana who had only a 1 percent chance in 2012 that breast cancer would return...
Life insurance is a common way for Florida residents to assure the continued security of family members in the event of one's death. A woman in Perryville has filed a lawsuit against Life Insurance Co. of North America, alleging breach of contract and claiming she is...
Losing a loved one is never easy, even if it was expected. After the funeral and burial, there are usually several matters to take care of in order to close out his or her estate. One of those items may be to file a claim against one or more life insurance policies...
Fibromyalgia and Chronic Fatigue Syndrome, also referred to as Myalgic Encephalomyelitis, are debilitating conditions characterized by feelings of extreme exhaustion, muscle and joint pain, memory problems, brain fog, and problems with concentration. Many of our...
Collecting on a life insurance policy can sometimes lead to unexpected problems for bereaved Florida families. One case on the other side of the country illustrates the kind of difficulties that people can face. In Utah, a man was shot and killed by a police officer....
People in Florida who have long-term disability insurance through their employers or as standalone policies may believe that they will be protected if they are disabled and no longer able to return to their jobs. Unfortunately, some insurance companies routinely deny...
Recently the United States District Court for the District of Colorado determined an insurance provider wrongfully terminated a client's long-term disability (LTD) benefits. Paquin v. The Prudential Insurance Company of America highlights potential issues for others...
Florida nurses face complex risks and hazards every time they clock in for work. Health care is an ever-changing and difficult industry, and the men and women who work in this field as nurses may face certain physical risks on the job. Nursing can be hazardous, no...
Nursing home care, assisted living care, home care and other types of long-term care can all carry high costs. One thing some individuals do to try to reduce the financial impact future long-term care needs would have on them and their family is to get a long-term...
In a clip from FRONTLINE's League of Denial, neuropathologist Dr. Ann McKee discusses the brain of Penn football player Owen Thomas, who took his own life at age 21. After Thomas's death, Dr. McKee studied Mr. Thomas's brain and was shocked to find evidence of Chronic...
It took far too long for the medical community to realize that eating disorders require the same attention, compassion and treatment as any other disease or disorder. It took even longer to understand that there is more than just a physical component to these...
Without a doubt, you have had some frightening moments in the recent past. Perhaps you have sat in an emergency room on more than one occasion or called for an ambulance for your unresponsive loved one. Certainly, you had more than one argument with your child, an...
The case Thomas v. The Prudential Insurance Company of America, 2018 WL 211 118020, US Dist. Ct. E.D. Pennsylvania, is a reminder of how important it is to understand the implication and consequences of all terms in a severance agreement. When drafting a severance...
An interesting article published in ACS Surgery News compares surgeons to athletes and discusses how surgery is a performance sport that often requires strength and grace.See...
was hired by Dr. Brown to assist him with his claim for disability benefits under both the group policy procured for him by his professional medical association and the private disability policies he took out on his own. While Dr. Brown...
On February 22, 2018, the American Conference Institute ("ACI"), one of the leading organizations on educating the insurance industry, conducted its annual National Advanced Forum on Litigating Disability Insurance Claims. Alicia Paulino-Grisham was again invited to...
A denial of disability insurance benefits too often comes as a surprise to individuals who file legitimate claims and are genuinely unable to competently perform their job duties with reasonable continuity. Making the decision to apply for disability insurance...
Section 503 of ERISA requires employee benefit plans to provide written notice to any participant or beneficiary whose benefit claim has been denied, and to provide the claimant a full and fair review of the claim. Despite these protections, claimants face an uphill...
Lincoln Financial Group has announced that it has entered into an agreement to acquire Liberty Life Assurance Company of Boston from Liberty Mutual Insurance Company for $3.3 billion. The acquisition is expected to be completed in the second quarter of 2018. With this...
In the case of Van Steen v. Life Insurance Company of North America ,WL 256806 (10th Cir. Jan. 2, 2018) the Tenth Circuit, affirmed the district court's decision, finding that Life Insurance Company of North America's decision to terminate Mr. Van Steen's benefits was...
In the case of Horneland v. United of Omaha Insurance Company, the eleventh circuit reversed the United States District court for the Middle District of Florida's decision finding for the defendant. In the case, Horneland sued United of Omaha Life Insurance Company...
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...
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...
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...
In a recent case, Horneland v. United Of Omaha Insurance Company, No. 16-16935, __F.App'x__, 2017 WL 5508496 (11th Cir. Nov. 17, 2017), the Eleventh Circuit Court of Appeals reversed a federal district court's grant of summary judgment to United of Omaha ("UOO") in an...
Hartford Financial Services Group just announced that it will purchase Aetna Inc.'s U.S. group life and disability business for $1.45 billion cash. Reuters reports that Hartford will use $273 million it has outstanding from its 2017 equity buyback program for the...
In October 2017, Attorney, Alicia Paulino-Grisham, presented a continuing education seminar to clinicians at the Alliance for Eating Disorders Awareness regarding the health insurance claims and litigation process.The course discussed the role of mental health...
In a recent case out of the Southern District of Florida, Johnston v. Aetna Life Ins. Co., No. 1720996 2017 WL 4654431 (S.D. Fla. Oct. 16, 2017), the court rejected Aetna's argument that discovery was not permitted, beyond the administrative record assembled and...
Ms. "Jones" contacted after being advised by her representative at Liberty Mutual that her claim was being reviewed under the "any occupation" definition of her Long Term Disability Policy. At the time Ms. Jones became disabled she was a...
In a recent case out of the Southern District of Florida, the district court held that while the PNC Plan provided PNC with discretion to determine questions of coverage and eligibility for benefits, there was not a proper grant of discretion to the third-party...
Many times, an interpleader action is pursued by a life insurance company after two or more individuals file a competing life insurance claims for the same death benefit that is only required to be paid once under a life insurance policy. A life insurance company...
Julissa Bradshaw had a healthy pregnancy and no other pre-existing medical conditions when she became insured under her ERISA governed disability insurance policy with Reliance Standard Life Insurance Company ("RSL"). Approximately six months after obtaining the...
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...
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...
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...
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,...
By Maggie Smith of :In a decision last month out of the Fifth Circuit Court of Appeals, the Court found Metropolitan Life Insurance Company ("MetLife") was unreasonable to reduce Mr. Thomason's long-term disability benefits by pension funds...
In a recent case, Marcin v. Reliance Standard Life Insurance Company and Mitre Corporation Long Term Disability Insurance Program, No. 16-7125, __F.3d__, 2017 WL 2818648 (D.C. Cir. June 30, 2017), the Court of Appeals for the District of Columbia, ruled against...
On behalf of the posted in ERISA on Monday, June 26, 2017.In a recent case out of the Second Circuit Court of Appeals, Arnone v. Aetna Life Ins. Co., No. 15-2322, 2017 WL 2675293 (2d Cir. June 22, 2017), the Court found that a personal...
Our client (Mr. X), a stockbroker in New York, experienced anxiety and major depression as the result of family related issues and the death of his mother after her long battle with cancer. His treating psychiatrist and therapist both advised him to avoid as much...
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...
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,...
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...
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...
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...
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...
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....
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...
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...
Almost fifteen years ago, Unum Provident entered into a historic multi-state settlement with 3 lead states, 46 other states and the District of Columbia, as well as the U.S. Department of Labor, that cost it in excess of $120 million to comply, required it to reassess...
In a recent case, Sec'y United States Dep't of Labor v. Kwasny, No. 16-1872, __F.3d__, 2017 WL 1244852 (3d Cir. Apr. 5, 2017), the Third Circuit Court of Appeals determined that held that the Secretary of the Department of Labor is not bound by the results reached in...
Many group Long Term Disability policies limit the payment of benefit to 24 months if the disability is "due in whole or part to mental illness." However, insurance companies can be quite liberal with this language and apply it to claims where there are cognitive...
In a recent case, the First Circuit Court of Appeals determined that Standard Insurance Company acted arbitrarily and capriciously when it denied an environmental attorney with severe depression Long-Term disability insurance benefits. The claimant was an equity...
As many insureds suffering from depression and/or anxiety can attest, filing a disability insurance claim based on these illnesses can be complicated and frustrating. Because "objective evidence" of depression and anxiety is not always readily available, these claims...
A recent case out of the North District of Oklahoma, Anderson-Posey v. Unum Life Ins. Co. of Am., involved a long-term disability insurance policy issued by Unum Provident and governed under the Employee Retirement Security Act of 1974 ("ERISA"). The claimant was a...
A federal district court recently overturned Northwestern Mutual's denial of own occupation disability insurance benefits to an attorney with congestive heart failure unable to handle stress. The case Mustain-Wood v. Northwestern Mututal Life Insurance Company...
Many group and individual disability insurance policies provide protection in the event that a claimant cannot perform the material duties of their Own Occupation ("Own Occupation Period") for a limited period of time (typically 24 months). In many policies, after the...
Many insureds are discouraged from pursuing a claim for long term disability benefits prior to receiving an approval of short term disability benefits or after receiving a submitting an appeal of short term disability benefits. A potential problem with simply waiting...
On February 1-2, 2017, the American Conference Institute ("ACI"), one of the leading organizations on educating the insurance industry, conducted its 20th National Advanced Forum on Litigating Disability Insurance Claims. Alicia Paulino-Grisham was honored to again be...
The value of making sure all necessary proof of disability is obtained and clarified prior to filing a claim for disability benefits is imperative to the success of any claim, whether it is filed under a group policy, an individual policy, or multiple policies...
Troiano v. Aetna Life Insurance Company, No. 16-1307 (1st Cir. 2016), involved a disability insurance claimant who was approved by an ERISA Plan Administrator, Aetna, for monthly disability benefits. However, the parties disputed how benefits should be calculated. A...
Liberty Mutual Insurance Company's Leave of Absence policy was recently changed to provide that "[failure to return from leave...after 24-months may result in termination of employment." As a result, many employees on an approved leave of absence because of medical...
Ms. A became a kindergarten teacher in 2001. She loved her job and each of the children she taught throughout the years. Unfortunately, in the winter of 2014, Ms. A. was in a serious car accident. She was stopped at a light when a pick-up truck struck her car from...
Many purchase long term care insurance for peace of mind. That is the selling point of these often pricey policies and the promise made to insureds by their long term insurance carrier. Unfortunately, when an individual has gotten to the point where they struggle to...
Attorney, Alicia Paulino-Grisham was interviewed by the Alliance for Eating Disorder Awareness regarding the health insurance claims process. In the interview, Ms. Paulino-Grisham discussed that many patients and their families often find the health insurance claims...
Insurance companies frequently use private investigators to place claimants under surveillance while "investigating" a claimant's right to disability insurance benefits. Surveillance is conducted at various stages in the disability insurance process including, when a...
For years, insurance companies have aggressively marketed their disability insurance coverage to physicians, specifically targeting "specialists" with attractive "Own Occupation" protection. They induced physicians to purchase disability insurance with liberal...
Our client, Mr. D was a partner at a large accounting Firm for 9 years. Unfortunately, he began to experience severe and debilitating symptoms and was ultimately diagnosed with Multiple Sclerosis ("MS"). Mr. D had difficulty accepting the diagnosis and sought a second...
After putting herself through law school, Victoria was offered and accepted a position as an associate attorney in a medium size law firm handling contract disputes. Victoria enjoyed the practice of law immensely and due to her strong work ethic and drive, she...
Cosmopolitan Magazine published an article titled, Why is it so Difficult to Treat Eating Disorders, authored by Anna Maltby. The article provides an in-depth analysis of the the social and legal attitudes toward eating disorders. It discusses that eating disorders...
Partner and prominent insurance lawyer, Maggie M. Smith, was interviewed by Myra Goldick on her Dancing On Our Disabilities Internet Radio Show segment focused on disability and long-term care insurance. The show was broadcast on Friday, October 14, 2016, and is...
In September 2016, the American Conference Institute (ACI), one of the leading organizations on educating the insurance industry, conducted its 19th National Advanced Forum on Litigating Disability Insurance Claims. Alicia Paulino-Grisham was again invited to...
Our client, Ms. W, enjoyed a long and successful career as an office manager for a mid-size company. Unfortunately, shortly after receiving a promotion, she began to experience unusual and troubling symptoms such as extreme fatigue, severe pain in her joints,...
Prominent disability insurance lawyer, Maggie M. Smith, was a featured guest on Legal News and Review Radio Show on the topic of disability insurance law. The show was broadcast on 1230 AM Radio - WBZT and iHeart HD Satellite Radio from 6-7pm on Friday, July 15, 2016....
In many cases, without the claimant's knowledge, insurance companies hire private investigators to follow the claimant and conduct video surveillance over a period of several days. This video is often used to create the illusion that because the claimant is functional...
Stories about unfair and what can often be described as despicable behavior by insurance companies are not all that uncommon. A recent segment on the CBS news show 60 Minutes, titled "Not Paid", exposed the unethical practice of many life insurance companies in which...
Chiropractic Physician, Joan Hangarter, owned her own chiropractic practice in Berkeley, California and during a typical day she would treat between 30 and 50 patients. In 1989, Dr. Hangarter purchased an "own occupation" disability insurance policy from Paul Revere....
Alicia Paulino—Grisham was invited by the Florida Chiropractic Physician Association (FCPA) to present a Continuing Education seminar on navigating the disability insurance claim process at the FCPA’s annual winter meeting in Orlando Florida. On February 26, 2016, Ms....
Alicia Paulino-Grisham was invited by the American Chiropractic Association (ACA) to present a Continuing Education seminar on navigating the disability insurance claim process at the ACA’s annual meeting in Washington, D.C. On February 27, 2016, Ms. Paulino-Grisham...
February is Eating Disorders Awareness Month, and Disability Insurance Law Group once again proudly sponsored and participated in The Alliance for Eating Disorders Awareness celebrating everybody walk. The 5th annual walk was held at Sunset Cover Amphitheater South...
February is Eating Disorders Awareness Month, and Disability Insurance Law Group believes a critical time to devote time and resources to raising awareness and promoting education of eating disorders. Among other efforts, Disability Insurance Law Group Partner Alicia...
In a recent Supreme Court Case, Montanile v. Board of Trustees of the Nat. Elevator Industry, the Supreme Court held that "Other Income" benefits (Social Security disability benefits, workers compensation awards, personal injury settlements) paid to a claimant by a...
In January 2016, the American Conference Institute (“ACI”), one of the leading organizations on educating the insurance industry, conducted its 18th National Advanced Forum on Litigating Disability Insurance Claims. Alicia Paulino-Grisham was again invited to...
Dr. Leonor, a dentist, recently sued Provident Life and Accident Company after it paid and then terminated his total disability benefits under his disability income insurance policies. The disability income insurance policies at issue obligated Provident to pay total...
Disability Insurance Law Group recognizes that amidst the bustle and joy of the holiday season is a tremendous need of many less fortunate. Helping others is at the heart of Disability Insurance Law Group‘s practice, and the firm believes the holiday season is a time...
There is a great deal of misinformation about the amount fraud against disability insurance carriers. While some people may believe going out on disability is akin to an early retirement, those individuals who are truly disabled know this is certainly not the case...
Disability Insurance Law Group Founding Partner, Alicia Paulino-Grisham was a featured guest for the webinar “Learn to Navigate Insurance Coverage and Exercise Your Rights,” as a part of The Renfrew Center’s 2015 Webinar Series. Ms. Paulino-Grisham presented with...
Whether an emergency room physician working as a general practice physician is totally disabled or partially/residually disabled under a disability insurance policy depends on the type of disability insurance policy that is at issue, and the law governing the policy...
Insurance Companies such as Aetna, Assurant, Berkshire, Cigna, Guardian, Liberty Mutual, MetLife, Reliance, Standard, and Unum are well-known for unfair and biased claims review processes, misrepresenting the facts, and for denying valid disability benefit claims....
Numerous cases exist where a physician who has specialized as a surgeon becomes unable to perform surgical procedures due to injury or illness but remains able to still perform other duties as a physician. Whether or not this is considered a total or residual...
In the case of Giddens v. Equitable Life Assurance Society of the United States, 445 F.3d 1286 (11th Cir. 2006), the Eleventh Circuit Court of Appeals held that regardless of his intent, if Dr. Giddens was not practicing dentistry at the time of his disability under...
It has been estimated that only about 40 percent of players in the National Football League (NFL) purchase disability insurance coverage. This combined with the fact that a mere 50 percent of the compensation in the NFL is guaranteed and the extremely high risk of...
Accepting that it's now time for a parent, loved one, or even yourself to seek the benefits provided by the long term care policy procured years ago and for which the premiums have been paid ever since is often difficult and life-changing. The one solace is that there...
When applying for disability insurance benefits it is extremely important that the application for benefits is properly completed and that there are no ambiguities that can be misrepresented or misinterpreted by the insurance carrier. The application is the insured's...
Most consumers purchase disability insurance coverage with the hope that they'll never have to use it....that the policy document will gather dust in a filing cabinet somewhere. The reason the disability insurance premiums are a justifiable cost is because the...
After a person with a life insurance policy dies, a situation may arise where more than one party believes they are the rightful beneficiary of the life insurance benefit at issue. As a result, two or more people file a claim with the insurance company for the life...
Disability insurance companies employ a variety of tactics to delay, deny, and defend claims and benefits. It is important for insureds to be aware of these strategies so they can maximize their chance for claim approval and avoid unnecessary delays and/or a denial of...
Typically, a statute of limitations-or the state mandated time period within which a claimant must file a lawsuit-begins to run once a cause of action arises. In ERISA disability claims, the cause of action arises and claimants are not permitted to file a lawsuit...
Another district court has found that Liberty Life failed to give a claimant a full and fair review of her claim for long-term disability benefits. Ruth Ann Hare suffered from fibromyalgia, forcing her to leave her physically demanding job and request disability...
In response to an investigation into the unfair claims handling practices of CIGNA since 2006, the CIGNA Group has agreed to set aside $77 million to settle claims that it improperly denied long term disability claims and wrongly terminated disability benefit...
A disability insurance policy lump sum buyout is where an insurance company pays an individual an agreed upon lump sum amount of money to fully "buyout" the life of an individual's disability insurance policy and claim. In other words, in exchange for a one-time check...
As those who suffer from medical conditions such as fibromyalgia and chronic fatigue syndrome know, these illnesses can incapacitate an individual physically and mentally. No current treatment has proven totally effective against these infirmities and in many cases...
Applying for disability insurance benefits and maintaining those benefits requires an understanding of the policy's terms as well as the tactics and review procedures utilized by many insurance companies throughout the duration of the...
There are many things that an administrator or insurance company may not tell claimants about their rights in ERISA benefit claims and ERISA appeals (when there has been a denial of their ERISA benefits). Just a few of the many things that the insurance company may...
Most group policies that you obtain as a result of your employment are governed by the Employee Retirement Income Security Act of 1974 ("ERISA"). ERISA is a federal statute that provides extremely strict deadlines and guidelines for claimants and insurance companies...
On October 4, 2012, **Unum announced that more than twice as many people who have battled breast cancer are returning successfully to work after short term disability leave. Unum explained that in 2009, nearly 64 percent of people on short term disability leave...
It appears that many companies that sold long term care and home health care insurance had little idea of what a claim would involve or that at some point they would be responsible for the payment of so many claims. Over the last several years, many companies...
Unum announced that Jack McGarry, will be taking over Unum's closed block of business in the United States. Unum's closed block of business includes Unum's individual disability policies issued almost two decades ago. It is important to understand that Unum no longer...
In cases where an employee has a serious illness or injury that will likely prevent them from returning to work for many months or longer, their employer may ask them to sign an employment/settlement agreement and/or severance agreement in exchange for additional...
It is often difficult to get a disability insurance company to accept liability of the claim, when a claimant suffers from a condition that is not readily diagnosed by objective testing. Insurance companies frequently target conditions such as fibromyalgia, chronic...
On June 25, 2012, the United States Supreme Court granted certiorari review in the case US Airways, Inc. v. McCutchen, which will greatly impact the landscape of employee benefits law, which is largely governed by the Employee Retirement Income Security Act...
Dealing with an insurance company at any stage of the disability claims process can be complicated, frustrating, time consuming and confusing. Whether you are applying for disability benefits, waiting for a claim determination, on claim, appealing a denial...
ERISA stands for the Employee Retirement Income Security Act which was passed by Congress and signed into law by President Ford in 1974. When the Employee Retirement Income Security Act ("ERISA") became law, it was codified as a part of Title 29 of the United States...
After being approved for disability insurance benefits for almost two years, without warning, Prudential Insurance Company simply terminated a disability insurance claim of a woman suffering from severe and uncontrolled systemic lupus. Financially devastated by the...
Those suffering from a severe case of Fibromyalgia know that it can cause widespread, debilitating pain, cognitive problems such as memory loss or difficulty with concentration, and overwhelming fatigue. Unfortunately, the cause of fibromyalgia remains unclear and...
Your disability insurance claims examiner is not their friend and the information you provide to them can often be misrepresented and used against you. It is essential to remember that insurance companies have an inherent conflict of interest in that they are...
Whether you are insured under an individual insurance policy that you obtained on your own, or a participant under a group benefit plan that was provided to you as a benefit of your employment, it is critical to have a copy of the documents...
Most employer sponsored group disability plans, and a very few individual disability insurance policies, limit the payment of disability benefits to 24 months if the disability is caused by a mental/nervous condition such as Fibromyalgia or Generalized Anxiety...
Designating someone to receive secondary notice under your (or your loved one's) long-term care insurance policy could mean the difference between losing a valuable insurance benefit or keeping it in force. Some long-term care insurance policies and even some state...
Most employer provided Long Term Disability policies and some individual disability insurance policies include an exclusion for disabilities caused by a pre-existing condition. Generally, a disability insurance pre-existing condition is defined as a mental or physical...
Often, after it becomes clear that an individual can no longer perform the duties of their occupation and must apply for disability benefits, they will attempt to work reduced hours and/or phase out their job prior to stopping work altogether. Usually, a claimant will...
Nearly every disability insurance policy contains a provision giving the insurance company the right to have a claimant (a person who has filed a disability insurance claim) examined by a doctor of its choosing. That same provision generally includes that if a...
The type of disability insurance policy that you have may affect your rights and obligations under the contract and law. Typically, disability insurance policies will fall into one of three categories, based on how the policy was obtained: private, group, or...
Long term disability insurance provides income to workers whose earnings are interrupted by a lengthy period of disability. However, it is important to recognize that under the terms of most employer-sponsored LTD plans and many group disability policies, Other Income...
Has your insurance company hired a biased doctor to support a denial or termination of your claim? A significant portion of disability insurance litigation is dedicated to the issue of whether insurance companies are repeatedly hiring biased doctors to avoid paying...
There is a plethora of disability insurance policies on the market and numerous coverage options, coverage limitations, terms, and definitions to consider and understand when applying for disability benefits, filing an appeal, renewing or changing coverage options, or...
Often, insurance companies will require that claimants submit to an interview during the application stage and periodically during the administration of a claim. These interviews can either be in person, called a "Field Interview," or over the telephone. There...
ERISA stands for the Employee Retirement Income Security Act which was passed by Congress in 1974 and signed into law by President Gerald Ford on Labor Day, September 2, 1974. When the Employee Retirement Income Security Act ("ERISA") became law, it was...
Our Firm often receives inquiries from individuals who are currently working, but due to the nature of their particular illness or injury the possibility of filing a disability claim at some point in the future appears inevitable. They are relying on their disability...
Your disability insurance claim can be denied or terminated based solely upon the opinion of an unscrupulous physician hired by your insurance company. Typically, these so called "paper reviewers" make a substantial amount of money working for insurance companies. At...
Signing a severance agreement with your employer can hugely affect your disability benefits claim. In fact, by signing a severance agreement you can entirely waive your right to pursue your disability benefits claim. Most severance agreements drafted by...
As noted in some of our previous blogs, insurance companies often require an in-person or telephone interview with a claimant either prior to making a claim determination or during the ongoing evaluation of a claim that is being paid. The goal of the insurer's...
Your disability insurance company could be stalking you on Facebook. Be careful who you Friend or what you post on the internet. Insurance companies have become extremely savvy in how to use social media to "investigate" and ultimately deny insurance claims. Facebook,...
Most every group long-term disability policy will include a complete exclusion for any disabilities caused by a pre-existing condition. Private long-term disability insurance policies purchased by individuals normally also exclude coverage for a pre-existing condition...
Recently, more and more disability insurance companies are denying claims on the basis that the individual or employee is not covered under the policy. More specifically, insurance companies are asserting that at the time the individual became disabled the policy at...
Does it matter whether you are considered Totally or Partially Disabled under your disability insurance policy if you are receiving benefits? Yes. This is because under many disability insurance policies, an individual with a Partial Disability will be paid only...
Under many disability insurance policies the definition of disability that you must satisfy in order to receive continued disability income benefits changes after as little as 12 months of your claim being paid. Most disability insurance policies begin with what is...
Long-Term Care Insurance covers costs involved with personal or medical services that are needed for an individual who is unable to care for him or herself due to disability, chronic illness, loss of functional capacity, or cognitive impairment. Thus, the goal and...
Have you properly prepared your claim in case you have to file suit against your disability insurance Company? The answer may surprise you. Group disability insurance lawsuits are not typical trials. Most group disability insurance plans that you...
Our firm receives many questions regarding the type of damages an insured can seek from a disability insurance company. Whether the insured is applying for disability benefits or has already been denied benefits, the insurance company's liability is important and many...
Many individuals purchase life insurance policies to ensure that their loved ones are protected and provided for in the event that they are unable to do so as the result of an untimely death. Following the loss of a loved one who may also be a financial provider,...
It is essential that you understand the importance of preparing an appropriate appeal of your group disability insurance claim denial. Most group disability insurance policies fall under the Employee Retirement Income Act of 1974 ("ERISA"). ERISA provides extremely...
The definition of disability included in your disability income insurance policy may be the most critical term in the entire insurance contract. This is particularly true in the medical profession where so many specialties exist and where the risk of...
While many insured's believe that medical evidence of a disability is enough to obtain >disability benefits from their disability insurance carrier, this unfortunately, is not the case. A successful disability insurance claim begins with the application...
Disability insurance companies often employ common insurance company tactics when investigating a claim or claimant. Insurance companies are businesses that profit when insurance claims are not paid. Accordingly, they spend a significant amount of money each year...