Almost every group long term disability insurance policy contains wording allowing the insurance company to reduce the monthly benefit it pays by any other income the disabled person receives. The most common other income is social security disability. The practical effect can be seen in the following example: Annual Income:…
SMDA recently helped a registered nurse obtain a favorable settlement of her claim for long term disability insurance resulting from her significant orthopedic spine problems. Our client had worked as a registered nurse for a local hospital system for more than two decades. As anyone in the nursing business knows-nursing…
ProPublica recently filed a very well sourced article on the lengths health insurers will take to deny coverage in order to preserve profits. https://www.propublica.org/article/priority-health-michigan-cart-insurance-vanpatten-denials When a claim is denied you as the claimant have certain rights. https://www.propublica.org/article/find-out-why-health-insurance-claim-denied As the article explains this includes the right to obtain a copy of the…
SMDA was recently able to get Long Term Disability insurance benefits reinstated for a client who had developed significant orthopedic spine problems. The client had last worked at a sedentary job for an engineering firm. The Disability insurance company (Reliance Standard) had initially approved and paid benefits for more than…
The attorneys at SMDA recently convinced long term disability insurer, Cigna to reverse its decision to deny an Oakwood Hospital employee disability insurance benefits when the claim transitioned to the “any occupation” standard. As with most LTD insurance policies this Cigna policy paid benefits for 24 months if the claimant…
The team at SMDA recently obtained a favorable administrative decision reversing Cigna’s (Life Insurance Company of North America) decision denying disability insurance benefits for a Registered Nurse who had been disabled by her treating physicians as a result of her significant orthopedic (back and shoulder) problems. The original denial was…
Almost every Long Term Disability Insurance Policy I have ever reviewed contains a limited period (usually 24 months) of time that it will pay benefits if a claimant is unable to perform the duties of his/her “Own” (see prior post on how “Own” occupation is misleading) occupation. The plans most…
In this recent case out of Louisiana the court rejected Cigna’s (Life Insurance Company of North America) efforts to deny a claim by a man who was permanently paralyzed and wheelchair bound. The claimant, Mr. Hughes, had been employed as an electrician when he was forced to stop working as…
Anyone familiar with LTD Insurance claims and ERISA knows that you must first exhaust your administrative remedies before filing suit. In other words, you have to try and convince the LTD insurer to reverse its decision to deny the claim for benefits. While this may seem like an difficult task…
In Rochow v. Life Ins. Co. of N. Am., 2015 U.S. App. LEXIS 3532 (6th Cir. 2015), the Sixth Circuit Court of Appeals (the Court) en banc overturned a previous decision of a 3 judge panel that had allowed plaintiff’s claim for the disgorgement of profits earned by the disability…