The Standard Insurance Company recently agreed to reverse its decision to deny LTD benefits to a client of the firm who had ongoing and persistent back problems. The Standard denied the claim ostensibly because “the medical records do not provide substantiation of a significant Physical or Mental Disease process which…
SMDA was fortunate enough to receive another favorable decision from the federal court finding that the Long Term Disability insurer again wrongfully denied our client’s claim for benefits. In Deloach v. The Great Atlantic & Pacific Tea Company (A&P) the Judge reversed the claims denial decision finding that the client…
SMDA was hired by an employee of ArvinMeritor when her claim for Short Term Disability benefits was rejected. The client had suffered a fractured coccyx in a slip and fall and overtime was eventually diagnosed with Fibromyalgia and Depression. Despite the universal support of each of her treating physicians her…
I came across this recent article by the Onion satirizing Long Term Disability insurer giant, Cigna. WARNING-STRONG LANGUAGE, NOT APPROPRIATE FOR ALL. The article takes a satirical poke at CIGNA for failing to treat its insureds fairly. While the article is obviously based upon the Onion’s imagination it will likely…
In another recent SMDA victory, the Federal Court overturned Metropolitan Life Insurance Company’s decision improperly under-calculating the claimants LTD benefits. In Gray v. Metlife the Court found that Metlife had wrongfully excluded the claimants “Health and Welfare” pay from his “base monthly earnings.” The Court determined that the ERISA claim…
SMDA filed a lawsuit against Liberty Life Assurance Company of Boston (LLAC) after it denied a claim for LTD benefits filed by an employee of DTE energy who had significant orthopedic back problems. The claim was governed by ERISA since it was a group plan provided through the employer. Despite…
SMDA received a favorable decision overturning Mutual of Omaha’s decision to terminate our client’s short term disability benefits. The firm represented a casino dealer who developed severe psoriasis of the hands as well as depression and anxiety stemming from her witnessing a gambler commit suicide by shooting himself at her…
The administrative record is simply all of the documents provided to the LTD insurance company during the claims process, the claims file, the documents provided during the administrative appeal and the contract documents. One of the little known but critical rules in ERISA Long Term Disability cases is that the…
Our client went off work due to the progression of her Meniere’s disease. She went back to work part-time and struggled to work five-hour days. She was scheduled to return to work full-time in November but was unable to do so due to her medical condition. She did gradually increase…
Long Term Disability Insurers love to use surveillance to find a way to terminate benefits. Think about it it from a business perspective. They can hire a private investigator and pay them $500 or a $1000 dollars to follow a claimant around for a few days and maybe save tens…