ERISA Disability and Life Insurance Litigation

A dentist can’t practice dentistry anymore, everyone agrees he’s disabled, and he still loses his long-term disability benefits. That’s not a shocking medical story, it’s a contract story, and it’s exactly why we recorded this breakdown of Caraba v Paul Revere from the Seventh Circuit Court of Appeals. If you’re a doctor, dentist, lawyer, or other high-earning professional counting on an “own occu...

This is a case that Ben Glass argued in the 4th Circuit Court of Appeals in November. It involved a former Cox Enterprises employee who's benefits were terminated by Aetna, the plan administrator, after seven years of payments. Ben argued that Aetna violated ERISA claim regulations in several ways, including ignoring the social security determination that the claimant remained disabled.  Ever...

In this episode, we explore a financial advisor's battle against the wrongful termination of his long-term disability benefits. He was a financial advisor at Fulton Financial Corporation, where he began working in 2009. In 2014, he started experiencing severe pain and numbness in his legs and feet, progressively losing his ability to stand, walk, and drive. By 2015, his condition had deterior...

The episode revolves around the denial of the claimant's claim for long-term disability benefits. The claimant was an employee at Procter & Gamble for many years. His role required him to perform various duties, which he could no longer carry out due to medical issues. Specifically, in June 2012, he underwent gallbladder removal surgery for gallbladder cancer. Following his surgery, he wa...

Can an insurance company really decide you're no longer disabled based on just one medical record? This episode begins with the story of Dr. Rohr, an anesthesiologist who had to stop practicing due to crippling hand and finger tremors in 2007. After a decade of receiving long-term disability benefits, a controversial 2017 reassessment by Sun Life concluded that his tremors had ceased, causing...

DISCOVER how one woman's struggle with her insurance company highlights the difficulties of getting long-term disability benefits.  Occupation: Insurance sales agent. Medical Condition: Persistent and severe pain in the neck, shoulders, upper extremities, and lower back. Despite extensive treatments like surgery, injections, medication, acupuncture, and physical therapy, the claimant's p...

LISTEN TO THIS EPISODE to find out how a founder and innovator fought against his insurance company for his long-term disability claim. The primary issue was whether Aetna's denial was random and unfair, particularly when their own hired consultants acknowledged Daniel's severe limitations. The CLAIMANT suffered from neuromyelitis optica (NMO) , a severe neurological condition also known...

IN THIS EPISODE, we take a closer look at the story of a former employee at a dental supply company who suffered a traumatic brain injury from a fall down a flight of stairs. Despite thorough treatment, she continued to suffer symptoms that ended her career. The claimant applied for long-term disability benefits but was denied on October 17, 2019. However, she didn't give up and appealed the...

THE CLAIMANT was a former employee at Wright Medical Technology. He was suffering from the side effects of prostate cancer treatment when he applied for long-term disability benefits. But, his insurance company, Hartford Life and Accident Insurance Company DENIED HIS CLAIM because they stated they did not have enough proof of loss to evaluate his disability, specifically citing missing medical rec...

TUNE IN to find out why the DSM (Diagnostic and Statistical Manual of Mental Disorders), often seen as the ultimate guide, might not be as reliable as we think. Discover why re-evaluating these standards could be key to making insurance claims fairer.  The claimant, employed by the School of Visual Arts, began receiving long-term disability benefits from Hartford Life Insurance Company in May 2010...

In this episode, the claimant was employed as a Security Director at Manhattanville College, where he experienced several health conditions, including: Aortic valve replacement in August 2010 Paroxysmal atrial fibrillation Fatigue and dizziness Chest pain and shortness of breath Anxiety and sleepless nights These conditions collectively contributed to his disability and inability to perform his du...

According to the physical demands analysis submitted by his employer, the claimant's job at Tower Hill Insurance Group required him to: Sit for a maximum of two hours at a time, for a total of seven hours a day. Stand or walk for thirty minutes at a time, for a total of one hour a day. Perform tasks that did not require lifting anything heavy. Claimed Disabling Conditions: Knee Injury: The cl...

How to Buy Long-Term Disability Insurance In today's podcast, listen in to a recording of a presentation long-term disability attorney Ben Glass recently gave to a national gathering of nurse anesthetists. During the session, Ben shared invaluable insights on how to navigate the complex world of long-term disability insurance. Here are the key takeaways from his talk: Understanding the Import...

The claimant was a former respiratory therapist and a director at Athens Limestone Hospital before she ceased working on October 12, 2012, due to multiple health issues. The disabling conditions she claimed included: Fibromyalgia Rheumatoid Arthritis Chronic Pain Her disabling conditions severely impacted her ability to perform her job. Specifically, her conditions led to: Intractable pain at mult...

The claimant, a former truck driver, was diagnosed with two primary medical conditions. Initially, he was diagnosed with Posterior Vitreous Detachment (PVD) in his right eye. Subsequently, a retina specialist diagnosed him with Macula-off Retinal Detachment, a more severe condition where the retina detaches from its normal position. In the claimant's case, this led to significant vision loss...

The claimant was a former salesperson, experienced serious physical and cognitive limitations following a car accident. These impairments, which affected his sustained attention, information processing speed, and neuromotor functioning, significantly impacted his ability to manage tasks and time, and he was given a poor prognosis for improvement. Subsequently, his insurance company, Reliance Stand...

The claimant, a plant manager, left his job due to a series of strokes and heart problems. His medical conditions included high-grade stenosis (narrowed blood vessels), hypertension, diabetes, two strokes, serious coronary artery disease leading to triple bypass surgery, numbness and neuropathy, slurred speech, facial droop, poor balance, memory problems, arteriosclerotic heart disease (hardened a...

The claimant was an Enterprise Storage Engineer who encountered severe health challenges due to hydrocephalus, requiring surgery to remove a brain cyst. Following this, he applied for long-term disability benefits, but his insurance company, Prudential, eventually terminated his claim based on neuropsychological tests suggesting possible malingering. These tests showed failures in nearly all valid...

The claimant was a physician, who transitioned from part-time to full-time disability due to her deteriorating health condition. But her application for long-term disability benefits, which is governed under the complex umbrella of ERISA was denied by her Insurance company - UNUM. At the heart of this dispute lies a contentious debate over the definitions of "full-time employment" versus...

The claimant appealed the district court's decision to deny his motion for attorney's fees under ERISA  after Unum Life Insurance Company of America terminated his long-term disability benefits. The claimant argued he deserved to have his legal fees paid because he somewhat succeeded in his case due to causing a change, a concept known as the "catalyst theory." However, the cou...

The claimant, a former accountant, was diagnosed with mild cognitive impairment by a board-certified neurologist and determined by a medical doctor specializing in occupational medicine to be unable to work due to his condition. These diagnoses led him to stop working as of October 31, 2015, and he has not resumed working since. He then found himself at odds with Prudential Insurance Company of Am...

The claimant, a former sociology professor at Rollins College, dedicated her career to teaching, advising students, developing courses, grading papers, and contributing to academic research and writing. Unfortunately, her career and daily life were significantly impacted by Chronic Fatigue Syndrome (CFS), fibromyalgia, and a spectrum of associated symptoms, including persistent pain and fatigue. W...

The claimant was a former social worker at Intermountain Health Care Inc.​ Her medical conditions included Chronic Fatigue Syndrome (CFS), hypersomnia, obstructive sleep apnea, severe depression, and anxiety. Her treatment for these conditions was documented, and during the appeals process, these conditions were considered in the evaluation of her claim for long-term disability benefits. Hartford...

The Supreme Court has established a principle for cases challenging the denial of benefits under the Employee Retirement Income Security Act (ERISA). According to this principle, such denials should generally be examined anew (de novo) unless the benefits plan specifically grants the administrator or fiduciary the power to decide on eligibility for benefits or interpret the plan's terms. The...

Before her health issues, the claimant was a distinguished attorney in Birmingham.  Unfortunately, she developed chronic pain syndrome, fibromyalgia, and lumbar disc disease, conditions that deeply affected her professional life and daily functions. She applied for an began receiving disability benefits under her firm's LTD policy with Sun Life.  That policy was replace by a new policy from H...