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…
We recently received notice that another administrative appeal of the denial of a client’s LTD claim has been successful. When a claim for LTD benefits is denied, pursuant to the ERISA regulations the claimant must file an administrative appeal of the denial decision with the entity that denied the claim,…
SMDA had the opportunity to represent a registered nurse who stopped working in the Emergency Department after two level cervical disc fusion surgery. Several months after the surgery the LTD insurer terminated her benefits when it determined “that the medical on file does not appear to support any significant functional…
The Eastern District of Michigan federal court recently granted my motion for discovery in a long term disability insurance ERISA case without requiring a predicate showing. In Back v Hartford I had submitted a limited number of questions to Hartford Insurance Company to try and investigate any potential bias on…
From the Insurance Companies perspective, the answer is simple- there is no reason for them to pay. My clients are universally surprised to learn that under ERISA the only thing you can sue for are the unpaid LTD benefits. There is no claim for emotional distress, or pain and suffering.…
Most Long Term Disability cases in our office are governed by ERISA as they are non-governmental employer provided benefits. The fact that they are ERISA claims is usually all bad for our clients as the law in this area has a number of inherent anti-claimant aspects. Primary among those aspects…
In a tremendously important decision, the 6th Ciruit court of appeals affirmed today a decision limiting the language that disability insurance carriers can include in their policies to protect themselves from making payments. In American Council Of Life Insurers v. Ross, No. 08-1406 , the panel agreed that the Michigan…
The Second Circuit Court of Appeals cited First Unum’s deception as one of the grounds for granting an attorney’s claim for long term disability insurance benefits. In McCauley v First Unum the Court the Court cited several isntances of biased and deceptive claims review in granting McCauley’s claim for disability…
Dr. Ghandi Gutta filed a claim for Long Term Disability Insurance when he was no longer able to continue his practice as a laparoscopic surgeon due to multiple medical conditions. When his definition of disability changed to “any occupation” at the end of two years his insurer, Standard Select, terminated…
A Louisiana court recently rejected a long term disability insurer’s attempts to hide behind the protections afforded insurance companies by ERISA. In Gulf Coast Plastic Surgery v Standard Insurance Co. the Court determined that a claim that the insurance agent failed to increase the policy limits despite the doctors request…