In a November 4, 2016 ruling, The Ninth Circuit Court of Appeals reversed a Central District of California ruling when it concluded an individual who cannot sit for four hours a day cannot perform sedentary work. In 2011, Avery Armani suffered a back injury while at work. He was covered under a group long-term disability insurance policy issued by Northwestern Mutual provided by his employer. Following his back injury, Mr. Armani sought treatment from chiropractors, pain specialists, and physicians. Each treatment provider confirmed Mr. Armani was not capable of sitting more than four hours per day because of his lumbar […]

When planning for the future, most people focus on family security and their retirement. They purchase insurance policies, invest in 401Ks and seek other ways to ensure their financial security through their career and into retirement. They do so with the hope of smoothly transitioning into their golden years. However, a plan is only as good as its implementation. Understanding the terms and conditions of your disability insurance policy is crucial to protecting your financial security. This is especially true given that the Social Security Administration reports that 25% of the American work force will become disabled prior to reaching […]

Orthopedic Surgeon John Duda filed a claim for disability benefits with The Standard for his long-term disability (“LTD”) benefits and Lincoln for his individual disability benefits due to a wrist injury. Both Standard and Lincoln determined Dr. Duda did not qualify for disability benefits under each of his policies. However, each company cited different reasons for their decisions. Following the denial of disability benefits by each company, Dr. Duda sued each Standard, under federal ERISA law, and Lincoln, under Pennsylvania breach of contract and bad faith law, for disability benefits. The United States District for the Eastern District of Pennsylvania […]

EXCLUSIONS AND LIMITATIONS ARE THE NEW TREND IN DISABILITY INSURANCE As of October 1, 2016, nearly every disability insurance company will either exclude or limit disability insurance claims related to mental nervous and/or addiction related impairments. This applies to both Individual Disability Insurance (“IDI”) policies as well as employer sponsored group Long-Term Disability (“LTD”) insurance plans. Historically, IDI policies were issued without exclusions or limitations for mental health and/or addiction related impairments. Conversely, nearly every LTD plan issued contained less favorable coverage, such as exclusions and 24-month limitations for these impairments. Studies confirm that 25% of professionals will suffer a […]

In prior articles I have written for Physicians’ News Digest, I have brought to your attention your Disability Insurance Company’s use of surveillance and other investigative techniques used to develop information to be considered in evaluating your claim.  If the results of that investigation can be viewed as contrary to your claimed activities or depicting activities your Company feels are inconsistent with what you would or would not be able to perform in relation to your disabling condition, your Company will likely use that information in a way that is beneficial to it and detrimental to your claim.  For years, […]

The United States Court of Appeals for the 3rd Circuit recently vacated the summary judgment opinion of the District Court of New Jersey in Baker v. Sun Life and Health Ins Co. Following Sun Life’s denial of continued long-term disability benefits, Kenneth Baker filed suit against Sun Life in New Jersey District Court. At conflict was whether Mr. Baker’s policy of disability insurance contained language granting discretionary authority to Sun Life in determining whether to award Mr. Baker disability benefits. If the policy contained discretionary language, a court could only review Sun Life’s decision under the arbitrary and capricious standard […]

A plan participant sued MetLife claiming an improper denial of his long-term disability benefits under ERISA. Participant Dionisio Santana-Díaz was a financial analyst at Shell Chemical and a participant in the company’s employee welfare benefit plan issued by Metropolitan Life Insurance Company (“MetLife”). Mr. Santana-Díaz suffered from major depression, high blood pressure, asthma and various other physical and mental conditions and stopped working. He received sick leave and then short-term disability benefits. After being out of work for five months, Mr. Santana-Díaz submitted his claim for long-term disability benefits and was eventually awarded LTD benefits. About a year and a […]

As an attorney, in a practice dedicated to representing impaired professionals with individual and group disability insurance matters, I am troubled by the general lack of knowledge regarding disability income replacement insurance. My concern stems from the sobering reality that more than 1-in-4 of today’s 20-year-olds will suffer a disabling medical condition before they retire.1 While this statistic is troubling, it pales in comparison when considering 68% of adult Americans fail to set aside money for emergencies.2 You need only reflect on your own financial situation. Take a minute. Research confirms 65% of working Americans would be unable to pay […]

The U.S. District Court for the Northern District of Texas, on February 19, 2016, granted in part and denied in part Dewayne Curtis’ motion to compel discovery from MetLife. While discovery in ERISA actions is generally limited, in this case, the court required MetLife to answer some of Mr. Curtis’ questions in the form of interrogatories. The court required MetLife “to more fully describe the policy and methods used to determine compensation for the claims and appeals specialists who handled Plaintiff’s claim, such as any policy or method for determining and calculating bonuses, pay increases, or gain sharing.” However, MetLife […]

The United States District Court for the Eastern District of Kentucky on February 12, 2016 found Aetna arbitrarily and capriciously terminated Scott Bishop’s ERISA-governed long-term disability benefits. Mr. Bishop stopped working in February 2012 due to “diffuse osteoarthritis and swelling in his joints, gout, and degenerative joint disease in his left knee.” Based upon his physical conditions, Mr. Bishop applied for his Aetna LTD benefits and Social Security (“SSA”) disability benefits. Social Security had Mr. Bishop examined by Dr. David Winkle, who authored a report on Mr. Bishop’s condition. Aetna quickly determined Mr. Bishop was not entitled to LTD benefits. […]