Most ERISA disability policies state that the insurer has “discretionary authority” to make all decisions regarding whether to award or deny disability benefits. If the policy contains this “discretionary authority” provision then the disability claimant can usually only overcome a denial if we are able to prove that the denial was: 1) wrong; and 2) the decision was arbitrary and capricious. This is an extremely difficult burden to meet. “Wrong” is not enough. It has to be wrong, and arbitrary and capricious.
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Long Term Disability
What do I do if Disability Insurance Denies My Claim?
By Mark Nation on
You are much more likely to become disabled during your work life than to die during your work life. Thus, disability insurance is very important to protect you and your family from financial ruin in the event of a disability. But, what happens when you insurance company denies your disability claim?Continue Reading What do I do if Disability Insurance Denies My Claim?
Court Rules on Definition of “Disabled” in an ERISA Disability Policy
By Mark Nation on
Recently, we prevailed in federal court on a contract interpretation issue under an ERISA short term disability insurance policy.
Due to an illness, our client could not perform some of the essential duties of her job. She could perform some of her duties, she just couldn’t perform them all. Our client filed a claim for STD benefits…
Life Insurance Company of North America Ordered to Reinstate Long Term Disability Benefits
By Mark Nation on
Posted in Disability, Long Term Disability
Life Insurance Company of North America (“LINA”) was recently ordered to continue paying disability benefits under an ERISA governed Plan. In that case, the our client was employed by UBS as a senior sales brokerage assistant earning over $100,000.00 a year. She left work as a result of a heart condition and fibromyalgia which caused…
Court Orders Aetna to Reinstate Long Term Disability Benefits
By Mark Nation on
Posted in Disability, Long Term Disability
Our client was insured under a self-funded long term disability plan which was administered by Aetna Life Insurance Company. Our client filed an LTD claim based on his anxiety, panic disorder and agoraphobia. Aetna initially approved the claim, but later terminated benefits and denied the claim.
We filed suit in Federal Court and the judge…
Administrative Appeals for Disability Benefits
By Mark Nation on
The Nation Law Firm recently filed an administrative appeal for certain disability benefits under the terms of the Harris Corporation Disability Plan. Plaintiff was successful in this appeal and benefits were reinstated.
The Nation Law Firm recently handled an administrative appeal under an ERISA plan against Principal Life Insurance Company. Plaintiff prevailed in the appeal…
Lawsuits filed for Disability Benefits
By Mark Nation on
We recently filed a lawsuit seeking certain short term disability benefits under the terms of the Federal Express Short Term Disability Plan. Litigation continues.
We also recently filed suit seeking short term disability benefits under the terms of the Blue Cross and Blue Shield of Florida Short Term Disability Plan. Plaintiff was an employee of…
New Long Term Disability Lawsuits Filed
By Mark Nation on
Posted in Disability, Long Term Disability
The Nation Law Firm recently filed a complaint seeking disability benefits on behalf of a pastor who became disabled. Suit was filed against Unum Life Insurance Company of America. Although the matter was not governed by ERISA, the case was removed to federal court allegedly based on diversity. Plaintiff is seeking to remand the case…
Suit Filed Against Standard Insurance For Long Term Disability Benefits
By Mark Nation on
Posted in Long Term Disability
I filed suit today against Standard Insurance Company on behalf of a former firefighter whose LTD benefits were recently terminated. After paying LTD benefits for two years, the insurer has advised my client that they are cutting off the benefits. As with most of these cases, if I win, the insurance company must pay all or…
ERISA Reimbursement of LTD “Overpayments”
By Mark Nation on
Posted in Long Term Disability
In Holmstrom v. Metropolitan Life Insurance Company, 2009 WL 901127 (N.D. Ill. March 31, 2009), Holmstrom sued Metropolitan for terminating her long term disability payments. Metropolitan counterclaimed seeking reimbursement from Holmstrom for an overpayment of LTD benefits which occurred when Holmstrom received a payment for back benefits from social security disability. (The Metropolitan plan contained a…